Intended for healthcare professionals

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Feature Conflicts of Interest

Two years of sunshine: has openness about payments reduced industry influence in healthcare?

BMJ 2016; 354 doi: (Published 25 August 2016) Cite this as: BMJ 2016;354:i4608

Rapid Response:

Transparency: a tricky smoke screen?

Lenzer rightly questioned if transparency about payments from industry could improve healthcare and showed not only that evidence is still missing but also that the road to hell is paved with good intentions: physicians who openly acknowledge their ties tend to make even more extravagant claims about product safety and efficacy, and patients tend to view doctors who declare their ties as particularly “honest.”(1) Disclosing conflicts is dissolving them.

In contrast, the metaphor “If a judge took money from a prosecuting attorney it would be considered a bribe” underestimated the problem.(1) Have prosecuting attorneys major criminal records? No, but Big Pharma is the biggest defrauder of US government.(2)

Nevertheless comparison with other professions may help. Eusey, a founding partner of Beacon Pointe (financial) Advisors, claimed: "As long as advisors understand their biases and so do their clients, they'll be all right."( In Australia, lay people understand why the pharmaceutical industry pays doctors.(3) Who would pay for nothing? When disclosure is optional, as in the UK, 70% of recipients agreed to have their named data published.”(1) In other words, only 30% of those paid by the industry are ashamed of their conduct and want to avoid disclosure. Most doctors don’t understand their biases. What’s worst, naivety or greed?

Last, calls for transparency look like the flawed Responsibility Deal.(4) Self-regulation is an oxymoron.

Transparency is not the goal. The goal is independence. Transparency is only a tool which must be included in a comprehensive framework: a) pharmaceutical promotion must be banned as it will always aim to influence prescribers’ choice; b) prescriptions must only use international non-proprietary (generic) names; c) data from industry sponsored trials must be available.(5)

1 Lenzer J. Two years of sunshine: has openness about payments reduced industry influence in healthcare? BMJ 2016;354:i4608.

2 Braillon A. Drug industry is now biggest defrauder of US government. BMJ 2012;344:d8219.

3 Moynihan R. Most Australians believe that drug company payments influence doctors' decisions. BMJ 2012;344:e1076.

4 Limb M. Public health body quits responsibility deal over government’s failure to act on tobacco and alcohol. BMJ2013;347:f4590.

5 Steinbrook R, Kassirer JP. Data availability for industry sponsored trials: what should medical journals require? BMJ 2010;341:c5391.

Competing interests: No competing interests

31 August 2016
Alain Braillon
senior consultant
University Hospital. 80000 Amiens. France