Doctors face compulsory system to declare gifts and hospitality from drug companiesBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4617 (Published 26 August 2015) Cite this as: BMJ 2015;351:h4617
All rapid responses
Might I suggest that our very public spirited drug firms of international reach, our instrument makers of equal cardiomegaly (I use the word to mean big-hearted, generous) to fund openly, for public and paying patients, two large hospitals, one in London, one in Manchester. In these hospitals, they could advertise to their hearts' content. We, the public could then compare the "patient-centred approach" of the clinical staff in these institutions with the NHS establishments.
Competing interests: NHS patient. I have, ages ago, received from drug companies eg May and Baker (not that any of you will recall M and B 693) diaries, eaten sandwiches provided by drug companies at clinical meetings. Sceptic about rules being observed, enforced, penalties (remember the Duck Ponds of one of our Noble Lords, house flipping by honourable members of the Commons?)
A similar compulsory system to the US sunshine act has been recently proposed by the health ministry of Colombia. (1) However, I am uncertain about their usefulness: does disclosure of competing interests cure the existence of the conflict? (2,3)
Declaration of conflict of interests is surely a step forward, but much more will be needed to address the lack of transparency of human research (clinical trials, observational studies, and meta-analysis) evaluating the safety and effectiveness of drugs and medical devices. Unpublished and unregistered pharmacological research in different experimental models (e.g., animals, tissues, and cells) is also unnerving.
The database Dollars for Docs by ProPublica have been gathering information about the ties between doctors (as well as their associations) with pharmaceutical and medical device companies.(4) There are also conflicts of interests between medical schools and pharmaceutical companies sponsoring research projects, basic biomedical research in the laboratories inside their campuses and clinical trials recruiting patients in their University hospitals. Ongoing negotiations of multinational trade agreements (e.g., TPP) could also have a negative impact for public health by further increasing drug prices,(5) it is plausible that many pharmacological and non-pharmacological interventions could become very expensive and unaffordable by any healthcare system in the world.(6)
Medical associations from Colombia have publicly declared several times their opposition to a compulsory declaration of conflict of interests by physicians working in Colombia. Nonetheless, these medical associations had not declared their competing interests with manufacturers of drugs and medical devices.(7) Moreover, academic meetings organized by these associations frequently keep the list of their sponsors hidden from the public eye (e.g., Congress of the Colombian & Latin American Associations of Psychiatry - 2014, Cartagena, Colombia). Public and private universities from the country have also ties with multinational pharmaceutical companies producing brand and generic medicines.(8,9)
1. Physician Payments Sunshine: Columbia Seeks to Join Global Transparency Trend
2. The declaration does not cure the conflict
3. Ricardo Soto's Law: healthcare access, key opinion leaders, and conflicts of interest.
4. ProPublica - Dollars for Docs. https://projects.propublica.org/docdollars/
5. Cohen Deborah. US trade agreement threatens to increase drug prices and withhold safety data. BMJ 2013; 347:f6908. http://www.bmj.com/content/347/bmj.f6908
6. Prices of new medicines threaten Colombia’s health reform. (by A. Gaviria - health ministry of Colombia - comment by J. Ramírez).
7. Sobre conflictos de interés, ética, transparencia y evidencia médica en Colombia: @IETSColombia ante Presidentes de la ACSC
8. Tecnoquímicas donó $4.700 millones a Universidad Icesi de Cali
9. Sesión de investigación: I+D clínico en la industria farmacéutica multinacional
Competing interests: Non-financial: http://chaoticpharmacology.com/disclaimer-coi/