Intended for healthcare professionals

Editor's Choice

Transparency and trust

BMJ 2004; 329 doi: (Published 21 October 2004) Cite this as: BMJ 2004;329:0-g
  1. Kamran Abbasi (kabbasi{at}, acting editor

    “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.


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