Today in the BMJ myself and colleagues have a letter discussing the need for patients and the public to see easily what potential conflicts of interest a doctor may have.
As we say in the letter
“The Association of the British Pharmaceutical Industry has estimated that the drug industry pays £40m (€48m; $65m) a year to doctors for speaking fees, flights, hotels, and other travel expenses.2 Yet who is being paid what is opaque. ..
The General Medical Council (GMC) says, “You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals . . . If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision making.”7 Yet there is no formal way to declare such interests, especially when conflicts may subtly influence a doctor’s practice—such as small gifts from the drug industry. The lack of a system to document payments means that patients cannot routinely be informed whether their doctor receives benefits from companies that may affect their prescribing…
There is a need for change. The current system of self declaration is variable, opaque, and unreliable….
We would discourage the long and potentially irresolvable discussion about what does or does not represent a conflict or interest (membership of a political party, board membership of a charity, ownership of a nursing home, or ownership of a primary care service while working as a commissioner of care). Rather, we suggest that patients may be good judges of this. Moving from the notion of an academic conflict of interest being something “that would embarrass you if it were to emerge after publication and you had not declared it”9 the question should become, “Is there anything that would embarrass your relationship with your patients or the public if you do not declare it now?” Although having an interest is not necessarily by itself a problem, failure to disclose some declarations might be. It is likely that doctors’ professionalism would lead to more over-declaration than under-declaration. However, patients are most likely to be concerned about payments from the industry, PR companies, and declarations of interest over commissioning of services.”
(The full version with references is available via the link, and Martin Brunet, @DocMartin68 was a signatory but his name is not on the list, unfortunately, my fault).
The http://www.whopaysthisdoctor.org/website which has been set up (by volunteers, unpaid, working late into the night) is an attempt to try and get this information to patients and the public.
It is not a perfect system, or solution – doctors who receive very large sums from pharma may be unwilling to voluntarily disclose this. That’s why we want the GMC to consult on a statutory register of declared interests. In the meantime, doctors can voluntarily declare their interests on the website. (Beware – confirmatory emails from the site have a tendency to go into email spam folders.) There will also be a delay period from a doctor making a declaration to it appearing to allow verification. If the site doesn’t work for you please let us know firstname.lastname@example.org and I will forward it on.
I think this is a good first step. To make it work, we need doctors to sign up. Please spread the word!