Intended for healthcare professionals

Analysis And Comment First person

The price of independence

BMJ 2006; 332 doi: (Published 15 June 2006) Cite this as: BMJ 2006;332:1447
  1. Joe Collier, professor of medicines policy (
  1. 1 St George's Hospital and Medical School, London SW17 0RE

    Career pressure and a focus on payment by results are making the critical and impartial thinker an endangered species. Society must take steps to protect this invaluable resource

    My professional life has been dominated by a drive to ensure that every opinion or piece of advice I give is independent and seen as such. Independence first became an issue for me in 1969 when I edited my first article for Drug and Therapeutics Bulletin.1 The then editor, Andrew Herxheimer, made my responsibilities clear: I was to scrutinise all the relevant published data, read and note all of the comments made by article reviewers, and use all this information to prepare the article for publication, ensuring clarity, reliability, and impartiality. The published article must reflect the scientific knowledge available and distinguish what was known about the product from what was derived from conjecture, bias, or the uncritical position of the establishment. Moreover, there would be no place for my own (preconceived) biases. Readers were to be given information they could trust and be confident that the advice given had no hidden agenda no ulterior motive.

    Four decades on, and I am still discovering the full implications of these ideals. Their meaning became more pertinent when I was appointed the bulletin's deputy editor in 1972, then its editor in 1992, and a year later when it coined the strapline, “The independent review for doctors.” Perhaps, more importantly, the ideals have taken on new dimensions as they have shaped my career as teacher, researcher, physician, administrator, writer, broadcaster, and adviser.

    What is independence and does it matter?

    In the context of this article, independence relates to intellectual function, the way our minds process information to make decisions; ultimately, it is the way we make up our minds and, as advisers, give our opinions.

    What has emerged over the …

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