BMJ  2007;334 (27 January), doi:10.1136/bmj.39105.657465.47

Editor's Choice

Editor's choice

Reputations for sale?

This week, BBC's Panorama programme again revisits the controversy surrounding the SSRI Seroxat. Its 2002 investigation into reports of adverse events from Seroxat prompted 67 000 people to contact the BBC, forcing a rethink of the safety data. Now GlaxoSmithKline faces legal action and, if found culpable, the possibility of huge payouts to thousands of patients.

As Joe Collier explains in his preview of this week's Panorama, to be aired on Monday 29 January (doi: 10.1136/bmj.39104.771597.59), the focus this time is on the interplay between industry and the forces that should counter what he calls "the adverse effects of drug companies." Panorama's account of GlaxoSmithKline's successful attempts to market Seroxat for use in children, despite the fact that its own published trial found evidence of serious adverse effects and failed to show benefit, is fascinating but depressingly familiar. The Vioxx story, told last week (BMJ 20 January, p 120), appears to have all the same hallmarks, including the paying of opinion leaders and ghost writers to talk up a drug when the evidence can't speak for itself.

What is even more depressing is that such behaviour is still so widely tolerated within medicine. There has been no shortage of outcry or official condemnation—including clear statements from the World Association of Medical Editors, the International Committee of Medical Journal Editors, and industry itself through its Good Publication Practice guidelines—that undeclared conflicts of interest and ghost writing are unacceptable. But, you might reasonably ask, what use are such huffings and puffings in the face of the individual rewards on offer from drug companies?

Let's be clear what is and is not acceptable. There is nothing wrong with getting help from medical writers, provided they and their source of funding are clearly acknowledged. In fact the BMJ agrees with Keith Dawes (doi: 10.1136/bmj.39104.595463.94), that medical writers are generally a good thing (see Resources for authors on bmj.com http://resources.bmj.com/bmj/authors). Nor is there anything wrong with academics or clinicians working with industry, provided they remain personally accountable for everything they say. What is clearly wrong is writers, academics, or clinicians concealing under their coat tails an army of company spin doctors intent on distorting the scientific record.

Legislation is not going to happen soon—the powerful industry lobby will make sure of that. Regulation is still inadequate (David Healy, BMJ 2006;333:92-5), although the US Food and Drug Administration is at last tightening up on postmarketing surveillance (doi: 10.1136/bmj.39104.352616.DB). So what can we do to change the blind-eye culture of medicine? In the interests of patients and professional integrity I suggest intolerance and exposure. As Joe Collier says, we shouldn't have to rely on investigative journalists to ask the difficult questions. So at meetings, why not slow hand clap any speaker who does not begin their talk with a sentence or slide declaring their conflicts of interest? And if journals discover authors who are guests on their own papers, they should report them to their institution, admonish them in the journal, and probably retract the paper. Reputations for sale are reputations at risk. We need to make that risk so high it's not worth taking.

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