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What we must learn from mesh

BMJ 2018; 363 doi: (Published 11 October 2018) Cite this as: BMJ 2018;363:k4254

Re: What we must learn from mesh

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)

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.

Competing interests: No competing interests

30 October 2018
Mark H Wilson
Guelph, Canada