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BackgroundThe Framingham Heart Study (henceforth Framingham) is among the gold standards for epidemiological research. Being a prospective cohort study of 5,000+ men and women, it provided early findings about the causes of coronary heart disease (CHD), following a cohort over the course of 24 years. After US government funding ended, the tobacco industry funded Council for Tobacco Research (CTR) provided continued funding for analyses related to smoking.ObjectiveThis study sought to understand the tobacco industry's motivation and activities in funding Framingham.Study design and settingWe analyzed previously undisclosed tobacco industry documents, conducting iterative searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/), and assembled a historical case study.ResultsCTR funded Framingham to obtain full access to Framingham data. CTR planned for long-time industry consultant Carl Seltzer to reanalyze them to suggest that tobacco-related morbidity and mortality primarily resulted from "constitutional" factors, such as age or ethnicity. Once data were obtained, CTR terminated funding for the Framingham principal investigator, who disagreed with Seltzer. Seltzer's critical analyses of subsequently published work by the Framingham team created confusion about the association between CHD and cigarette smoking.ConclusionResearchers accepting tobacco industry funding risk losing control of data, analysis, and publication.

BackgroundThe Framingham Heart Study (henceforth Framingham) is among the gold standards for epidemiological research. Being a prospective cohort study of 5,000+ men and women, it provided early findings about the causes of coronary heart disease (CHD), following a cohort over the course of 24 years. After US government funding ended, the tobacco industry funded Council for Tobacco Research (CTR) provided continued funding for analyses related to smoking.ObjectiveThis study sought to understand the tobacco industry's motivation and activities in funding Framingham.Study design and settingWe analyzed previously undisclosed tobacco industry documents, conducting iterative searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/), and assembled a historical case study.ResultsCTR funded Framingham to obtain full access to Framingham data. CTR planned for long-time industry consultant Carl Seltzer to reanalyze them to suggest that tobacco-related morbidity and mortality primarily resulted from "constitutional" factors, such as age or ethnicity. Once data were obtained, CTR terminated funding for the Framingham principal investigator, who disagreed with Seltzer. Seltzer's critical analyses of subsequently published work by the Framingham team created confusion about the association between CHD and cigarette smoking.ConclusionResearchers accepting tobacco industry funding risk losing control of data, analysis, and publication.

Around-the-clock tobacco talks, multibillion-dollar lawsuits against the major cigarette companies, and legislative wrangling over how much to tax a pack of cigarettes-these are some of the most recent episodes in the war against the tobacco companies. The Cigarette Papers shows what started it all: revelations that tobacco companies had long known the grave dangers of smoking, and did nothing about it.In May 1994 a box containing 4,000 pages of internal tobacco industry documents arrived at the office of Professor Stanton Glantz at the University of California, San Francisco. The anonymous source of these "cigarette papers" was identified only as "Mr. Butts." These documents provide a shocking inside account of the activities of one tobacco company, Brown & Williamson, over more than thirty years. Quoting extensively from the documents themselves and analyzing what they reveal, The Cigarette Papers shows what the tobacco companies have known and galvanizes us to take action

