Methods for Mapping Conflicts of Interest
How did we develop the map?
We began by reviewing publications known to the research team, cataloguing all identified parties (individuals and organizations involved in healthcare, e.g. hospitals, prescribers, public health agencies), activities (domains of clinical inquiry, judgment, and decision-making, e.g. research, clinical care, guideline development), and linkages among them. We then conducted a targeted search of the medical and scientific literatures to document industry ties to these parties and activities and identify additional parties, activities, and linkages in the healthcare ecosystem. To further explore additional, poorly-documented ties, we searched the gray literature, business publications, and the lay literature. We used our findings to draft a preliminary map showing the network of ties industry and each party and activity, as well as ties among parties and activities.
We then refined the map via input from an international panel of experts with broad expertise in industry ties and deep knowledge of specific parties and activities. In semi-structured interviews, the experts reviewed the map for completeness and accuracy, guiding us to further search the literature, evaluate depicted ties, identify missing ties, etc. We worked iteratively, making alterations to the general approach, categorizations, and visual presentation. We continued recruiting experts until we achieved saturation (with no further changes suggested), which occurred after interviewing eight experts. We also worked with design experts to optimize the visual clarity of the map.
Finally, we conducted a systematic scoping review to verify and refine the map and to catalog and characterize all documented industry ties across the healthcare ecosystem. This process involved abstracting data from 538 relevant publications spanning 37 countries. Our primary outcome measures were presence and types (financial, non-financial) of medical product industry ties to activities and parties, and presence of COI oversight and publicly available data sources.