On Wednesday 1st August there was the first ever global health policy summit that, according to the website, convened some of “the most important figures in healthcare”. They were apparently “key decision-makers” and “the most important business leaders worldwide”, creating “one of the most high-powered meetings on the subject of health policy ever assembled”. They produced six reports. I urge you to be cautious when using their reports – at least for the time being.What these key and important global leaders failed to realise was that these days we expect them to be transparent, and yet not one of them declared their conflicts of interest in the reports. This is a major omission.
I don’t have a problem with people having conflicts. People who have worked hard to gain experience and knowledge will inevitably be asked to share their views, either in return for remuneration or at least by having their costs covered. They may also climb into income brackets that enable them to put money aside in investment funds, and their experience and knowledge may help them to choose funds that they think will grow. It’s all part of modern life and resisting it is illogical and unrealistic.
But people should be transparent. Transparency is key to trust, and we need to be able to trust the people that want to lead us. Without knowing the conflicts of interest of the reports’ contributors we cannot know whether they are pushing ideas and initiatives from which they might gain.
What’s most surprising about all this is that declaring one’s conflicts of interest is not a new concept. Journals have been asking authors to declare their conflicts for years. Indeed, I was asked to fill out a disclosure form just to co-blog on the BMJ. I’ve also been to scientific meetings at which presenters include a slide on their conflicts, although many people prefer to call them “competing” interests or just a “declaration” of interests in order to avoid the stigma in the word “conflict”.
I could have ignored the summit and its reports but in a recent meeting I was asked how my client’s products fit within “digital health”. It’s a pretty broad term so I asked for a definition and was sent one of the summit’s reports. Although I then answered the question, by mapping my client’s aims to those described in the report, I was left wondering how we’d become accountable to the views of the report’s contributors. I’ve since looked them up and they’re clearly experienced enough to have an opinion or two on digital health, but how do I know their definition doesn’t serve them in some way? I don’t because they haven’t published what their interests are.
Obviously this is also a failing of Imperial College and the Qatar Foundation, the organisers of the summit. They must have commissioned the reports, which could have included the condition that contributor’s conflicts of interest would be published. They clearly didn’t. Indeed, it appears that conflicts of interest are not of paramount importance to them. Imperial College’s website happily tells you about their equality and diversity, freedom of information, and data protection policies but there is nothing on whether they expect their staff to declare their interests in their work. The Qatar Foundation is equally silent.
For me, though, this doesn’t let the contributors off the hook. Each and every one of them could have – and should have, in my view – made publishing their interests a condition of their participation. It is for that reason that I am listing each and every one of them (alphabetically by first name) so you can be just as surprised as I was, given the people involved:
Alex Jadad; Ali Parsa; Alistair Burns; Anand Parekh; Andrew Dillon; Andy McKeon; Andy Murdock; Andy Naarva; Anibal Faúndes; Annabel Bentley; Anne Avidon; Anne C. Haddix; Anthony Costello; Aparajita Gogoi; Ara Darzi; Armand Leroi; Ashley Manzoor; Azeem Majeed; Barak Richman; Ben Richardson; Benn Grover; Bob Kocher; Bobby Milstein; Boris Azais; Britt Marie; Bruno Strigini; Catalina Denman Champion; Catherine Gordon; Christine Hancock; Cristina Rabadan-Diehl; Christopher Exeter; Clive Ballard; Clive Bowman; Cynthia LeRouge; Daniel Becker; David Behan; David Bloomer; David Blumenthal; David Durack; David Shaw; Deborah Bae; Debra Sloane; Denis Xavier; Denise Platt; Desmond Johnson; Dinky Levitt; Donna Otten; Doug Eby; Dorothy Shaw; Dylan Kneale; Edward Alan Miller; Elizabeth Mason; Ezekiel Emanuel; Farhad Riahi; France Donnay; Frances Day Stirk; Francesca Carega; Geoff Mulgan; Geoffrey Love; George Halvorson; Glenn Steele; Graham Mulley; Grail Dorling; Greg Parston; Gu Yuan; Guillaume Sarkozy; Gunther Faber; Hamid Rushwan; Harry Cayton; Hilary Cottam; Hilary Thomas; Hugh Grant; Ivy Bourgeault; James Dunbar; James Goodwin; James Kent; Jan Sobieraj; Javier Okhuysen; Jean-Luc Butel; Jeffrey Moe; Jennifer May; Joanne Shaw; Joe Cafazzo; John Grumitt; John Oldham; Johnny Lundgren; Julie Jones; Julie Louise Gerberding; Julius Puneen; Kacey Bonner; Karalee Close; Khawar Mann; Kieran Brett; Krishna Udayakumar; Lesley Regan; Lee Chien Earn; Leo Celi; Lijing L Yan; Martin Knapp; Martin Marshall; Mark McClellan; Matthew Pettigrew; Michael Birt; Michael Kidd; Michael Macdonnell; Michael Mbizvo; Mike Hobday; Muhammed Ali Pate; Natalie Grazin; Nathalie Verin; Naveen Rao; Neil Pearce; Nick Seddon; Nicolaus Henke; Nigel Jones; Niti Pall; Oliver Harrison; Paul Corrigan; Paul Hodgkin; Paul Wicks; Parashar Patel; Peter Goldsbrough; Peter Howitt; Phil Hope; Philip Hunt; Prabhakaran Dorairaj; Parashar Patel; Richard Bartlett; Richard Bohmer; Richard Devereaux-Phillips; Richard Grol; Richard Smith; Rifat Atun; Roberto Tapia-Conyer; Robyn Norton; Rodamni Peppa; Sabaratnam Arulkumaran; Sally Greengross; Sally-Marie Bamford; Sandeep Kishore; Sarah Brown; Sarah Morgan; Sian Griffiths; Simon Kennedy; Simon Stevens; Scott Maslin; Sneh Khemka; Stephen Beales; Stephen Bloom; Stephen MacMahon; Stephen Thornton; Thomas Hughes-Hallett; Thomas Kibasi; Tim Smart; Tom Kibasi; Tom Wright; Tan Chorh Chuan; Victor J. Dzau; Viktor Hediger; Victor Matsudo; KM Venkat Narayan; Zulfiqar Ahmed Bhutta.
That’s 162 global leaders of healthcare. How can it be that so many leaders failed to appreciate the need to be transparent?
I realise this may seem overly cynical but this is a world in which GlaxoSmithKline only recently bribed doctors – and doctors let themselves be bribed – to prescribe drugs to children when they were not licensed for such use. Cynicism should be the order of the day – and these healthcare leaders should have known that.
The global health policy summit should collect and publish the declarations of interest of all the people involved. They should be added to new versions of the reports, which should be published with an apology for their oversight. Until then, it is important to be cautious when using their reports. Let’s see what they do.
Competing interests: I know a few people in the above list personally, some I would even call friends, including Richard Smith who is my mentor. Although I don’t know George Halvorson, as such, I have met him twice and I believe his organisation, Kaiser Permanente, funded my recent trip to the Institute of Medicine in the US.
This post was first published on my original blog, Optimising Clinical Knowledge.