- Navjoyt Ladher, clinical editor, The BMJ
The BMJ, with its commitment to transparency and open data, is not a great fan of secrecy.
The
European Union’s Clinical Trials Regulation, passed last month,
stipulates that a summary of study results should be made available
within one year of trial completion for most European clinical trials
(doi:10.1136/bmj.g2579). The regulation’s introduction was in part due to campaigns such as AllTrials (alltrials.net), backed by The BMJ.
Showing why this new legislation is so important, a research paper by
Lamberto Manzoli and colleagues looks at randomised trials of vaccines
and analyses the time from completion of the trials to their publication
in peer reviewed journals (doi:10.1136/bmj.g3058).
The survey found that delays to publication were common and that over a
quarter of trial results remained unpublished after four years. In a
linked editorial (doi:10.1136/bmj.g3259)
Christopher Jones and Timothy Platts-Mills outline the various
obstacles to timely publication of trials: “In short, sponsors, authors,
and journal editors all have interests, and none of these interests
align exactly with the public’s interests in prompt access to trial
results and publication of peer reviewed manuscripts.”
It’s
clear that much work still needs to be done to increase the
transparency of research, so news of the European Medicines Agency’s U
turn on its plan to allow public access to clinical trial reports has
been met with disappointment and surprise (doi:10.1136/bmj.g3432). In a BMJ
blog, Tom Jefferson and Peter Doshi, two of the authors of the recent
Cochrane reviews of neuraminidase inhibitors, and Trudo Lemmens describe
the damaging effects these changes could have (bmj.com/blogs).
The hidden interests of lobbyists also come under scrutiny this week (doi:10.1136/bmj.g2908),
with calls for media organisations to be more transparent about the
potential conflicts of interest of interviewees. The perception that
lobbyists and think tanks represent an independent point of view is
false, argues Meg Carter, and she highlights the BBC’s recent coverage
of the debate over plain packaging of tobacco products as an example. A
member of the right wing think tank the Institute of Economic Affairs
was invited on to BBC Radio 4’s Today news programme to argue
the case against brand free packaging. The arguments presented were
similar to those of the tobacco company Phillip Morris, one of several
big tobacco funders of the institute—links that the BBC failed to
clarify during the debate.
Lobbyists are active in many
areas of healthcare where businesses have a vested interest. Not only
tobacco but salt, sugar, climate change, health service delivery, and
alcohol are all areas that are subject to attempts to influence
legislation and policy. In the United States the spend on healthcare
lobbying in 2012 was just under $0.5bn (doi:10.1136/bmj.g135).
It’s a big business, and key players will often be invited to offer
comment and opinion in the media. Where there are commercial and
competing interests it is vital that media organisations make these
clear so that audiences can make an informed judgment on the issues
being discussed. As Tamasin Cave, director of Spinwatch, explains in
Carter’s feature, “Lobbyists and the interests they represent have a
right to be heard. But all of us—including the media—must engage in a
more mature discussion of lobbyists’ role. End the secrecy and everyone
will benefit.”
One form of secrecy that is an essential
part of healthcare and building trust with patients is confidentiality.
With the advent of text messaging, email, and social networking, it can
be difficult to know what measures are needed to ensure that
communication to and about patients is appropriate and secure. Bradley
Crotty and Arash Mostaghimi highlight the ethical and legal
considerations of confidentiality in the digital age (doi:10.1136/bmj.g2943) and offer practical advice on safeguarding patient information to ensure that what needs to be secret stays that way.
Notes
Cite this as: BMJ 2014;348:g3439
Footnotes
- Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest
Secrets in healthcare
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