The Shadows of Sunlight: Why Disclosure Should Not Be a Priority in Addressing Conflicts of Interest
The Shadows of Sunlight: Why Disclosure Should Not Be a Priority in Addressing Conflicts of Interest
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DOI：
10.1093/phe/phy016
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发表时间：
2019-07-01
影响因子：
2.1
通讯作者：
Goldberg, Daniel S.
中科院分区：
文献类型：
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作者：
Goldberg, Daniel S.
本文认为，将披露定位为解决医学和健康领域利益冲突所带来的伦理问题的主要补救措施是错误的。相反，生物伦理资源应该致力于解决与自动减支相关的问题，自动减支的定义是在所有情况下消除商业行业和卫生专业人员之间的关系，在任何情况下都是完全可行的。争论的开始是，采用安德鲁·斯塔克的信息来源概念框架有助于理解信息来源和确定干预的优先顺序。然后，这篇文章借鉴了先前的工作，确立了在普通流行病学标准下，被适当地视为人群健康危害。这就有理由关注可能的补救措施，其中披露信息产生的分析遥遥领先。鉴于大量证据表明，披露信息作为对公民身份的补救措施充其量是无效的，因此这种至高无上的地位是没有根据的。“充其量”是合理的，因为证据还表明，披露信息可能会产生反常效果，加剧有偏见的行为。将大量注意力花在无效甚至有害的干预上是不合理的，还会排挤将资源投入到自动减支所涉及的真正问题上。因此，在可能的COI干预措施中，披露应该被视为较低的优先级。
This article argues that positioning disclosure as a primary remedy in addressing the ethical problems posed by conflicts of interest ('COIs') in medicine and health is an error. Instead, bioethical resources should be devoted to the problems associated with sequestration, defined as the elimination of relationships between commercial industries and health professionals in all cases where it is remotely feasible. The argument begins by arguing that adopting Andrew Stark's conceptual framework for COIs leads to advantages in understanding COIs and in ordering priorities for intervention. The article then draws on prior work establishing that COIs are, under ordinary epidemiologic standards, properly regarded as population health hazards. This justifies attention to possible remedies, of which disclosure generates by far the most analysis. Such primacy is unwarranted given the extensive evidence suggesting that disclosure as a remedy for COIs is at best ineffective. 'At best' is justified because the evidence also shows that disclosure may have a perverse effect, intensifying biased behaviors. Expending significant attention on an ineffective or even deleterious intervention is unjustified and also crowds out devotion of resources to the real problems that attend sequestration. Therefore, disclosure ought to be regarded as a lower priority among possible COI interventions.