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Feature Essay

Justifying conflicts of interest in medical journals: a very bad idea

BMJ 2015; 350 doi: (Published 02 June 2015) Cite this as: BMJ 2015;350:h2942

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Re: Justifying conflicts of interest in medical journals: a very bad idea

The series of articles by Lisa Rosenbaum are not only a very poor journalistic work, her assertions are data-free and fanciful as underscored by authors, and they can also be deemed as being surrealist.
Why? Because in every country, we have whistleblowers that have precisely described how things work concerning the relations between experts and big pharmaceutical companies. We now know for long that most publications funded by pharmaceutical companies and signed by physicians with conflicts of interests , often undeclared, are part of promotional strategy managed by the marketing services of Big Pharma, and thus are not impartial information. This articles will have reprint orders and will be used for promotional purposes to doctors in hospitals and in primary care settings [1]. Reprint orders, are, in turn, an important financial resource for medical journals and will also contribute to make the conflicts of interests more attractive to authors, because then they will bring them fame among their peers and credibility to their statements.
The main point and the main misconception about experts related to pharmaceutical companies is thinking they are free to express their own view In their presentation of a product. The public, and doctors believe so and then they credit the “information” this experts give as a personal and informed opinion. However, it has been underscored by whistleblowers who have been personally involved in relations with experts paid by pharmaceutical companies that, in fact, the expert currently receives instructions about messages the company wants to promote. This messages are prepared by the marketing services of pharmaceutical companies and are not scientifically based.
What is taken for information, is no more than a promotional strategy and the experts are sought after and used by pharmaceutical companies for their influence rather than for their expertise.
In France, Bernard Dalbergue, a former director for Merck in France in charge of management of key opinion leaders, and who is also a whistleblower, explained how he organized meetings in hospitals in which a local expert, a specialist, was invited and paid for presenting a drug of the company. The expert spoke as if he had expressed his own view and his status gave credibility to his message. In fact he was adapting the promotional messages the pharmaceutical company had given to him [2].
Bernard Dalbergue describes the relations with experts as a “fight for influence” and he says there were very few those doctors who resisted his enticing proposals [3] .
Having conflicts of interests and working with pharmaceutical companies implies behaviors that are not necessarily illegal but that are in clear contradiction with ethics in medicine. That implies to accept deliberate skewing of clinical trials to get better results, to accept refusing to publish results of a research when they are negative, to accept ghostwriting… All these practices will have a direct impact on public health, on drugs safety and on the appropriateness of healthcare expenses.
Why do many doctors accept to be involved in such harmful practices? Because they initially don’t know what the relations with pharmaceutical companies will involve, they are only shown mirific prospects. And when they could finally realize the harm they are doing it is too late. Because, to put it simply, the Fetsinger’s cognitive dissonance theory implies that we all tend to adapt our beliefs to our behavior (and not vice versa) in order to avoid discomfort and guilt [4]. “When people are in an absurd situation their minds rationalize it by inventing a comfortable illusion”. This theory has in turn been used to experimentally understand and develop manipulation techniques that are useful for commercial purposes [5].
This is how it really works. Big pharmaceutical companies are pursuing their own goals, that is reward shareholders, constantly increase their revenue in order not to be eaten by bigger companies . They use experts legitimacy and medical journals to spread messages that are consistent with this goals. Doing so, they generate fake consensus and undermine scientific democracy and public health.

[1] Mc Cartney M. Medical journals and their parasitical profit, BMJ 2015;350:h2832.
[2] Dalbergue Bernard and Anne-Laure Barré, Omerta dans les labos pharmaceutiques, Flammarion, feb, 2014.
[3] Bernard Dalbergue interview,
[4] Mc Leod SA (2014). Cognitive dissonance.
[5] Joule, Beauvois, Petit traité de manipulation à l’usage des honnêtes gens, éd presses universitaires de Grenoble.

Competing interests: No competing interests

14 June 2015
MD, Preventive medecine for children
Lyon, France