What price integrity?

Whether we know it or not, we are all under some form of influence. The questions taxing contributors to this week's journal are, how well do we manage those influences, and can anyone be truly independent?

First, how worried should we be that medical education relies so much on the drug industry? Very, say Adriane Fugh-Berman and Sharon Batt writing in the American Medical Association Journal of Ethics (which devotes its June issue to looking for ways to reduce drug company influence on doctors, (p 1410). “Only CME activities that are entirely free of pharmaceutical industry funding should qualify as education,” they say. What's their plan for replacing the billions spent by drug companies on CME each year? Doctors should pay for it themselves. They say that US doctors can well afford to, having the highest median income in the US. The same may now be true of doctors in the UK.

But perhaps based on long experience that doctors won't pay for information, an editorial this week calls instead for strategic funding to create a proper market for good learning content (p 1403). The editorialists-James Johnson of the BMA, Stella Dutton and Edward Briffa of the BMJ Publishing Group, and Carol Black of the Royal College of Physicians-make their plea on behalf of producers of online learning resources, themselves included. But it's a cause we should all champion, since as doctors or patients, better educated doctors must be what we all want.

Journals too need to maintain their integrity. Writing in this week's BMJ, Joel Lexchin and Donald Light say journals should do more to protect editorial decisions from commercial influence (p 1444). They say (and I agree) that failing to do this would represent “a fundamental threat to the credibility of journals and to science as a whole.” The BMJ takes its integrity seriously. Our transparency policy (http://bmj.com/advice/transparency_policy.shtml) describes the well established barriers that prevent commercial interests from influencing our decisions on what to publish. But we still rely on the drug industry for some of our revenue. Lexchin and Light make five recommendations to minimise influence, of which we already do three and are soon to adopt a fourth. We disclose conflicts of interest for everyone making editorial and business decisions for the journal (http://bmj.com/aboutsite/competing_interests.shtml). We preclude editors from direct financial ties with health related businesses. We publish full competing interest statements for authors. And we are soon to start posting all previous versions of published manuscripts. The only recommendation we have no plans to adopt is publishing detailed information about our sources of revenue. Perhaps we should.

Is total independence possible? Joe Collier, who writes the first of our new First Person features in this week's journal, has probably got closer than anyone (p 1447). But readers are warned: true independence comes at a personal cost.