The idea that disclosure of financial conflicts of interest would better our medicine is rapidly gaining traction among all stakeholders involved. On the one hand, those who generate such conflicts (the bodies on which doctors depend financially) and/or benefit from them (both these bodies as well as the doctors nursed thereby) expect disclosure thereof to restore patient trust in them. On the other hand, the patients expect disclosure of these conflicts to be either proof of the dominance of their interests over the financial interests of their doctors and those who feed them, or at least a condition sufficient to enable them to distinguish between those who care about the money and those who care about them.
In this regard, the patients have got it all wrong. Even if it were to be full, disclosure would not be proof of the dominance of their interests over the financial interests. But things get even worse for the patients, since disclosure cannot be full. This is because most financial conflicts of interest are not even recognised as such, and because there is not even a single doctor who is free from these unrecognised conflicts.
For example, the fact that most doctors are being employed by a system that increasingly demands that they give precedence to its financial interests over the interests of the patient generates an unrecognised, and hence undisclosable, conflict. Disclosure, then, would not enable patients to separate the wheat from the chaff.
The only thing it could do is induce false trust. False trust is not what the patients need. What they need is a medicine that has no conflicts of interest at all. A growing number of critics now understand that. What they still do not understand is that this requires total separation of the doctors’ income from their clinical decision-making process.
Declarations
Competing interests
As a medical ethicist employed by a medical school, I am being paid to convince my students that compliance with ethical regulation will necessarily render them good doctors. In fact, that is not the case.
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