Key opinion leaders and Industry: Snakes, ladders and Monopoly

Dr Margaret McCartney in her recent ‘No Holds Barred” perspective set this challenge:

“Here’s a game: try and find a doctor’s conflicts of interest. Set a timer, and give yourself the freedom of the internet”.

I have indeed played this “game” but my experience lasted much longer than Dr McCartney’s 4 hours and played out as a strange cross between Monopoly and Snakes and Ladders. It was a “game” that, on behalf of the public, I lost.

The outcome of the “game” I was involved in related to the interests of our older generation yet they were not included. I was playing against financial backers and their ‘Key opinion leaders”. This group of players worked together as the “consensus”. Curiously, the “game” started at the finish line where the “disease” in question had been re-defined by the key opinion leaders. The rules of the game were not clear and much seemed to be hidden.

Leaving the metaphor behind, I found that the “consensus” of key opinion leaders, in a published article in a leading Journal, was instructing a most significant change of disease definition and for this to be “operationalised” in the NHS. In the declarations of competing interests I noted significant discrepancies and apparent omissions. I noticed this because some of those involved had failed to be transparent in the past. They had also been made aware of this at the time.

Back to the “game”. This is a brief description of a protracted experience. I wrote to the Journal in question. The Journal told me to write to the key author. After several months of correspondence with the key author I was finally sent the ICMJE declarations (International Committee of Medical Journal Editors) of all authors, none of which were in the public domain. These ICMJE declarations confirmed that several of the authors had not submitted declarations before the article was published and that for several of the rest of the authors the ICJME declarations included competing financial interests not included in the publication. Concerned about this, I approached the Association of the British Pharmaceutical Industry (ABPI). The voluntary register they have – Disclosure UK – did not help as most of the authors were not on it. The ABPI therefore advised me to go to the Prescription Medicines Code of Practice Authority (PMCPA). However the PMCPA told me that the ABPI code “did not apply here”.

I sought the advice of the General Medical Council (GMC). However the GMC seemed only interested in Fitness to Practice procedures, whereas I was simply wishing all players to follow the guidance (the ‘rules’) as set out in Good Medical Practice. After some further correspondence, the GMC advised me to go back to the Journal where the “consensus” was published.

My experience was that it was like falling down lots of snakes and back to the start! But it also seemed like a game of Monopoly where finance mattered most. It is always possible to cheat in games. In this “game”, the rules were far from clear and there was no referee.