***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To compare physicians ’ and their patients ’ attitudes toward pharmaceutical gifts . DESIGN : Survey of physicians and their patients . SETTING : Two tertiary-care medical centers , one military and one civilian . PARTICIPANTS : Two hundred sixty-eight of 392 consecutively surveyed physicians , 100 of 103 r and omly selected patients at the military center , and 96 patients in a convenience sample at the civilian center completed the survey . MEASUREMENTS : Participants rated 10 pharmaceutical gifts  on whether they were appropriate for physicians to accept and whether they were likely to influence prescribing . Patients found  gifts less appropriate and more influential than did their physicians . About half of the patients were aware of such gifts ; of those unaware , 24 % responded that this knowledge altered their perception of the medical profession . Asked whether they thought their own physician accepted gifts , 27 % said yes , 20 % no , and 53 % were unsure . For patients , feeling that gifts were inappropriate was best predicted by a belief that gifts might influence prescribing , while for physicians , the best predictor was knowledge of guidelines . CONCLUSIONS : Patients feel  pharmaceutical gifts are more influential and less appropriate than do their physicians . Physicians may want to consider this in deciding whether to accept particular gifts . Broader dissemination of guidelines may be one means of changing physician behavior . At the same time , future guidelines should further consider the potentially different viewpoints of patients and physicians Background Published pharmaceutical industry – sponsored trials are more likely than non-industry-sponsored trials to report results and conclusions that favor drug over placebo . Little is known about potential biases in drug – drug comparisons . This study examined associations between research funding source , study design characteristics aim ed at reducing bias , and other factors that potentially influence results and conclusions in r and omized controlled trials ( RCTs ) of statin – drug comparisons . Methods and Findings This is a cross-sectional study of 192 published RCTs comparing a statin drug to another statin drug or non-statin drug .  Data on concealment of allocation , selection bias , blinding , sample size , disclosed funding source , financial ties of authors , results for primary outcomes , and author conclusions were extracted by two coders ( weighted kappa 0.80 to 0.97 ) . Univariate and multivariate logistic regression identified associations between independent variables and favorable results and conclusions . Of the RCTs , 50 % ( 95/192 ) were funded by industry , and 37 % ( 70/192 ) did not disclose any funding source . Looking at the totality of available evidence , we found that almost all studies ( 98 % , 189/192 ) used only surrogate outcome measures . Moreover , study design weaknesses common to published statin – drug comparisons included inadequate blinding , lack of concealment of allocation , poor follow-up , and lack of intention-to-treat analyses . In multivariate analysis of the full sample , trials with adequate blinding were less likely to report results favoring the test drug , and sample size was associated with favorable conclusions when controlling for other factors . In multivariate analysis of industry-funded RCTs , funding from the test drug company was associated with results ( odds ratio = 20.16 [ 95 % confidence interval 4.37–92.98 ] , p < 0.001 ) and conclusions ( odds ratio = 34.55 [ 95 % confidence interval 7.09–168.4 ] , p < 0.001 ) that favor the test drug when controlling for other factors . Studies with adequate blinding were less likely to report statistically significant results favoring the test drug . Conclusions RCTs of head-to-head comparisons of statins with other drugs are more likely to report results and conclusions favoring the sponsor 's product compared to the comparator drug . This bias in drug – drug comparison trials should be considered when making decisions regarding drug choice BACKGROUND Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients . However , limited data on the outcomes of disclosure exist to guide policy . METHODS This r and omized trial was conducted among 8000 adult patients at 2 multispecialty group practice s based in the Boston , Mass , and Los Angeles , Calif , areas . Intervention patients were mailed a compensation disclosure letter written by the chief medical officer of their physician group , and all patients were surveyed approximately 3 months later . RESULTS Disclosure patients were significantly more able to identify correctly the compensation model of their primary care physician , in Boston ( adjusted odds ratio , 2.30 ; 95 % confidence interval , 1.92 - 2.75 ) and in Los Angeles ( adjusted odds ratio , 1.37 ; 95 % confidence interval , 1.03 - 1.82 ) . Disclosure patients also had more confidence in their ability to judge the possible influence of incentives on their health care : in Boston , 32.5 % vs 17.8 % ( P<.001 ) ; and in Los Angeles , 31.8 % vs 26.4 % ( P = .20 ) . The disclosure intervention did not change trust in primary care physicians overall . However , of patients who remembered receiving the disclosure , 21.4 % in Boston and 24.4 % in Los Angeles responded that the disclosure had increased trust either greatly or somewhat , while in both cities less than 5 % of patients responded that the information decreased trust . Patients ' loyalty to their physician group was higher among disclosure patients in Boston ( 73.4 % vs 70.2 % ; P = .03 ) and Los Angeles ( 74.1 % vs 66.9 % ; P = .08 ) . CONCLUSIONS Among diverse patient population s , a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians ' compensation models . Patients ' trust in their physicians was unharmed , and their loyalty to their physician group was strengthened . For physician groups with similar compensation programs , disclosure to patients should be considered an effective method to enhance the patient-physician relationship BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician  disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship Conflict of interest has been defined as a set of conditions in which professional judgment concerning a primary interest ( such as patient welfare or the validity of research ) can be influenced by a secondary interest ( such as financial gain).1 Despite increasing evidence that conflict of interest influences authors ' conclusions , 2–4 we found no research into the effect on readers ' perceptions of research . We studied whether a declaration of financial competing interest influences readers ' perceptions of the interest , importance , relevance , validity , and believability of a study .  