Dissertations

2016 Oral Defences

Adrienne Shnier

Dissertation Title: Medical Education and Financial Conflict of Interest Relationships with the Pharmaceutical Industry in Canada: An Analysis of Four Areas of Medical Education

Committee Members: (Chair) F. Ahmad, (Supervisor) J. Lexchin, (Member) H.G. Rosenburg, (Member) M.A. Gagnon, (Outside Member) K. Thomson
Date of Defence: July 20, 2016
University, Degree and Year: York University, PhD, 2016
Current Email:
adrienne.shnier@gmail.com

Abstract: Financial conflict of interest (FCOI) relationships in medicine have been found to expose medical education in medical schools, medical journals, and continuing medical education (CME) hosted by professional medical associations (PMAs) to vulnerability to corporate bias. Institutional policy analysis concerning FCOI relationships and industry involvement in medical education in Canada is limited. Therefore, informed by neoliberal corporate bias theory and Mertonian norms of science, this dissertation contributes analyses of conflict of interest policies, disclosures, and opportunities for drug company involvement in the production and dissemination of medical knowledge. In a publication-based dissertation format, the first manuscript provides an evaluation of conflict of interest policies at the 17 medical schools in Canada. The second manuscript provides an analysis of the culture of corporate science, informed by neoliberal ideology, through an examination of the extensive and pervasive roles of the drug promotion industry in clinical trial research, interpretation, writing, and publishing in medical journals. The third manuscript offers an evaluation of policies concerning FCOI relationships and industry involvement in CME development and programming adopted by 60 professional medical associations in Canada. The fourth and final manuscript comprises an quantitative analysis of FCOI relationship disclosures in Canadian clinical practice guidelines. In general, these evaluative efforts found that the policy environment concerning industry involvement in various types of medical education in Canada is permissive and FCOI relationships are common among guideline authors. Positioned within the context of neoliberal corporate bias theory and Mertonian norms of science, these findings of general policy permissiveness indicate an alignment of goals between the pharmaceutical industry and medical education institutions. The necessity for increased transparency in terms of industry’s roles in not only conducting, analyzing, interpreting, and publishing pharmaceutical research, but also data sharing is supported by existing literature on financial conflict of interest relationships with the pharmaceutical industry. Furthermore, the strengthening and enforcement of policies on industry involvement and FCOI relationships in these areas of medical education would help to ensure that medical education in the public’s interest is achieved.

2015 Oral Defences

Julia Brassolotto

Dissertation Title: Querying Everyday Scarcity: A Feminist Political Economy Analysis of Kidney Dialysis and Transplantation in Rural British Columbia

Committee Members:  (Chair) M. Hynie, (Supervisor) T. Daly, (Member) P. Armstrong, (Member) M. MacDonald, (Outside Member) D. Davidson
Date of Defence: October 16, 2014
University, Degree and Year: York University, PhD, 2015
Current Email: julia.brassolotto@uleth.ca

Abstract: This thesis uses a feminist political economy perspective to analyze the findings from a qualitative case study regarding kidney dialysis and transplantation in rural and remote British Columbia. This case study was conducted in order to investigate the concept of "scarcity," which is very common in organ transfer discourse. Critical ethnography and document analysis were used to examine the ways in which scarcity manifests in policy, practice, and everyday life. The main areas of focus include: the systemic context for the practices; the intersection of social location and geographic isolation; the intersection of gender, work and health; the implications of work in the local resource industry for renal health and renal replacement options; the role of unpaid care work provided by family members; and the implications of shifting care from institutions to families and individuals – particularly in a rural and remote context. Broadly, I argue that the scarcity of transplantable organs remains the dominant public discourse, that this discourse informs policies and practices, and that, despite these trends, lived experiences of scarcity at this site of study have more to do with the scarcity of human and health care resources, particular services, and health and life-sustaining resources for patients.