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Editorials

Judging the benefits and harms of medicines

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j3129 (Published 30 June 2017) Cite this as: BMJ 2017;357:j3129

Credibility and trust are required to judge the benefits and harms of medicines

Freer and Godlee (1) consider the serious doubts held by both the public and the profession regarding drug efficacy and safety, and lament the weak recommendations made by the Academy of Medical Sciences to address the fundamental problem of conflicts of interest (CoI) in drug information (2).

Since medical journals play a key role in accessing clinical trial and other evidence regarding medicines, it is essential that they have robust policies with regard to CoI. Unfortunately, progress in this area has been inconsistent, with some prominent journals having recently taken a more ‘flexible’ view regarding conflicted authors (3). The International Society of Drug Bulletins (ISDB) is a worldwide network of journals that operate independently, both financially and intellectually, from the pharmaceutical industry. Founded in 1986 with the support of the WHO Regional Office for Europe, ISDB’s rationale is that drug bulletins without industry funding avoid problems faced by editors of other journals, for example in reporting the results of sponsored drug trials (4).

Financial conflicts are, however, not the whole story, and ISDB has continued to debate its policies regarding CoI (5). At a recent extraordinary general meeting, ISDB members voted overwhelmingly to further strengthen the Society’s policy on CoI, defined as any financial or advisory relationship (paid or unpaid) with the pharmaceutical industry. ISDB decided that its editorial teams, and external authors influencing therapeutic choices, must be completely free from CoI. This policy change reflects the accumulating evidence of bias arising from both financial and advisory links with industry, as well as the recognition that disclosure of CoI is often inadequate and may, under some conditions, even aggravate bias (6). While trust in doctors is largely determined by our perception of their knowledge and experience, credible drug information requires that CoI are not merely managed but effectively excluded.

1. Freer J, Godlee F. Judging the benefits and harms of medicines. BMJ. 2017;357:j3129.
2. Academy of Medical Sciences. Enhancing the use of scientific evidence to judge the potential
benefits and harms of medicines. 2017. https://acmedsci.ac.uk/file-download/44970096.
3. Godlee F. Conflict of interest: forward not backward. BMJ. 2015;350:h3176.
4. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research
outcome and quality: systematic review. BMJ. 2003;326:1167-76.
5. Menkes DB. Conflicts of interest and drug information. BMJ. 2011;343:d5617.
6. Loewenstein G, Sah S, Cain DM. The unintended consequences of conflict of interest disclosure.
JAMA. 2012;307:669-70.

Competing interests: Dick Bijl is physician-epidemiologist (Utrecht, the Netherlands) and President of ISDB.

14 July 2017
David B Menkes
academic psychiatrist
Dick Bijl
University of Auckland
Waikato Clinical Campus, Hamilton 3240, New Zealand