Time to deal with medicine's dirty little secrets?

As health care eats up more of US GDP year after year, it is being held increasingly accountable. Today the Wall St. Journal's has another front page article (At Medical Journals, Writers Paid by Industry Play Big Role) revealing something not so nice about the field:It's an example of an open secret in medicine: Many of the articles that appear in scientific journals under the bylines of prominent academics are actually written by ghostwriters in the pay of drug companies. These seemingly objective articles, which doctors around the world use to guide their care of patients, are often part of a marketing campaign by companies to promote a product or play up the condition it treats...The practice of letting ghostwriters hired by communications firms draft journal articles -- sometimes with acknowledgment, often without -- has served many parties well. Academic scientists can more easily pile up high-profile publications, the main currency of advancement. Journal editors get clearly written articles that look authoritative because of their well-credentialed authors.There are other "open secrets" as well. A few examples:

• Academic medical centers and individual physicians sometimes have an ownership stake in companies whose devices they are using and doing research on. These stakes are rarely disclosed. (See How a Famed Hospital Invests in Device It Uses and Promotes.)
• Orthopedic device sales reps are often in the operating room to assist or guide orthopedic surgeons in performing procedures
• Physicians who are on the influential committees that set guidelines (e.g., for cholesterol and blood pressure levels) often have consulting relationships with companies that benefit from how those guidelines are set

It's time to bring these and other secrets out in the open, to debate them and to change the practices that aren't right. The fact that conflicts of interest are rarely disclosed and are sometimes intentionally hidden shows that the people involve realize something's not quite ok. Disclosure is a first step, but as we've seen in the financial services business, disclosure of conflicts isn't enough to ensure objectivity.An idea I've suggested before --to avoid conflicts of interest in drug trials-- is to outsource evaluation to India.