Nine in 10 professional organisations say doctors should have to register their financial interests

Influencing clinical decisions

Cumberlege told The BMJ that any introduction of a register of healthcare workers’ financial interests must start with doctors.

“Some are calling for registers of interests to apply to all health professionals, not just doctors,” she said. “As we said in our report, that is a matter for each professional regulator to determine. But doctors are the principal decision makers in patient care: they determine the treatment, they perform surgery. So, it is with doctors that we must start.”

She said that all patients had a right to know their doctor’s interests and whether those interests might influence their clinical decisions.

“During our review, my team and I were concerned by conflicts of interest, both potential and real, in the provision of care,” said Cumberlege. “This is especially significant where doctors have financial or other links with pharmaceutical or medical device companies. There is no central register of doctors’ financial and non-pecuniary interests. There needs to be one: at present there is a real lack of transparency.”

She added, “Every patient has a right to know their doctor’s interests and whether those interests may be influencing their clinical decisions. We recommended in our report that the GMC’s register should be expanded to include financial and non-pecuniary interests, as well as each doctor’s clinical specialisms, and I am keen to see that recommendation implemented without delay.”

Margaret McCartney, a GP and health journalist, said that declaring interests had been made too complicated for too many doctors while not getting to the heart of the problem. She said, “Most doctors have nothing of significance to declare and yet find themselves having to fill in numerous forms for different organisations, while those who do have significant interests can end up making declarations which are hard for others to interpret and understand.

“A central register has the potential to cut bureaucracy and time demands while making it more rigorous a process where necessary.”

Kath Sansom, founder of the patients’ campaigning group Sling the Mesh, said that until the introduction of a mandatory register of doctors’ interests patients would have no idea who was funding their doctor’s voice or who might be biased towards certain treatments.

She said, “One look at the Disclosure UK website3 [where doctors can voluntarily declare their interests] shows it is clear that voluntary reporting does not work. Some argue that taking a gift will not lead to bias, but studies prove otherwise. As patient campaigners we will always argue that there is no such thing as a free lunch.

“Studies show time and again that, whether consciously or subconsciously, medics linked to pharmaceutical companies have higher prescribing frequency, higher costs, or lower prescribing quality.”