Register of interests would improve doctors' transparency

After the MPs' expenses scandal, is it the turn of doctors? It could just be - and it wouldn't necessarily be a bad thing.

At the end of last year, GlaxoSmithKline said it would stop paying doctors to promote its products through speaking engagements. The pharmaceuticals giant is making major changes to its incentive schemes following a damaging corruption scandal in China.

Now, doctors, health professionals and academics are calling on the GMC to set up a central registry of doctors’ competing interests. A recent letter in the BMJ, signed by 15 doctors and academics, points out that citizens can access MPs’ central register of their financial conflicts of interest, yet patients cannot find out whether their doctor has a financial conflict of interest.

How would this have changed things in diabetes?

Of course the short answer is that we can’t be sure but few of us will have been to a major diabetes conference and not seen some familiar faces talking about their favourite drug or class of drugs, and seen the conflict of interest slide dispensed with in the blink of an eye.

Many of us attend the pharma sponsored plenary talks. Few of us cannot, at some point, have graciously accepted pharma hospitality. I certainly have.

These processes and acts in themselves are perhaps not the real issue - the real issue is what influence do they have on our decision making, our prescribing practice and on the profession as a whole? The likely - and regrettable - answer is possibly quite a significant influence and therefore an open and transparent register of interests has to be in the best interests of medicine.

Take, for example, analogue insulins; these have been a great step forward in diabetes. There is an extensive evidence base supporting this and the pharmaceutical industry should be lauded for driving this innovation forward.

However, should every single insulin treated patient be on an analogue insulin? Patently not, with more than 3 million people diagnosed with diabetes in the UK - and a conservative estimate suggesting 10-20% might need insulin treatment - the cost of putting all on analogues would be immense and yet the benefit for many would likely be small at best.

And yet we were inexorably moving towards automatic analogue prescription for most insulin starts until recently.

So, where was the mismatch between evidence base and practice actually coming from?

Undoubtedly many quarters, but perhaps one source of influence in the speciality may have been hospitality, educational grants, speaker engagements and professional endorsements.

Is it time for a register of interests? I think so.

Tags for this article: Insulin

The author - Dr Jeremy Turner

Jeremy Turner A consultant diabetologist and endocrinologist in Norfolk, and author of Diabetes Bible

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My blog expresses my personal views on the rapidly advancing field of diabetes. It is aimed at fellow physicians and is not offering medical advice to readers. I will not respond to requests for clinical advice. If you have health concerns please contact your GP or specialist.

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