Abstract
I write this on a sunny day. Earlier a colleague told me how he loves sunshine, how it lifts his mood. Sunshine has a curious effect. Many people quickly expose as much of themselves as possible. When the sun shines in some hot countries, people hide from the intensity of the sun’s glare. Personally, I’m a fan of sunshine and seek it out as much as possible. It makes me happy, which might be one reason I’m impressed by the US Physician Sunshine Act.
Doctors, according to US legislators, must declare their commercial competing interests. A national register has been created to document these entanglements. The argument is that by declaring these commercial interests, the US public will be able to better weigh up the advice or information that any physician is delivering. This process of casting sunlight on concealed commercial conflicts will cleanse the doctor–patient relationship and increase confidence in the recommendations of advisory groups and guidelines panels. In essence, transparency will be a panacea.
Mark Wilson, writing in this month’s JRSM, begs to differ. 1 He challenges the notion that transparency has such power. His argument is that transparency alone has failed to deliver the cleansing effects it promised. So, when UK campaigners call for their own version of a Sunshine Act, they should wish for something better than elevating ‘transparency to the governance status of an unassailable self-evident philosophical principle’. Our fixation on declaration of commercial interests, says Wilson, has diverted us from scrutinising the commercial conflicts of interest themselves as well as their corrupting influence. That does not mean that a register of doctors’ commercial interests has no purpose. Wilson proposes that such a register can instead be used to identify physicians free of commercial interests to serve on clinical guideline and oversight committees.
Like Wilson, JRSM is not proposing to throw the baby out with the bathwater. Declaration of competing interests for authors submitting articles to the journal will remain standard practice, but the question is whether only articles by authors free of commercial interests should be published? This is a difficult question since the real politik of editing a monthly journal like JRSM is that high-quality submissions are less bountiful than those received by bigger, more frequently published journals. It might be a risky step for JRSM to take, and perhaps JRSM readers disagree with Wilson? Either way, we’d be interested to hear your views about whether we should only publish articles from authors free of commercial competing interests?