We r and omly selected 300 BMJ readers from the BMA 's membership data base , which contains individual reader characteristics . All readers were sent a short report indicating that the impact of pain from herpes zoster on patients ' daily functioning may be substantial.5 Readers in group 1 were sent a version of this paper with different named authors to the original and with a Financial relationships among industry and academic institutions are diverse and common.1 These interests can influence authors ' conclusions 2 and readers ' perceptions of published studies .3 We report the effects on reader perceptions of different statements of competing interests for two manuscripts . We used computer generated r and om numbers from the British Medical Association 's membership data base ( to select 900 BMJ readers ) . We r and omised 450 to be sent a paper about the use of problem lists in letters between hospital doctors and general practitioners4 ( problem lists paper ) and 450 to be sent a paper indicating that the impact of pain from herpes zoster on patients ' daily functioning may be substantial ( herpes paper).5 We previously reported a study using the herpes paper,3 and we have incorporated the results from that study in this paper . For each of the papers , 150 readers received the paper with no competing interests declared , 150 with a financial statement , and 150 with a statement that the author was a recipient of funding for studentships and research grants . The competing interest statements for each group were as follows . For both papers , when the type of competing interest was “ none , ” the phrasing of BACKGROUND Policy discussion s concerning pharmaceutical promotion often assume that small promotional items are unlikely to influence prescribing behavior . Our experiment measures whether exposure to these items results in more favorable attitudes toward marketed products and whether policies that restrict pharmaceutical marketing mitigate this effect . METHODS This is a r and omized controlled experiment of 352 third- and fourth-year medical students at two US medical schools with differing policies toward pharmaceutical marketing . Participants assigned to treatment were exposed to small br and ed promotional items for Lipitor ( atorvastatin ) without knowledge that the exposure was part of the study . We measured differences in implicit ( ie , unconscious ) attitudes toward Lipitor and Zocor ( simvastatin )  in exposed and control groups with the Implicit Association Test ( IAT ) . Self-reported attitudes were also measured , and a follow-up survey was administered measuring attitudes toward marketing . RESULTS Fourth-year students at the University of Miami Miller School of Medicine exposed to Lipitor promotional items had more favorable implicit attitudes about that br and -name drug compared to the control group ( IAT effect : 0.66 vs 0.47 ; P = .05 ) , while the effect was reversed at the University of Pennsylvania School of Medicine ( IAT effect : 0.22 vs 0.52 ; P = .002 ) where restrictive policies are in place limiting pharmaceutical marketing ( interaction effect : P = .003 ) . No significant effect was observed among third-year students . On a " skepticism " scale , University of Miami students held more favorable attitudes toward pharmaceutical marketing compared to University of Pennsylvania students ( 0.55 vs 0.42 ; P < .001 ) but the results were similar to those of a previously published national study ( 0.42 vs 0.43 ; P = .53 ) . CONCLUSIONS Subtle exposure to small pharmaceutical promotional items influences implicit attitudes toward marketed products among medical students . We observed a reversal of this effect in the setting of restrictive policies and more negative school-level attitudes toward marketing OBJECTIVE To examine patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry . DESIGN A r and om-digit dialing telephone survey . SETTING AND PARTICIPANTS A sample of 649 adults ( > or = 18 years old ) living in Kentucky . MAIN OUTCOME MEASURES Patient awareness of office-use gifts ( eg , pens , notepads ) and personal gifts to physicians from the pharmaceutical industry , patient exposure to office-use gifts , and attitudes toward physician acceptance of both office-use and personal gifts . RESULTS The survey had a response rate of 55 % . Eighty-two percent of the respondents were aware that physicians received office-use gifts , while 32 % were aware that physicians received personal gifts . Seventy-five percent reported receiving free sample s of medication from their physicians . Compared with office-use gifts , more respondents believed that personal gifts to physicians have a negative effect on both health care cost ( 42 % vs 26 % ) and quality ( 23 % vs 13 % ) . After controlling for demographic variables , as well as awareness and exposure to physician gifts , individuals with at least a high school education were 2.4 times as likely to believe that personal gifts have a negative effect on the cost of health care and 2.3 times as likely to believe that personal gifts would have a negative effect on the quality of health care . CONCLUSIONS These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians . If public perception regarding the objectivity of the medical profession is to serve as a guide , these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the pharmaceutical industry BACKGROUND Little is known about the effects of investigators ' financial disclosures on potential research participants . METHODS We conducted a vignette trial in which 470 participants in a telephone survey  were r and omly assigned to receive a simulated informed consent document that contained 1 of 2 financial disclosures ( per capita payments to the research institution or equity ownership by the investig 
    Output:
    
In clinical care , patients believed FTs decreased the quality and increased the cost of care .
Patients believe that FTs influence professional behavior and should be disclosed .
Patients , physicians , and research participants believe FTs decrease the quality of research evidence , and , for some , knowledge of FTs would affect willingness to participate in research