‘If we want things to stay as they are, things will have to change’*

Abstract

LetterTo submit a letter in response to a JRSM article, please visit http://jrsm.sagepub.com to find the article concerned, then click on the 'Submit a comment' link found in the Reader Responses section. Comments will automatically be submitted for consideration to be published in print.'If we want things to stay as they are, things will have to change'* Mark Wilson discriminates between conflicts of interest (COIs) and bias, and challenges the notion that just declaring the former mitigates the latter. Moreover, he hypothesizes that declaration of COIs may result counterproductive, as it may favour the status quo.1 Certainly, transparency should not be mythologised and must not remain a stand-alone measure. However, doctors may not be conscious of the degree of industry interference within the medical community and may not be prepared to autonomously detect undue influence or bias.2 Therefore, transparency still seems a crucial first-line measure to raise public awareness on the issue, and the premise for additional initiatives. Despite shortcomings, written scientific information undergoes various stages of evaluation before dissemination. This may not be the case with oral dissemination of scientific information. 4 Thus, it cannot be excluded that medical conferences and educational events constitute the conditions at highest risk of undue influence or bias. Here, transparency might indeed act as a disinfectant, but only if applied at its highest level. In this regard, it has been suggested that all COIs regarding scientific societies, presidents, members of organising and scientific committees, and invited speakers should be published in detail in the online and printed conference programme, indicating the exact amount and source of the money received.5 Similarly, the number of registrations bought by individual companies and the organisations or people responsible for economic and commercial aspects should be indicated. Moreover, the final financial balance should be published online.5 This seems immediately feasible, and health authorities may grant CME credits only when such simple requirements are satisfied. When industry pays at the same time scientific societies, conference organisers, invited speakers, and attendees, in-depth transparency might point out presentations at particular risk of bias, hopefully limiting undue influences on prescribing practices, and thus benefitting patients.

If we want things to change, we need to eliminate commercial conflicts of interest

“…Responding to my editorial on transparency, Paolo Vercellini 1 argues that disclosure of commercial conflict of interests (COIs) for oral presentations in educational contexts is necessary. I could not agree more.…”