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Home arrow Philosophy arrow Philosophical Issues in Pharmaceutics: Development, Dispensing, and Use
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The COI Cascade

A PubMed search using “conflict of interest” as a search term returned one article from 1974. Three appeared in 1975. The number reached 98 in 1991. In 1995, 252 appeared. In 1997, the number reached 236. In 2009, Lanier (editor, Mayo Clinic

Proceedings) returned more than 7300 articles, 70% published over the previous decade. British Medical Journal, Journal of the American Medical Association, The New England Journal of Medicine, and The Lancet registered more than 195, 170, 160, and 125 COI items each. The evidence is that COI was made increasingly “available” in the professional and public media (PubMed Spread Sheet 1974-2013).

PubMed Spread Sheet

Pubmed - conflict of interest [MeSH Terms]

Year

Count

Year

Count

2014

131

1993

147

2013

422

1992

147

2012

414

1991

98

2011

449

1990

48

2010

566

1989

24

2009

513

1988

11

2008

502

1987

17

2007

525

1986

12

2006

500

1985

16

2005

510

1984

7

2004

489

1983

10

2003

495

1982

29

2002

482

1981

16

2001

366

1980

8

2000

297

1979

4

1999

231

1978

4

1998

281

1977

7

1997

236

1976

2

1996

192

1975

3

1995

252

1974

1

1994

174 search date

10/22/14

An availability cascade has been described as a self-reinforcing process of collective belief formation, by which an expressed perception triggers a chain reaction that gives the perception ever increasing plausibility through its apparent availability in public discourse. The driving mechanism involves a combination of informational and reputational motives: individuals endorse the perception partly by learning from the apparent beliefs of others and partly by conforming, even distorting their public responses in the interest of maintaining social acceptance (Kuran and Sunstein 1999).

Availability entrepreneurs are activists who manipulate the content of public discourse, who strive to trigger and sustain availability cascades likely to advance their agendas. Availability campaigns sometimes yield social benefits, but they also bring harm, by hijacking social resources for precaution-taking that would better promote the general welfare when used elsewhere. Most cascades tend to die out. But their institutionalized effects linger and are very difficult to undo and often become permanent.

 
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