5 Doctors' participation in research |
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?
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.
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."
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.
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.
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
This view was echoed by Sense about
Science who argued that all medical trials should be registered
and "full methods and summary results reported."
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
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.
The GMC stated clearly that it is incompatible
with their guidance for a registrant to suppress research findings.
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.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".
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.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
Dr Ben Goldacre et al, (GMC 19) p 1 Back
Sense About Science, (GMC 21) para 3 Back
Ibid, para 11 Back
Q81- Q82 Back
GMC (GMC 027) p 5 Back