What we must learn from meshBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4254 (Published 11 October 2018) Cite this as: BMJ 2018;363:k4254
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The mesh scandal and lessons ignored
The Mesh scandal as Godlee notes is all to familiar. (1) It joins a growing list of scandals where commercial conflicts of interest (COI) and effective marketing of a defective product have led to serious injury and loss of life. Against the backdrop of Avandia, Vioxx, Praxil, Opiod crisis and now the Mesh scandal one wonders what kind of tipping point is needed to prevent a disturbing pattern from repeating itself. And where will the leadership come from given that sectors of the medical community are enmeshed with private industry?
Politicians might step up the plate. In the United States they passed the Sunshine Act. But as Godlee notes it did not solve the problem.(1) Indeed, unbeknownst to many people the Sunshine Act reflected how Wall Street and politicians manage their own commercial COIs. Disclosure has been the governance option of choice on Wall Street for years. (2) And it failed to prevent ongoing scandals underpinned by commercial COI - including the global banking crisis of 2008. Calls to end commercial COI on Wall Street continue. Politicians also accept campaign financing from the very banking sector and pharmaceutical and medical device industry that have been involved in fraud and scandal and have had a profound negative impact on the public. Managing these financials relations through disclosure has allowed politicians to have their cake and eat it too. Responding to public concerns about these kinds of financial COIs, politicians note that it does not compromise their ability to act in the public interest. (3) It’s a familiar response echoed on Wall Street and in many areas of medicine. Self denial has helped to sustain the status quo.
Until politicians end their own financial conflicts through legislation scandals in both medicine and in the market place will likely remain a familiar - albeit disturbing - pattern. The need to go beyond disclosure in addressing commercial COI can not be stated enough. And it needs to start at the top.
1. Godlee F. What we must learn from mesh.MJ 2018;363:k4254 doi: 10.1136/bmj.k4254 (Published 11 October 2018)https://www.bmj.com/content/363/bmj.k4254
2. .Bazerman MH and Watkins M. Predictable Surprises. Boston, MA: Harvard Business School Press, 2004.
3.Facher Lev. In public lawmakers scold drug distributors. Come campaign season , they accept their cash willingly. Stat, Octo12, 2018. https://www.statnews.com/2018/10/12/drug-distributors-campaign-cash/
Competing interests: No competing interests
Can we do more to limit direct to physician advertising of medical products in the printed journals of BMJ Group?
The BMJ has published several articles, opinion pieces and news stories over recent years highlighting a strong stance in the promotion of academic research that is unbiased from those that fund it, such as the pharmaceutical industry. Bringing this important topic to the forefront of medical journal publishing should be supported and promoted. I welcome Fiona Godlee's editorial on greater separation between healthcare professionals and the pharmaceutical industry including doctors and researcher's accepting payments from pharma.
However, this strong stance I feel is juxtaposed by a continuation to include full page advertisements for pharmaceutical products in the printed version of The BMJ. It is accepted that such advertisements act as a significant source of funding for some medical journals. However, it does come across with a slight sense of irony to read this editorial in the printed edition of The BMJ directly opposite a full page advertisement for a pharmaceutical product. Even more so it is ironic to see in the same edition of the BMJ, drug advertisements from pharmaceutical companies such as Glaxosmithkline which the BMJ itself highlighted in a recent news article to have restarted direct payments to doctors for promoting medical products .
The BMJ Group has a policy on the acceptance of advertisements where it cites that the promotion of a medicine must conform to the Association of British Pharmaceutical Industry Code of Practice  and that decisions on the inclusion of adverts is subject to editorial discretion. However, it confuses me to see adverts for medical products included in The BMJ from pharmaceutical companies, such as GSK, whose practices the journal openly criticises in its news reports or analyses.
More thought could, and should, be put into the choice of companies which are allowed to promote their wares in the journal. To go even further, it is my belief that the acceptance of advertising revenues from the pharmaceutical industry, especially companies such as GSK, contradicts the messages and ideals that BMJ Group puts forward in editorials such as this.
 Godlee F. "What we must learn from mesh" BMJ 2018;363:k4254
 Wise J. "GSK will resume paying doctors to promote its drugs after policy U turn" BMJ 2018; 363 :k4157
 BMJ Group. "BMJ revenue sources" https://www.bmj.com/company/bmj-revenue-sources/ Accessed 22nd October 2018.
Competing interests: I am a current member of PharmAware-UK which seeks to educate healthcare professionals on how to interact with the pharmaceutical industry in an ethical way. The views expressed in this rapid response do not represent the official views of the organisation and are written in a personal capacity,