2013 accountability hearing with the General Medical Council - Health Committee Contents


5  Doctors' participation in research

Register of doctor's interests

83. In advance of the accountability hearing the Committee received a number of submissions concerning the participation of doctors in medical research and the declaration of interests in such cases. Margaret McCartney, a GP in Glasgow and broadcaster on BBC Radio 4's Inside Health said in her evidence:

    At the moment I can find out what financial conflicts of interest my MP has. But I can't find out what potential COIs my doctor has-and my patients can't find out that about me easily (though they have been listed for some time on my blog). So when a doctor prescribes me a drug, I'd like to know whether they are a paid consultant to that drug company, whether they have received education from that drug company, etc. [...]Doctors have to pass appraisals every year when 'probity' issues are discussed. Why can't that information be held by the GMC for patients to check, just as they can to see if that doctor is registered with them or not?[110]

84. Commenting on the suggestion that the GMC should hold a public register of doctor's interests, Sir Peter Rubin told the Committee that at present the public would not know if a doctor has a financial conflict of interest.[111] Niall Dickson gave a commitment on behalf of the GMC that they would examine the possibility of operating a register of interests as "part of our wider look at how we can make the register as useful as possible."[112]

85. The Committee believes that there is a compelling case for the GMC to hold a public register of doctors' interests with the responsibility for maintaining the accuracy of the register sitting with registrants. Although the Committee welcomes the fact that the GMC is willing to explore this, we believe that the regulator should examine the practical considerations of developing a registerwhich is reliable and open to public scrutiny. At our next accountability hearing the Committee will ask the GMC to outline its progress in this area in detail.

Publication of research findings

86. The evidence submitted by Dr Ben Goldacre, Sir Iain Chalmers, Dr Trish Groves, Dr Fiona Godlee and Dr Virginia Barbour backed the view that the GMC should maintain a register of doctors' interests.They did not argue against doctors participating in commercial medical research, however, their submission did state that:

    there is extensive research evidence showing that doctors with financial conflicts of interest often express more favourable views on the treatments in question, when compared to doctors who have not received such payments. It is therefore important that information about these conflicts of interest is transparent. It is currently extremely hard - and in many cases impossible - for patients, colleagues, patients and the public to establish who has paid a doctor.[113]

87. Their evidence noted that the "GMC do good work on misdeeds by individuals in individual studies". Their submission concluded, however, that the GMC should:

    clarify their position, and strengthen the wording of their guidance, requiring that any doctor working on a trial both past and present - on all treatments currently in use-is responsible for ensuring that the trial is registered, with its results made publicly available within a year of completion; and forbidden from entering into contracts with trial sponsors that relinquish access to data and prevent dissemination of results.[114]

The overriding concern expressed in their written evidence was that whilst the GMC has been able to tackle cases whereby doctors have participated in fraudulent studies there are no mechanisms to reveal the outcomes of studies with unflattering results.

This view was echoed by Sense about Science who argued that all medical trials should be registered and "full methods and summary results reported."[115] They concluded that the GMC should:

    have a role in ensuring that doctors working on clinical trials or who worked on a clinical trial in the past on any treatment in current use ensure that the clinical trial has been registered and a summary of the findings is publicly available.[116]

88. The GMC took an assertive stance in discussing the requirement to publish the outcomes of research and clinical trials. Sir Peter Rubin observed that advances in the ability to publish findings means that there are no longer legitimate reasons for failing to publicise negative results. He told the Committee that:

    There was a time when it was very difficult to get negative studies published in peer review journals, so a doctor, try as he might, just could not get it published. Now, with open access, you can put your results online and they are there without peer review. The landscape has changed, and there is now no justification for negative, seemingly boring, results to be withheld; they can be put into the public domain.[117]

The GMC stated clearly that it is incompatible with their guidance for a registrant to suppress research findings.[118] Professor Sir Peter Rubin and Niall Dickson both described how the GMC is preparing to alter the guidance available in Good Medical Practice because the shortened version did not directly address the issue of transparency in medical trials.[119]Sir Peter Rubin noted that the GMC's supplementary guidance did address this issue, but the question of transparency was "implicit but not explicit in that guidance".[120]

89. The Committee welcomes the GMC's recognition that the contemporary research landscape no longer offers any valid justification for failing to publish the results of negative drug trials. The Committee believes it is now essential that the GMC re-words its guidance so that the need for transparency is made explicitly clear. The GMC's written evidence showed that there have been a small number of fitness to practise cases resulting from doctors failing to publish the results of medical trials.[121]It is essential that all registrants are made aware by the GMC that the failure of a doctor to ensure publication of the results of medical trials constitutes a serious breach of professional obligation.


110   Margaret McCartney (GMC 09) para 2 Back

111   Q79 Back

112   Q77 Back

113   Dr Ben Goldacre et al, (GMC 19) p 1 Back

114   Ibid Back

115   Sense About Science, (GMC 21) para 3 Back

116   Ibid, para 11 Back

117   Q84 Back

118   Q85 Back

119   Q81- Q82 Back

120   Q81 Back

121   GMC (GMC 027) p 5 Back


 
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Prepared 2 April 2014