Full disclosure

David Maxwell

I note that the article on acute otitis media in children with tympanostomy tubes1 lists as a competing interest the fact that the article was “funded by RT Communications Inc,” with no further explanation. While I commend the authors for disclosing this fact, I would suggest that this disclosure is entirely inadequate to permit readers to evaluate the potential biases and conflicts of the authors, which is ultimately the whole point of including the disclosure section. While the article appears to be entirely objective and evidence-based, the credibility of its conclusions rests on the credibility of the study’s authors, who made the selection of the articles reviewed. And here we have no information to guide us. There is no statement attesting to the author’s connections, or lack of the same, with the pharmaceutical companies manufacturing the products in question. On the contrary, the reference to the funding arrangement leaves the strong impression that the whole thing was in fact engineered by a pharmaceutical company.

The whole issue of manipulation of the medical literature by the pharmaceutical industry is now very well recognized, and most journals put in place extensive controls in an attempt to avoid such abuse. As a reader I would expect 1) an explicit declaration of the relationship of each author to the pharmaceutical industry, 2) an explicit declaration of the contribution of each author to the text (Was this article ghost-written by RT Communications?), and 3) if the journal’s editors are going to accept references to shadowy agencies as “disclosure,” I would suggest that they have an obligation to include a note explaining their nature. In this instance, not one of these conditions has been met, and I am left with the strong suspicion that this review might not be quite as objective in its conclusions as it appears. I would suggest that a critical function of an editor is the preservation of the reputation of the journal as a source of credible information, free of outside influence and bias. The extensive statements of relationships with potential sources of bias now required by most journals have been put in place for precisely this reason. I would suggest that Canadian Family Physician has failed in this regard.