BMJ  2004;329 (23 October), doi:10.1136/bmj.329.7472.0-g

Editor's choice

Transparency and trust

"Disclosure is almost a panacea," said John Bailar. I must tell you—in the interests of transparency, of course—that I have never heard him say this, although I firmly believe he must have—or words to that effect—because this was a favourite quote of the BMJ's former editor, Richard Smith, and I trusted what he had to say. But if I use this quote now, should I say, " `Disclosure is almost a panacea, said John Bailar,' said Richard Smith" or should I stop using the quotation altogether because using it without verification is some kind of fraud or misconduct? Perhaps this is turning transparency into absurdity.

England's soccer captain and cultural icon, David Beckham, tried his hand at transparency by admitting that he deliberately fouled a player to pick up a yellow card and an automatic one match ban for a game he was going to miss anyway. Howls of derision greeted this dastardly admission. John Bailar might say, "Well done David, you have just proven why disclosure is almost a panacea."

Another David (Healy), and cultural icon of sorts for his work in criticising SSRIs, gave evidence at a UK House of Commons select committee inquiry into the dastardly drug industry, claiming that 50% of papers on drugs in the BMJ and the Lancet are ghost written (p 937). Can this be true? We know that gift authorship happens, and the nature of the gift may vary from a pat on the back and anonymity to a six figure sum and elevation to the presidency of a royal college. We know that ghost writing happens, and the identity and the motivations of the ghost writer are not revealed. Whether this happens in 50% of papers on drugs is an incredible claim that needs substantiation. Our articles on drugs this week discuss the use of placebo (pp 927, 944), antipsychotics in pregnancy and breastfeeding (p 933), safety of COX 2 inhibitors and NSAIDs (pp 935, 948), individual response to treatment (p 966), perindopril and stroke recurrence (p 968), and the "fourth" hurdle in drug licensing (p 972).

The BMJ requires authors to declare competing interests, and we ask for a contributorship statement in the form of film credits. You can tell us who wrote the article and who was the key grip (if anyone knows what that is please write in). Crucially, we ask for a guarantor to take responsibility for the intellectual content and the honesty of the work. When we smell misconduct we hunt it down with editorial zeal, culminating in trial by academic institution or the Committee on Publication Ethics. Beyond these attempts to urge authors to full transparency, journals operate on a basis of trust. Thanks to transparency and trust, journals maintain their integrity. And it is the integrity of drug companies and some (or many, according to Healy) researchers that has been crushed by commercial interests—a warning for all of us who gyrate in this seven veiled dance.

Kamran Abbasi, acting editor

(kabbasi{at}bmj.com)

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Relevant Articles

Transparency and trust: Figure for ghost written articles was misquoted
David T Healy
BMJ 2004 329: 1345. [Extract] [Full Text]

Transparency and trust: In defence of medical writers
Adam Jacobs
BMJ 2004 329: 1345. [Extract] [Full Text]

Transparency and trust: Clear definition of ghost writing would be helpful
Nicholas Moore
BMJ 2004 329: 1345-1346. [Extract] [Full Text]

Placebos in practice
David Spiegel
BMJ 2004 329: 927-928. [Extract] [Full Text] [PDF]

Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis
Louise Howard, Roger Webb, and Kathryn Abel
BMJ 2004 329: 933-934. [Extract] [Full Text] [PDF]

US government agency to investigate FDA over rofecoxib
Jeanne Lenzer
BMJ 2004 329: 935. [Extract] [Full Text] [PDF]

Consumer organisations criticise influence of drug companies
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BMJ 2004 329: 937. [Extract] [Full Text] [PDF]

Individual response to treatment: is it a valid assumption?
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The PROGRESS trial three years later: time for a balanced report of effectiveness
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Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle
R S Taylor, M F Drummond, G Salkeld, and S D Sullivan
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The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review
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Questionnaire survey on use of placebo
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This article has been cited by other articles:

  • Masterton, G., Shah, P. (2007). How to approach a research ethics committee. Adv. Psychiatr. Treat. 13: 220-227 [Abstract] [Full text]  
  • Healy, D. T (2004). Transparency and trust: Figure for ghost written articles was misquoted. BMJ 329: 1345-1345 [Full text]  
  • Jacobs, A. (2004). Transparency and trust: In defence of medical writers. BMJ 329: 1345-1345 [Full text]  
  • Moore, N. (2004). Transparency and trust: Clear definition of ghost writing would be helpful. BMJ 329: 1345-1346 [Full text]  

Rapid Responses:

Read all Rapid Responses

Re: ghost writing
Nicholas D. Moore
bmj.com, 22 Oct 2004 [Full text]
50% ?
David T Healy
bmj.com, 23 Oct 2004 [Full text]
Key grip
Jeff Aronson
bmj.com, 24 Oct 2004 [Full text]
Transparency and trust?
Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, et al.
bmj.com, 25 Oct 2004 [Full text]
In defence of medical writers
Adam Jacobs
bmj.com, 28 Oct 2004 [Full text]
Re: In defence of medical writers
John Stone
bmj.com, 6 Nov 2004 [Full text]
Re: In defence of medical writers II
John Stone
bmj.com, 10 Nov 2004 [Full text]
Regarding Adam Jacobs
John Stone
bmj.com, 17 Nov 2004 [Full text]
Never mind the ethics, is it legal?
John Stone
bmj.com, 19 Nov 2004 [Full text]
Re: Never mind the ethics, is it legal?
Adam Jacobs
bmj.com, 21 Nov 2004 [Full text]
Re: Re: Never mind the ethics, is it legal?
John Stone
bmj.com, 23 Nov 2004 [Full text]
Adam Jacobs: an earlier declaration (30 May 2004)
John Stone
bmj.com, 27 Nov 2004 [Full text]
The BMJ has failed in 'Transparency and Trust'
John Stone
bmj.com, 17 Jan 2005 [Full text]
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