• Adherence
• Adverse effects

Since 1962, DTB has been an independent voice publishing impartial articles on medicines and therapeutics to help clinicians and patients make informed and unbiased choices. In line with our publisher’s principles, we strive to be transparent about any interests that our readers might want to know about and ensure that all those involved with DTB disclose all relationships and activities that could be viewed as potential conflicts of interest and sources of bias. We recognise that the disclosure process is not perfect and too often focuses on financial matters. Nevertheless, perceptions of conflict of interest are as important as actual conflicts of interest, and we believe that it is important to allow readers to judge whether our content is independent of commercial and other biases. For this reason, we now publish an annual declaration from our board members as well as declarations from authors of articles that we commission. All authors who write articles that could influence therapeutic choices must be free from conflicts of interest with the pharmaceutical or healthcare products industry.

The importance of publishing information on conflicts of interest is well known. Various Cochrane reviews have described the effects of commercial involvement on healthcare research. Studies of drugs and medical devices sponsored by the manufacturer tend to lead to more favourable results and conclusions than those that have other sources of sponsorship.1 Systematic reviews with financial conflicts of interest have favourable conclusions more often than those without financial conflicts of interest.2 Work is underway to examine whether financial or non-financial conflicts of interest have an effect on authors’ recommendations in clinical guidelines, opinion pieces and review articles.3 Despite this, not all journals routinely publish all conflict of interest statements for all articles, and not all journals have policies for disclosure from their staff and editorial boards. Beyond the world of publishing, the lack of transparency over the influence of donations to patient advocacy organisations and hospitals has been highlighted.4–6 In addition, many patient advocacy organisations do not have publicly available conflict of interest policies.7

Attempts have been made to improve access to information on financial relationships with commercial organisations. In the USA, the Sunshine Act requires pharmaceutical companies and other organisations to report payments and charitable donations given to physicians and teaching hospitals. The details published in a national database also include information of ownership or investment interest physicians have in a company. In France, companies producing and selling healthcare products have to declare the level of support they contribute to patient organisations.8 In the UK, the Association of the British Pharmaceutical Industry’s database of payments and benefits in kind made to healthcare professionals and organisations was launched in 2016.9 However, as declarations are voluntary and individuals can opt out of disclosure, the database does not include detailed information of every payment received.10

It remains the case that identifying potential conflicts of interest requires considerable research without any guarantee of success. It is disappointing that in the UK there are no comprehensive registers of conflicts of interest relating to healthcare professionals, healthcare providers and patient support groups. It is time that regulatory bodies require all healthcare professionals to submit an annual declaration of conflicts of interest. Furthermore, all healthcare providers and patient support groups should be mandated to publish details of any funding arrangement from commercial organisations on their websites and in their public accounts. It should no longer be acceptable for conflicts of interest to remain undocumented, undisclosed or hidden.