AbstractBackgroundThis study aimed to investigate how strongly Australian university codes of research conduct endorse responsible research practices.MethodsCodes of research conduct from 25 Australian universities active in health and medical research were obtained from public websites, and audited against 19 questions to assess how strongly they (1) defined research integrity, research quality, and research misconduct, (2) required research to be approved by an appropriate ethics committee, (3) endorsed 9 responsible research practices, and (4) discouraged 5 questionable research practices.ResultsOverall, a median of 10 (IQR 9 to 12) of 19 practices covered in the questions were mentioned, weakly endorsed, or strongly endorsed. Five to 8 of 9 responsible research practices were mentioned, weakly, or strongly endorsed, and 3 questionable research practices were discouraged. Results are stratified by Group of Eight (n = 8) and other (n = 17) universities. Specifically, (1) 6 (75%) Group of Eight and 11 (65%) other codes of research conduct defined research integrity, 4 (50%) and 8 (47%) defined research quality, and 7 (88%) and 16 (94%) defined research misconduct. (2) All codes required ethics approval for human and animal research. (3) All codes required conflicts of interest to be declared, but there was variability in how strongly other research practices were endorsed. The most commonly endorsed practices were ensuring researcher training in research integrity [8 (100%) and 16 (94%)] and making study data publicly available [6 (75%) and 12 (71%)]. The least commonly endorsed practices were making analysis code publicly available [0 (0%) and 0 (0%)] and registering analysis protocols [0 (0%) and 1 (6%)]. (4) Most codes discouraged fabricating data [5 (63%) and 15 (88%)], selectively deleting or modifying data [5 (63%) and 15 (88%)], and selective reporting of results [3 (38%) and 15 (88%)]. No codes discouraged p-hacking or hypothesising after results are known.ConclusionsResponsible research practices could be more strongly endorsed by Australian university codes of research conduct. Our findings may not be generalisable to smaller universities, or those not active in health and medical research.

Abstract
Background
Australian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices.

Methods
We conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively sampled to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised these responsible research and reporting practices: (1) publicly register study protocols before starting data collection, (2) register analysis protocols before starting data analysis, (3) make study data openly available, (4) make analysis code openly available, (5) make research materials openly available, (6) discourage use of publication metrics, (7) conduct quality research (e.g. adhere to reporting guidelines), (8) collaborate with a statistician, and (9) adhere to other responsible research practices. Each criterion was answered using one of the following responses: "Instructed", "Encouraged", or "No mention".

Results
Across the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 (range 0 to 5) of the 9 criteria. Three criteria received no mention in any scheme (register analysis protocols, make analysis code open, collaborate with a statistician). Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required.

Conclusions
Funders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research.

OBJECTIVES: To investigate the proportion of potentially relevant undisclosed financial ties between clinical practice guideline writers and pharmaceutical companies. DESIGN: Cross-sectional study of a stratified random sample of Australian guidelines and writers. SETTING: Guidelines available from Australia's National Health and Medical Research Council guideline database, 2012–2014, stratified across 10 health priority areas. POPULATION: 402 authors of 33 guidelines, including up to four from each area, dependent on availability: arthritis/musculoskeletal (3); asthma (4); cancer (4); cardiovascular (4); diabetes (4); injury (3); kidney/urogenital (4); mental health (4); neurological (1); obesity (1). For guideline writers with no disclosures, or who disclosed no ties, a search of disclosures in the medical literature in the 5 years prior to guideline publication identified potentially relevant ties, undisclosed in guidelines. Guidelines were included if they contained recommendations of medicines, and writers included if developing or writing guidelines. MAIN OUTCOME MEASURES: Proportions of guideline writers with potentially relevant undisclosed financial ties to pharmaceutical companies active in the therapeutic area; proportion of guidelines including at least one writer with a potentially relevant undisclosed tie. RESULTS: 344 of 402 writers (86%; 95% CI 82% to 89%) either had no published disclosures (228) or disclosed they had no ties (116). Of the 344 with no disclosed ties, 83 (24%; 95% CI 20% to 29%) had potentially relevant undisclosed ties. Of 33 guidelines, 23 (70%; 95% CI 51% to 84%) included at least one writer with a potentially relevant undisclosed tie. Writers of guidelines developed and funded by governments were less likely to have undisclosed financial ties (8.1%vs30.6%; risk ratio 0.26; 95% CI 0.13 to 0.53; p<0.001). CONCLUSIONS: Almost one in four guideline writers with no disclosed ties may have potentially relevant undisclosed ties to pharmaceutical companies. These data confirm the ...

OBJECTIVE: We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN: We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING: We identified mechanisms at the national, regional and global levels. RESULTS: Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS: We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS: The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).

