In a society rife with conflicts of interest, disclosure of such conflicts is usually a good tonic. In finance, we can read the fine print and decide whether to invest or seek other advice. We can hedge our bets. But in medicine, where decisions on treatment can have lasting effects, mere disclosure isn't enough. Patients need advice they can act on without having to calibrate how likely it is to be biased. Physicians and scientists with financial ties to the pharmaceutical industry should not just have to disclose conflicts -- they shouldn't be permitted to issue guidelines at all...

In describing the use of disclosure in business circles, an economist recently said, "It has become a truism on Wall Street that conflicts of interest are unavoidable. In fact, most of them only seem so, because avoiding them makes it harder to get rich. That's why full disclosure is so popular: It requires no substantive change." Disclosure covers up the question of bias with a patina of honesty. It tells you little or nothing about whether the disclosed conflicts of interest actually tainted a report. Because the issue of bias challenges the very integrity of researchers, people in the field shy away from talking about it.

...we should dissuade leading physicians from doing non-scientific work for pharmaceutical makers. Doctors who want to be respected as independent authorities should not become paid speakers for drug companies or consult with the industry on marketing issues. These arrangements do not benefit medicine or improve patient care; they only promote the profit goals of the companies. We should save the prized task of preparing clinical practice guidelines for experts without such conflicts. After all, having a financial conflict is voluntary; physicians can either take it or leave it. We must convince them to leave it.

...If medical organizations continue to use heavily conflicted experts to make clinical policy, they will erode the confidence of the public. The public needs medical institutions it can trust for help with decisions it can barely understand.