A practical guide to informed consent to treatment

Competing interests

David Sackett has been wined, dined, supported, transported, and paid to speak by countless pharmaceutical firms for over 40 years, beginning with two research fellowships and interest-free loans that allowed him to stay to finish medical school. Dozens of his randomised trials have been supported in part (but never in whole) by pharmaceutical firms, who have never received or analysed primary data and never had power of veto over any reports, presentations, or publications of the results. He has twice worked as a paid consultant to advise pharmaceutical firms whether their products caused lethal side effects; on both occasions he told them "yes." He has testified as an unpaid expert witness for a patient who sued a manufacturer of oral contraceptives after having a stroke and as a paid expert in preparing a class action suit against a manufacturer of prosthetic heart valves. He was paid by a pharmaceutical firm to develop "levels of evidence" for determining the causation of adverse drug reactions. His wife inherited and sold stock in a pharmaceutical company. While head of a division of medicine he enforced the banning of drug detail personnel from clinical teaching units (despite the threat of withdrawal of drug industry funding for residents' research projects). He received the Pharmaceutical Manufacturers' Association of Canada Medal of Honour (and cash) for "contributions to medical science in Canada" for the decade 1984-94. His most recent award (the 2001 Senior Investigator Award of the Canadian Society of Internal Medicine) was sponsored by Merck Frosst Canada.