It was not of course in relation to the NHS that Tony Blair famously said “I only know what I believe.” His assertion was in defence of military action in Iraq despite the millions on the streets saying “Not in my name.” It is however a convenient method of ignoring the troublesome masses who disagree and it has a hint of direct communication with higher powers as an infallible guide to action. more…

JAMA  15 Feb 2012  Vol 306
669    This week’s star Viewpoint piece is about The Unintended Consequences of Conflict of Interest Disclosure. It seems to me that twenty-first century medicine operates on roughly the same principle as the court of the Grand Vizier of the Ottoman Empire – prestige is judged by the number of bribes you are offered. Far from being a source of shame and reluctance to publish, these are routinely flaunted at the end of most interventional trials in the leading medical journals. I once counted 63 for a single individual; and perhaps he would argue that once you enter double figures, they begin to cancel each other out. How did we reach a state where the default setting of our medical culture is conspicuous corruption? As the authors here point out, this cannot go on: “Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in healthcare costs in the United States, and transparency is no substitute for more substantive reform.” And just as the US health system thinks of ways to get out of this hole, our British political masters are determined to push us into it.
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