It seems that transparency and public accessibility is all the rage these days. For the past decade or more, concerns among journalists, medics, politicians and (to a much lesser extent) the general public have been calling for greater transparency around the biomedical research process, from summaries and protocols of proposed and ongoing studies through to reports of finished studies and even for raw datasets for re-analysis. Under the thought-leadership of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE), registration systems such as the International Standard Randomised Controlled Trial Number (ISCRTN), EU projects like EudraCT and EudraPharm, and the US-based www.clinicaltrials.gov, the bar has been raised and the infrastructure put in place for information about every study to in the public domain.
This is a good thing, although the debate continues about what information should be made public when, and how much you can discuss your work and still have it accepted for a prestigious journal. The most important thing for all of us is that the biomedical science community and the general public have increasing confidence in the accuracy and applicability of the evidence provided by clinical trials. In the absence of documented evidence to the contrary, the social climate is such that it is all too easy for allegations of wrongdoing by the pharmaceutical industry to be believed even if these cannot be proved. This is not least because of a few ‘horror stories’ of studies that were conducted but not reported (particularly by industry, and thus prominently reported in the media) or reported but not conducted (mostly by individual medics, and thus barely reported at all!)
There has been a great deal of brouhaha (and rightly so) about who should or should not be listed as an author: ‘guest authors’ have been widely deprecated, while ‘ghost writers’ should be ghosts no more, with the important contribution made by medical writers to the clarity and structure of a good paper being increasingly recognised. However, there is one area about which I’ve heard no calls for greater transparency and compulsory registration: the space at the end of each paper in a medical journal, where the authors (or, better, ‘contributors’) are required to list their conflicting interests. This is dangerous for two reasons: there is no independent mechanism to verify these statements are complete and accurate and, more importantly, it is left to the judgement of the individual contributor to decide what conflicts with their contribution to the paper.
If the world of industry can sometimes be an ethically messy place, the same is certainly true of academia, with professional jealousy and one-upmanship playing as much of a role as commercial interests such as consultancy fees and the potential for spin-out businesses. The precise details of such a system would need to be worked through, and a suitable body found to oversee and enforce it (perhaps the World Medical Association?) but it is unrealistic to think that this is the one area where subjective judgement should be accepted as rigorous. As the English saying goes, “what’s sauce for the goose is sauce for the gander”…
