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How could disclosure of interests work better in medicine, epidemiology and public health?
When Transparency International was founded in 1993, the focus for fighting corruption was mainly on bribes and corruption of civil servants in developing countries. While our definition of corruption was broad from the beginning, that is abuse of power or of a powerful position for personal advantage or benefit, the concept of preventing corruption had to be adjusted more recently. A first consideration of conflicts of interests appeared in our A–B–C of fighting corruption (2002) stating that
… conflicts between private and professionally consigned interests—be it in public office or in the private sector—create susceptibility to corruption. In addition to the general demand of keeping private and professional interests separate, specific codes of conduct should provide suitable examples of potential conflicts. A reliable code should contain the obligation to disclose and obtain a permit for acceptable cases or, vice versa, examples of unacceptable cases of conflicts of interests which should be explicitely prohibited, as well as tangible punishment or sanctions against infringements.1
Conflicts of interests are now considered as a major gateway for corruption in medicine and public health.2They predominantly affect the way that doctors evaluate and use the products of the pharmaceutical and medical device industry by a systematic and ubiquitous exposure during professional life, starting at medical school. Recent estimates of marketing expenditures of the pharmaceutical industry amount to US$57.5 billion (2004) in the USA alone, with 63.2 per cent or US$ 36.3 billion for samples and detailing directly addressing individual physicians, the majority of them working in private practice.3 The other 21.2 billion are spent on scientific meetings, e-promotion, promotional drug use trials, journal advertising, direct-to-consumer advertising and unmonitored promotion. Yearly marketing expenses …
Competing interests: None declared.
A comment by Anke Martiny, Peter Schoenhoefer and Angela Spelsberg for the Working Group on Health of Transparency International, German Chapter. All authors are members of Transparency International, German Chapter.