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If we want things to change, we need to eliminate commercial conflicts of interest

Responding to my editorial on transparency, Paolo Vercellini argues that disclosure of commercial conflict of interests (COIs) for oral presentations in educational contexts is necessary. I could not agree more. It should be mandatory. But Vercellini’s claim that disclosure can serve to neutralise commercial COIs at the ‘highest levels’ of medical education is wishful thinking. The claim lacks an evidence base and runs up against what is known about the limits of transparency as an accountability tool and its failure to combat commercial COI. Even those who have strongly lobbied for greater transparency note that simply declaring a commercial conflict runs the risk of normalising it and that there is a need for medical boards and guideline committees to be free of financial COIs because of their negative effects. Disclosure alone will not secure their independence. Indeed, there is a good reason why ‘the Institute of Medicine, the American Medical Association and the Association of American Medical Colleges have all recently issued reports calling for elimination or limitation of industry sponsored continuing medical education’. What is needed is leadership at all institutional levels to carry out this challenging task.