Risks and Rewards of Transparency
On some of the benefits and limitations of transparency in medicine and health
Among virtues that seem incontrovertible, transparency ranks high nowadays. Everyone wants everyone else to be more transparent. In healthcare, we increasingly demand that regulatory agencies like the FDA, drug companies, and medical centers reveal their inner workings. Healthcare providers and the authors of medical research studies must disclose all sources of potential conflicts of interest, especially money they receive from the pharmaceutical industry.
Clearly, the public has a right to know what its taxpayer-funded agencies are doing. It is also believed that disclosing sources of payments and other favors will help consumers of medical care and scientific journal articles decide if conflicts of interest are unduly influencing decisions and practices. Is our physician recommending a specific medication because the drug’s manufacturer pays him to lecture about it? Is the clinical trial published in a reputable journal likely to be underplaying adverse side effects of an investigational drug because the drug company that hopes to market it funded the study?
The expectation behind disclosure of financial and other conflicts of interest is that greater transparency will reduce the influence of biased investigations and reports. Interestingly, there are few studies that show whether disclosures have their intended effects. In one study, 290 readers of the British Medical Journal (BMJ) were randomized to receive a fictitious scientific report in which the authors were either identified as employees of a drug company or of an ambulatory care center. Readers who were told the report was authored by drug company employees rated it as less interesting and valid than those who were told the report was authored by people with no declared conflicts of interest. Clearly, we need many more such studies in order to understand what kinds of disclosures are effective.
We, like many others, wholeheartedly support increased transparency in every aspect of healthcare and science. But questions arise about how much personal, non-financial information should be disclosed in the interests of transparency. One thing we have often wondered about, for example, is the extent to which scientists ought to disclose their own political leanings. Studies show that political affiliation is one lens through which people view scientific topics. Democrats are more likely to believe in climate change but to fear nuclear energy and GMO’s compared to Republicans. People with liberal values tend to want stronger gun control laws than people with conservative values. It appears clear that political feelings and affiliations bias us about what scientific information we believe. Does that mean that everyone who discusses scientific evidence should disclose his or her political associations?
Whenever we write something about guns we are invariably attacked as “you Northeastern liberals.” Indeed, we believe the evidence that personal gun ownership is dangerous is overwhelming and therefore that prudent public policy must be in the direction of reducing firearm possession. But would our critics on gun control still believe we are “Northeastern liberals” if they knew that, based on our understanding of the science, we oppose labeling foods if they contain GMOs and want more research on the safe application of nuclear energy?
A recent study calls into questions whether scientists’ disclosure of their political values improves public acceptance of science. Researchers from Michigan State University conducted experiments in which they varied how much disclosure a hypothetical scientist made of his political values when explaining the data on an environmental issue. These investigators acknowledge that “ the best course for scientists is to make their value commitments more transparent.” Nevertheless, the results of their studies showed exactly the opposite to be the case: the more scientists disclosed their own values, the less credible the non-scientist subjects found them. The conclusion seems to be that scientists are better off keeping their political, philosophical, and religious values to themselves when communicating scientific findings in order to maintain maximum credibility. Despite these findings, it is hard to oppose the move toward greater transparency in science and medicine.