Healthy Skepticism Library item: 11653
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Kassirer JP.
By Financial Disclosures, We're Fixing the Wrong Problem
Medscape General Medicine 2007 Sep 24
http://www.medscape.com/viewarticle/562838?src=mp
Full text:
For several years medical editors have been castigated for failing to disclose the financial ties between some of their prominent authors and the drug industry. None of the major journals have escaped the public’s wrath, and all of them have tightened their disclosure policies by requiring more and more personal financial detail.
Disclosure is widely considered the “great disinfectant,” the best way to manage financial conflicts of interest, and thus clean the informational palate of all bias. Unfortunately, disclosure does no such thing. Disclosure may alert readers of possible bias, but it requires them to become mind readers. Did the author pen an unvarnished manuscript? Were his opinions subtly influenced by consulting or speakers’ fees? Did he intentionally bias the material to satisfy the company whose fees help to pay for his daughter’s college tuition? Interpreting the opinions and recommendations of financially conflicted authors in editorials and review articles is more akin to reading a mystery novel than reading a scientific paper.1 I believe that an excessive focus on disclosure has distracted us from paying attention to the real problem, namely, the conflict itself.
Financially conflicted experts are often given waivers and allowed to serve on clinical practice guideline committees, FDA panels, and United States public health panels, and many are selected to write for the best journals regardless of the extent and depth of their financial ties.2
Disclosure is certainly a necessary, but not a sufficient, solution to these conflicts. Rather than obsess on disclosure or lack thereof, let’s begin to deal with the real problem, namely, the conflicts themselves.3 When we want clinical advice that can affect thousands of patients, let’s try harder to find unconflicted experts so we don’t have to try to figure out what the writers really think.4
That’s my opinion. I’m Dr. Jerome Kassirer, Distinguished Professor of Medicine at Tufts University School of Medicine and Visiting Professor at Stanford University.
