Conflict of Interest: The Attitude of Iranian Physicians Involved in Breast Cancer Management

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Farhad Shahi
Sanaz Zand
Shayan Abdollah Zadegan
Hirbod Nasiri Bonaki
Ali Labaf
Akbar Fotouhi
Ahmad Kaviani


Conflict of Interest, Ethics, Attitude, Surveys, Questionnaires, Breast Neoplasms


Background: Evidence on physicians' attitude toward conflict of interest is scant on a global scale and almost non-existent in a regional/national scale. This investigation is a pioneer to evaluate this issue in the Middle East and Iran.

Methods: We invited physicians of different (sub)specialties/educational levels who were engaged in breast cancer management to take an online 13-question survey regarding their attitude toward different statements on conflict of interest. The responses were then collected and analyzed.

Results: The questionnaire was returned by 91 out of 157 recipients (response rate = 57.9%). Based on the answers, advertisement by pharmaceutical sales representatives in academia was considered inappropriate (63.8%) and influential on clinical practice (80.2%). It was the belief of 59.4% of participants that local practice norms defined whether or not to accept travel grants.  According to these norms, they might have accepted paid travels (53.9%), but not financial offers (72.2%). It was acceptable to deliver (74.8%) or attend (68.9%) a speech when a financial/scientific relationship with industrial companies existed and 93.4% believed that the disclosure and transparency rules should be respected in such situations. Physician-industry financial contracts were generally unfavorable (60.5%), especially when it came to prescribing a drug among other equally effective choices (71.1%). The majority of respondents (92.3%) stated that they would choose the best approach for the patients regardless of possible prejudgments on conflict of interest.

Conclusion: The observed variation in physicians' standpoints highlights the necessity for more comprehensive training and implementation of rigorous protocols regarding conflict of interest.

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