OBJECTIVE: We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN: We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING: We identified mechanisms at the national, regional and global levels. RESULTS: Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS: We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS: The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).

BACKGROUND: Reducing the transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a global priority. Contact tracing identifies people who were recently in contact with an infected individual, in order to isolate them and reduce further transmission. Digital technology could be implemented to augment and accelerate manual contact tracing. Digital tools for contact tracing may be grouped into three areas: 1) outbreak response; 2) proximity tracing; and 3) symptom tracking. We conducted a rapid review on the effectiveness of digital solutions to contact tracing during infectious disease outbreaks. OBJECTIVES: To assess the benefits, harms, and acceptability of personal digital contact tracing solutions for identifying contacts of an identified positive case of an infectious disease. SEARCH METHODS: An information specialist searched the literature from 1 January 2000 to 5 May 2020 in CENTRAL, MEDLINE, and Embase. Additionally, we screened the Cochrane COVID‐19 Study Register. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster‐RCTs, quasi‐RCTs, cohort studies, cross‐sectional studies and modelling studies, in general populations. We preferentially included studies of contact tracing during infectious disease outbreaks (including COVID‐19, Ebola, tuberculosis, severe acute respiratory syndrome virus, and Middle East respiratory syndrome) as direct evidence, but considered comparative studies of contact tracing outside an outbreak as indirect evidence. The digital solutions varied but typically included software (or firmware) for users to install on their devices or to be uploaded to devices provided by governments or third parties. Control measures included traditional or manual contact tracing, self‐reported diaries and surveys, interviews, other standard methods for determining close contacts, and other technologies compared to digital solutions (e.g. electronic medical records). DATA COLLECTION AND ANALYSIS: Two review authors independently screened records and all ...

Background: Private healthcare providers deliver a significant proportion of healthcare services in low- and middle-income countries (LMIC). Poorer patients get sick and go without care more frequently, and spend more of their incomes on private healthcare than the wealthy. This review is focused on comparing health outcomes in private versus public care settings. It seeks to summarize what is known regarding the relative morbidity or mortality outcomes that result from treatment by public or private providers in LMIC.Methods: We conducted a systematic review of studies evaluating the impact of public and private healthcare provision. We performed meta-analyses on data within identified studies, in order to estimate the effects of type of healthcare provision on identified health outcomes.Results: Twenty-one studies met our inclusion criteria and explicitly compared health outcomes between the public and private sectors. Of those, 17 were cohortstudies, from 9 countries. Eleven studies were conducted in lower-middle-incomecountries ($996–$3,945 GNI per capita) and 10 studies from upper-middle-incomecountries ($3,946–$12,195 GNI per capita). Eighteen studies were conducted inurban settings. Fifteen of the 21 studies provided mortality for a health outcome,and studies examined a wide range of diseases, with tuberculosis (TB) being themost represented. A meta-analysis of all studies exploring the impact of healthcare type and mortality showed that patients in a private healthcare setting are less likely to die than patients in a public healthcare setting (OR 0.60; 95% CI 0.41–0.88). The pooled analysis showed that patients in a private healthcare facility are more likely to have unsuccessfully completed TB treatment than patients in a public healthcare facility (OR 2.04; 95% CI 1.07–3.89). Regardless of outcomes, the quality of evidence is rated, by objective measures, as either low or very low. Conclusions: More evidence is needed to compare health outcomes between the public and private sectors. Governments and researchers can play a critical role in improving the evidence base for decision making about the contributions of the public andprivate sectors in a given country's health system.Governments should encourage data collection in both public and private settings that would permit ongoing comparison of clinical data. When government facilities are absent or insufficient, contracting with private-sector facilities or providerswould appear to be an acceptable option. Governments must consider appropriateprofit margins, regulations and training for private providers.Further research is needed in this area, and should include low-income countriesand rural settings. Diseases of the poor – notably malaria and childhood illnesses – are largely absent from the current literature, with the exception of one study onHIV/AIDS and six on TB.