Pathways to independence: towards producing and using trustworthy evidence

Ray Moynihan, Lisa Bero, Sue Hill, Minna Johansson, Joel Lexchin, Helen Macdonald, Barbara Mintzes, Cynthia Pearson, Marc A Rodwin, Anna Stavdal, Jacob Stegenga, Brett D Thombs, Hazel Thornton, Per Olav Vandvik, Beate Wieseler, Fiona Godlee

Research output: Contribution to journalArticleResearchpeer-review

73 Citations (Scopus)


A global team of influential researchers, clinicians, regulators, and citizen advocates suggest how we can start to build an evidence base for healthcare that is free of commercial influences

We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice.1 It highlighted that extensive industry influence may be jeopardising “the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.”1

At the same time there’s increasing appreciation across nations and within clinical and scientific communities of the problem of too much medicine. Overtesting, overdiagnosis, and overtreatment divert resources from tackling genuine need, cause harm to health, and threaten health system sustainability. Necessary tests, treatments, and diagnoses are vital, and manufacturers have rights to make profits. But it’s time to ensure the scientific evaluation of tests and treatments, and dissemination of the resulting evidence, are conducted as independently as possible from industries profiting from their use.

Perspectives differ on the financial relationships between industry and health professionals, and debate is ongoing about where to draw the line between valuable collaboration and relationships that don’t serve patients or the public. Some see transparency as the best strategy, while others regard it as necessary but insufficient. We argue that endemic financial entanglement is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems. Building on the evidence and practical examples cited below, we propose pathways towards financial independence from industry across healthcare decision making. We hope that our proposals will catalyse and inform development of more detailed recommendations for fundamental reform within research, education, and practice.
Original languageEnglish
Article numberl6576
Number of pages5
JournalBMJ (Clinical research ed.)
Issue number8226
Publication statusPublished - 3 Dec 2019


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