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Throughout history, people have attempted to influence others by offering money, goods or services. If such influence-peddling had not been so successful, it might have vanished long ago. However, following Darwinian principles, it has progressively evolved, becoming more prevalent, complicated, extremely successful and, too often, damaging to people who, unaware of influence-peddling schemes, become their victims.
The most succinct argument for transparency of influence-intended financial transactions was made over 100 years ago when former US Supreme Court Justice Louis Brandeis said, ‘Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants’.1
What is the problem?
As the practice of medicine evolved into what former New England Journal of Medicine editor Arnold Relman called the ‘new medical–industrial complex’ (a term first used by health policy experts Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled ‘The Medical Industrial Complex’ and in a subsequent book, The American Health Empire: Power, Profits, and Politics2) with increasing use of private companies to supply healthcare services to patients for a profit, a larger percentage of health expenditures are spent on pharmaceuticals and medical devices.2 Not content with merely influencing physicians and other health professionals via advertising, these industries also offer free meals, vacations and, more expensively, well-paying speaking and consultant fees. Such conflict of interest has been described as ‘a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest’.3
By the end of the first 6 years of government-mandated industry Open Payments Database (OPD) disclosure (2014–2019), US physicians, also defined as including dentists, podiatrists, optometrists and chiropractors,4 had been given more than $18 billion of ‘general payments’, …
Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.
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