Where the mesh inquiry leaves us regarding a register of doctors’ interests

How did it happen that a product approved with little evidence of long term safety was taken up so enthusiastically by surgeons and implanted in thousands of women, many of whom went on to develop devastating complications? The murky tale of pelvic mesh, laid bare last year in meticulous detail at the Cumberlege inquiry, shines a light on inadequate research, failures in regulation, lack of informed consent, and surgeons keen to take advantage of an apparently quick and easy procedure for stress urinary incontinence and pelvic organ prolapse.1

Evidence to the inquiry, led by the life peer Julia Cumberlege, put common industry practices under the spotlight: aggressive marketing; manufacturers funding research; doctors taking sponsorship for training, travelling fellowships, honoraria, and speaking fees; professional bodies taking money from drug and device makers; and members of professional committees with conflicts of interest. As Carl Heneghan, director of the Centre for Evidence Based Medicine in Oxford, put it in evidence to the inquiry, “Is the whole system commercially conflicted? Yes, it is.” He added, “I think it’s important that, if I’m treating you, you know who’s paying me.”

Taking evidence around the UK as vice chair of the review, the retired paediatric nephrologist and former medical school dean Cyril Chantler recalls a “constant voice across the country of patients telling us they felt the mesh had been very commercially promoted and doctors were receiving benefits from companies prescribing it.”

He and his colleagues on the review—which also looked at two drugs linked to harm to unborn children, the hormone pregnancy test Primodos and the …