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Disclosure is a good first step when there are competing interests
for
guideline writers, but seems inadequate where competing interests are
found.
The shortcomings of disclosure alone are that the ‘discloser’ may
feel he has
a moral licence to say something biased because the audience has been
warned to be wary; or he may feel he has to be so cautious in what he says
that his bias turns the other way. And for the audience, the problem is
they
don’t know how much or even which way to adjust for his competing
interests, or whether to accept the disclosure as a sign of integrity, and
put
aside concerns of partiality. Put all those together, and in most of the
nine
possible combinations it is impossible for a reader/audience to make best
use of the guideline.
But a warm glow suffuses us: the disclosure makes the ‘regulator’
feel good;
the discloser feels good; and some of the audience feel they’ve been
respected. Unfortunately, the audience might actually be worse off with
the
disclosure, as some research has demonstrated. (Cain DM, Loewenstein G,
Moore DA. The dirt on coming clean: perverse effects of disclosing
conflicts of
interest. J Legal Studies. 2005;34:1–25.) All up, disclosure alone simply
shifts
the burden of the conflict of interest onto those least deserving of that
burden: the patients. How fair is that?
Disclosers will deny their competing interests affect their judgment,
as any
decent person would; to do otherwise would be to insult those who solicit
or
use their guideline.
Bias is the concern with competing interests, and bias is part of
human
nature. Patients are likely to be better off without commercial biases
influencing their care, unless the patient’s interest is well aligned with
the
commercial interest which in essence is to sell more drugs.
Is disclosure adequate?
Disclosure is a good first step when there are competing interests
for
guideline writers, but seems inadequate where competing interests are
found.
The shortcomings of disclosure alone are that the ‘discloser’ may
feel he has
a moral licence to say something biased because the audience has been
warned to be wary; or he may feel he has to be so cautious in what he says
that his bias turns the other way. And for the audience, the problem is
they
don’t know how much or even which way to adjust for his competing
interests, or whether to accept the disclosure as a sign of integrity, and
put
aside concerns of partiality. Put all those together, and in most of the
nine
possible combinations it is impossible for a reader/audience to make best
use of the guideline.
But a warm glow suffuses us: the disclosure makes the ‘regulator’
feel good;
the discloser feels good; and some of the audience feel they’ve been
respected. Unfortunately, the audience might actually be worse off with
the
disclosure, as some research has demonstrated. (Cain DM, Loewenstein G,
Moore DA. The dirt on coming clean: perverse effects of disclosing
conflicts of
interest. J Legal Studies. 2005;34:1–25.) All up, disclosure alone simply
shifts
the burden of the conflict of interest onto those least deserving of that
burden: the patients. How fair is that?
Disclosers will deny their competing interests affect their judgment,
as any
decent person would; to do otherwise would be to insult those who solicit
or
use their guideline.
Bias is the concern with competing interests, and bias is part of
human
nature. Patients are likely to be better off without commercial biases
influencing their care, unless the patient’s interest is well aligned with
the
commercial interest which in essence is to sell more drugs.
Competing interests:
None recognised.
Competing interests: No competing interests