There is good news and bad news when it comes to conflicts of interest (COI) between the drug industry and clinical medicine. The good news is the “Sunshine Act,” part of the Affordable Care Act, has been implemented and many drug company web sites now list the payouts–including to “grassroots” groups that are actually Pharma fronts like the National Alliance on Mental Illness (NAMI).
The bad news is that editors and publishers sill cooperate with pulling the wool over the public’ eyes when it comes to conflicts of interest. Here are some ways that transparency about pharma payouts is blocked, even though it greatly affects the drugs that doctors recommend and prescribe.
1) Omnibus disclosure
All of a study’s authors are listed together with all the drug companies for whom they have consulted, in one undecipherable block of solid type. Who goes with whom? You’ll never know–but the author with no drug company links sure isn’t happy about the shared guilt!
2) Initials
“R.L.T. has consulted for Merck” is set in 8-point type at the end of the article. Will readers return to the first page of the study, five pages back, to decode the initials? When several authors also have first names that begin with R?
3) Disclosures You Have To Work For
Conflicts of interest of Continuing Medication Education faculty in online articles are often tucked away in a pull-down menu. Like drug ads that make you scroll for safety information, the COIs are there but you can’t see them all at once and they disappear quickly.
4) One Disclosure is Enough
When a previous article is cited in journal letters sections, author disclosures are often said to “be found with the original article.” Surely you have that issue, published four months ago, on your desk right now!
5) Protective Coloring
Disclosures of drug company links are embedded between government grants and charitable foundations as if they are the same thing. Not too many government agencies and charities are marketing drugs for patients.
6) Paying Customers Only
There are 20 million citations of medical literature in the U.S. National Library of Medicine web site. Most contain authors’ institutions and emails to be helpful. Where are the disclosures? Behind a paywall. Password please.
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