Intended for healthcare professionals

Analysis Commercial Influence in Health: from Transparency to Independence

Pathways to independence: towards producing and using trustworthy evidence

BMJ 2019; 367 doi: (Published 03 December 2019) Cite this as: BMJ 2019;367:l6576

Commercial influence in health: from transparency to independence

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  1. Ray Moynihan, assistant professor1,
  2. Lisa Bero, professor,2,
  3. Sue Hill, senior adviser3,
  4. Minna Johansson, family physician4,
  5. Joel Lexchin, professor emeritus5,
  6. Helen Macdonald, UK research editor6,
  7. Barbara Mintzes, associate professor2,
  8. Cynthia Pearson, executive director7,
  9. Marc A Rodwin, professor8,
  10. Anna Stavdal, president elect9,
  11. Jacob Stegenga, reader10,
  12. Brett D Thombs, professor11,
  13. Hazel Thornton, honorary visiting fellow12,
  14. Per Olav Vandvik, professor13,
  15. Beate Wieseler, head of department14,
  16. Fiona Godlee, editor in chief6
  1. 1Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
  2. 2School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
  3. 3Science Division, World Health Organization, Geneva, Switzerland
  4. 4Cochrane Sustainable Healthcare, Lund, Sweden
  5. 5School of Health Policy and Management, York University, Toronto, Ontario, Canada
  6. 6The BMJ, London, UK
  7. 7National Women’s Health Network, Washington, DC, USA
  8. 8Suffolk University Law School, Boston, MA, USA
  9. 9Wonca World, Oslo, Norway
  10. 10Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK
  11. 11Lady Davis Institute of the Jewish General Hospital and McGill University, Montreal, Quebec, Canada
  12. 12Department of Health Sciences, University of Leicester, Leicester, UK
  13. 13Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
  14. 14Drug Assessment, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
  1. Correspondence to: R Moynihan raymoynihan{at}

A global team of influential researchers, clinicians, regulators, and citizen advocates suggest how we can start to build an evidence base for healthcare that is free of commercial influences

We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice.1 It highlighted that extensive industry influence may be jeopardising “the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.”1

At the same time there’s increasing appreciation across nations and within clinical and scientific communities of the problem of too much medicine.2345 Overtesting, overdiagnosis, and overtreatment divert resources from tackling genuine need, cause harm to health, and threaten health system sustainability.2345 Necessary tests, treatments, and diagnoses are vital, and manufacturers have rights to make profits. But it’s time to ensure the scientific evaluation of tests and treatments, and dissemination of the resulting evidence, are conducted as independently as possible from industries profiting from their use.

Perspectives differ on the financial relationships between industry and health professionals, and debate is ongoing about where to draw the line between valuable collaboration and relationships that don’t serve patients or the public.678 Some see transparency as the best strategy, while others regard it as necessary but insufficient. We argue that endemic financial entanglement is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems. Building on the evidence and practical examples cited below, we propose pathways towards financial independence from industry across healthcare decision making. We hope that our proposals will catalyse and inform development of more detailed recommendations for fundamental reform within research, …

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