• drug-related side effects and adverse reactions
• health care quality
• access
• and evaluation

In July 2020, the Independent Medicines and Medical Devices Safety Review (IMMDSR) team published the findings of its investigation into the avoidable harm caused by hormone pregnancy tests, sodium valproate and pelvic mesh implants.1 Baroness Cumberlege, who chaired the review, concluded, ‘the healthcare system—in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers—is disjointed, siloed, unresponsive and defensive. It does not adequately recognise that patients are its raison d’etre’. One of the report’s nine recommendations focused on financial links between companies that produce drugs and medical devices, and clinicians, hospitals and other organisations. The IMMDSR team were particularly concerned over the lack of transparency, and included a plea from a group representing patients that ‘we should be aware of clinicians’ allegiances or involvements whether they be financial or other’.1 The review team heard that ‘clinicians have been paid or otherwise incentivised by manufacturers’ and raised concerns over the impact this may have on their clinical recommendations. There were also concerns over the direct or indirect influence of the pharmaceutical and devices industry on organisations that are involved in providing advice, guidance and regulation. One of the report’s recommendations called for the registration of doctors to include a declaration of financial and non-pecuniary interests as well as mandatory reporting of commercial payments made to clinicians, healthcare providers and research organisations.

In February 2020, DTB discussed the importance of disclosing any relationship or activity that could be viewed as a potential conflict of interest and source of bias.2 This is not a new theme and is one that we and many individuals, journals and organisations recognise as important and believe should be widely publicised. Nevertheless, in the UK it is still the case that it is not easy to find information on the relationship (financial or otherwise) between pharmaceutical and medical device companies, and clinicians, healthcare providers and patient support organisations. Furthermore, it is not clear whether patients are made aware when a service is being been funded, supported or facilitated by a pharmaceutical or medical device company. The Sunshine UK website (http://www.whopaysthisdoctor.org) was independently established by doctors to allow them to record their financial and commercial interests and although it is a welcome development, it is voluntary and does not cover other healthcare professionals, organisations or services. Disclosure UK, the Association of the British Pharmaceutical Industry’s database of payments and benefits provided to healthcare professionals and organisations, is not comprehensive and has been criticised over insufficient information on payments and recipients, and the ability for clinicians to opt out of being included in reports.3 Nevertheless, several countries, including the USA, France, Portugal and Latvia, have shown that it is possible to operate mandatory reporting systems with the US Open Payments database being the most user-friendly.4 Furthermore, in the UK there is support for mandatory reporting from most organisations that represent doctors.5

In a written statement to Parliament, the Department of Health and Social Care (DHSC) responded to the IMMDSR’s recommendations.6 Although progress has been made in some areas, there does not appear to have been significant movement on the recommendation that ‘transparency of payments made to clinicians needs to improve’. We believe that a national registry should be established with a legal requirement that pharmaceutical and medical device companies report all payments (and other benefits) made to all healthcare professionals, healthcare organisations and patient support organisations. Access to the registry should be made public so that it is easy to find details of consultancy work, financial interests and sponsorship arrangements. In addition, healthcare providers should be required to inform patients if they have received support from pharmaceutical and medical device companies. Despite the DHSC’s acknowledgement that it will consider the issue of publication of declarations of interest, it has not set out a timetable or a work programme to make sure that this happens. This is a missed opportunity to demonstrate greater openness and transparency and one that needs to be swiftly rectified. The public has a right to know.