A global team of influential researchers, clinicians, regulators, and citizen advocates suggest how we can start to build an evidence base for healthcare that is free of commercial influences.
The landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice. It highlighted that extensive industry influence may be jeopardizing “the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.”
However, there’s increasing appreciation across nations and within clinical and scientific communities of the problem of too much medicine. Overtesting, overdiagnosis, and overtreatment divert resources from tackling genuine need, cause harm to health, and threaten health system sustainability.
Necessary tests, treatments, and diagnoses are vital, and manufacturers have rights to make profits. But it’s time to ensure the scientific evaluation of tests and treatments, and dissemination of the resulting evidence, are conducted as independently as possible from industries profiting from their use.
Collaboration or Conflict of Interest?
Perspectives differ on the financial relationships between industry and health professionals, and debate is ongoing about where to draw the line between valuable collaboration and relationships that don’t serve patients or the public. Some see transparency as the best strategy, while others regard it as necessary but insufficient.
It could be argued that endemic financial entanglement is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems. Building on the evidence and practical examples cited below, multiple pathways are proposed towards financial independence from industry across healthcare decision making. It is hoped that these proposals will catalyze and inform development of more detailed recommendations for fundamental reform within research, education, and practice.
Financial Independence from Commercial Interest
Below are suggested pathways towards research that is free from commercial influence. They include research synthesis being conducted without industry ties and government reforms to ensure product testing and regulatory agencies are independent of industry.
Possible pathways to financial independence from commercial interests
- Governments require independent production of evidence used for healthcare decision making, including the evaluation of new treatments, tests, and technologies
- Governments require that public healthcare organisations, including regulatory and health technology assessment agencies, receive no industry funding and that their advisers have no financial relationships with industry
- Groups conducting research synthesis, including systematic reviews, ensure reviewers have access to all information on study methods and all relevant study results, including clinical study reports, and are conducted without industry funding and by authors with no financial relationships with companies that could benefit from the outcomes
- Professional, advocacy, or academic groups engaged in educational activities for health professionals or the public or advocacy affecting regulatory or policy decisions, move to end reliance on industry funding and end financial relationships between their leadership and industry
- National governments work with professional associations and licensing bodies to develop policies that ensure educational activity supported by industry cannot contribute to accreditation of health professionals
- Medical journals and their editors move to end reliance on healthcare industry income
- Professional groups, hospitals, health services, and governments prohibit marketing interactions between industry and decision makers, including practising professionals, and actively support development of healthcare information independent of commercial interests
- Professionals, policy makers, and the public move to reliance on practice guidelines produced and written by groups that have no financial relationships with industry and that have access to evidence, including research synthesis, free of industry influence
- Research funding bodies and academic institutions modify academic metrics and incentives explicitly to reward academic collaboration with public agencies and civil society groups as well as industry
These proposed pathways arise from the analysis of relevant evidence and examples from around the world. The list is not comprehensive or definitive and is designed to inform intensified debate and development of detailed recommendations.
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