It's time to stop the endemic financial entanglement with industry that is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems, argue an influential group of international experts in The BMJ today.
The group proposes "pathways" towards financial independence from industry across healthcare,"to build a more trustworthy evidence base to inform healthcare decisions.
Their call to action comes against a backdrop of growing evidence of the problem of "too much medicine" - the threat to health and the waste of money caused by overdiagnosis and unnecessary care.
If we want to produce trustworthy evidence and tackle the epidemic of medical excess, decision-makers at all levels within healthcare need to disentangle themselves from those profiting from that excess."
Dr. Ray Moynihan, lead author, Assistant Professor at Bond University in Australia
Today's article marks the launch of a BMJ themed collection on commercial interests, transparency and independence at the Preventing Overdiagnosis conference in Sydney Australia on 5-7 December 2019, where Dr Fiona Godlee, The BMJ's Editor in Chief, will deliver a keynote presentation.
"Patients and the public deserve to have evidence they can trust," said Dr Godlee. "Commercial influence has no place in scientific research, nor in the education and guidance of clinicians, nor in decisions about diagnosis and treatment. We hope that people around the world support our call for fundamental reforms."
Over the coming months, articles will be added to the collection to help better understand the nature of commercial conflicts of interest, to explore when involvement with industry is necessary, and to share examples of progress towards independence.
The proposals for fundamental cultural change were developed by a global group from eight nations, with expertise across medicine, the law and philosophy. It includes leading researchers, regulators, citizen health advocates, and doctors, including the president-elect of the World Organisation of Family Doctors.
The group point to examples across medical research, education and practice, from around the world, where individuals and organisations are shifting to independence from commercial influence, demonstrating that change is not only necessary but also feasible.
Proposed pathways to independence outlined in The BMJ today include governments requiring independent testing of new treatments and technologies; policies to ensure only education that is free of industry support will count towards to health professional accreditation; and a move to reliance on clinical guidelines produced and written by groups free from financial relationships with industry.
These proposed pathways "are not comprehensive or definitive, but rather designed to encourage the development of more detailed practical recommendations for change, and how to fund it, involving players across healthcare," explain the authors.
"Such transformation will be slow, but may be unstoppable, because human health, the sustainability of our health systems, and trust in medical science will be the beneficiaries," they conclude.
The BMJ is also offering others the chance to endorse the call to action, and to become involved in the development of more detailed recommendations for change.
Moynihan, R., et al. (2019) Pathways to independence: towards producing and using trustworthy evidence. BMJ. doi.org/10.1136/bmj.l6576.