Intended for healthcare professionals

Rapid response to:

Head To Head

Has the hunt for conflicts of interest gone too far? Yes

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39493.489213.AD (Published 28 February 2008) Cite this as: BMJ 2008;336:476

Rapid Response:

who to trust?

I doubt either author is opposed to disclosure; for as jurist Sir John Chadwick said in 1990, "secrecy is the badge of fraud". So how do we make sense of these two views?

Much of the art we take for granted, many historical buildings and much science and technology we enjoy were produced by people who had patrons, wealthy or powerful individuals that sponsored their work. Perhaps disclaimers are required in case we think that that our enjoyment of a particular art work for instance would be compromised by knowing this. No, instead we commend the far-sightedness of the sponsor, and are grateful that they saw the talent in the individual whose work we today enjoy. The bloodlessness of the world that would have otherwise come to pass would be without merit or humanity.

To some extent, that is the point I take from Stossel.

From Lee, however, I see a neo-McCarthyism, of officious approval and retribution, indeed authoritarianism thinly veiled by the aura of public interest claims. For who is without conflict, who is without a sponsor, who is immune from the pressures to publish, to perform on committees, donate time to charities and who does not reciprocate, often with kindness and often out of duty? Are we to stop sharing our experience for fear of opporbrium from colleagues who have little of interest to say as they sit in their tiny conflict-free worlds?

Let those without sin cast the first stone.

The interesting people are all conflicted -- they are engaged in the real world, with all its faults. The world is not neat and tidy, it is messy and complex, and better we learn to understand the conflicts, than naively believe we can avoid them. I believe the public interest has far more to fear from the Lees of the world than the Stossels; the latter drives us closer to honesty while the former toward fear and concealment.

Competing interests: I advise companies and governments on health policy.

Competing interests: No competing interests

01 March 2008
Michael Tremblay
health policy advisor
Tremblay Consulting, TN25 5RJ United Kingdom