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Healthy Skepticism Library item: 19679

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Wilson M, Epstein M
A sunshine act for Europe: The dark side of the sun
BMJ 2011 Nov 1; 343:


The US Sunshine Act raises a cautionary note.1 Its stress on
transparency as a solitary measure to tackle commercial conflicts
of interest will preserve the status quo.
The act assumes that disclosure of conflicts between commercial
and consumer interests entails victory of the latter over the
former—this is not true. It assumes that because such disclosure
is necessary for consumer autonomy, it is a sufficient condition
thereof. This is false, too. Public competence and an unpolluted
information environment are also required for transparency to
make a difference, but they rarely exist in environments
dominated by market forces. The act fails to fix the problem.
So what should be done?
The first step is to create independent oversight to protect the
integrity of medical data. But under the hegemony of the market,
independence is difficult to achieve and recognise. It risks being
drowned in a sea of polluted information and can be
We need a culture “in which serving two masters becomes as
socially unacceptable as smoking a cigarette.”2 An educational
campaign may help. But it will fail without a journal policy of
zero tolerance for papers sponsored by private industry and if
the National Institute for Health and Clinical Excellence does
not reject privately sponsored information. It will fail without
a legal ban on drug and device advertising and on all financial
ties between the private medical industry and medicine. The
BMA should head such a campaign.
Finally, financial interests and the patient’s interests often
conflict—medicine would be different had it been driven solely
by patients’ interests. If such a medicine is our goal, then
nationalising the medical industry and the funding of medical
science must not be ruled out.


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909