Regulating spoons.

T here is an old proverb that goes: ‘‘He who sups with the devil should use a long spoon.’’ This seems to apply to the increasingly uneasy relationship between physicians and the pharmaceutical industry, with the perception that some spoons have become short to nonexistent, as some people have perhaps allowed professional boundaries to become blurred. Some recent activities of big pharma companies have been troubling. There have been well-publicised scandals about the suppression of data unfavourable to a novel medication or, at least, of extreme economy with the truth. There have also been concerns that meta-analyses commissioned by the industry usually come up with answers favourable to the industry [1]. A welcome attempt at openness on the part of the medical profession is the increasing publication of conflict of interest statements, so that the reader or listener can determine whether there is likely to be any bias. The philosophy is that everything should be declared and that the target audience, not the author, should determine what is relevant, and this is right. But although this is a step in the right direction, it does not go nearly far enough. The statement ‘‘I have received US$5,000 from Company X as lecture fees’’ could mean, ‘‘I have been paid expenses to lecture at a meeting which is compiled completely independently from industry’’ but also, ‘‘I have spoken at a satellite symposium from slides completely provided by the company, uncritically purveying what the company has instructed me to say’’. The implications of these two interpretations of the same (truthful) conflict of interest statement are very different.