Policies on doctors' declaration of interests in medical organisations: a thematic analysis.

OBJECTIVES: There has been growing concern about doctors' conflicts of interests (COIs) but it is unclear what processes and tools exist to enable the consistent declaration and management of such interests. This study mapped existing policies across a variety of organisations and settings to better understand the degree of variation and identify opportunities for improvement. DESIGN: Thematic analysis. SETTING: We studied the COI policies of 31 UK and international organisations which set or influence professional standards or engage doctors in healthcare commissioning and provision settings. PARTICIPANTS: 31 UK and international organisations. MAIN OUTCOME MEASURES: Organisational policy similarities and differences. RESULTS: Most policies (29/31) referred to the need for individuals to apply judgement when deciding whether an interest is a conflict, with just over half (18/31) advocating a low threshold. Policies differed on the perception of frequency of COI, the timings of declarations, the type of interests that needed to be declared, and how COI and policy breaches should be managed. Just 14/31 policies stated a duty to report concerns in relation to COI. Only 18/31 policies advised COI would be published, while three stated that any disclosures would remain confidential. CONCLUSIONS: The analysis of organisational policies revealed wide variation in what interests should be declared, when and how. This variation suggests that the current system may not be adequate to maintain a high level of professional integrity in all settings and that there is a need for better standardisation that reduces the risk of errors while addressing the needs of doctors, organisations and the public.

State capture and development: a conceptual framework.

This article argues that the concept of state capture helps to structure our understanding of patterns of grand corruption seen around the world in varied contexts, and increasingly even in countries once regarded as secure democracies. This article seeks to lay the groundwork for future empirical research into state capture in three areas. First, it situates the concept within a wider literature on corruption and describes how it relates to other similar terms, including regulatory capture and kleptocracy. Second, it elaborates on three pillars of activity that are subject to capture, and a variety of mechanisms through which state capture occurs. This provides a structure for the gathering of evidence on how capture plays out in different cases, and raises questions about the interactions among mechanisms and variation in sequencing. Third, the paper considers the impact of state capture on economic and social development, by outlining the ways in which it skews the distribution of power and potential long-term consequences for the allocation of rights and resources.

Monitoring, reporting and regulating medicine quality: tensions between theory and practice in Tanzania.

In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors 'on the ground' to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforcement challenges conspires to limit the efforts of local regulators to achieve the GSMS goals, shedding new light on the relationship between apparent 'misconduct' and structural constraints.