Conflicts of interest are a critical issue in dermatology (Citation1). Many potential conflicts exist, not just financial ones; conflicts involving publication bias are important considerations for authors, journals, readers, and, ultimately, patients (Citation1). Author bias may compromise the impartiality of research conclusions (Citation2). The forward-thinking British Journal of Dermatology (BJD) addressed conflicts in a series of articles (Citation3–6). The BJD’s editor stated the issue with crystal clarity: “Our judgement is influenced by conflict of interest” (Citation7). The number one proposal to address the issue was “To accept that personal conflicts of interest are mostly unavoidable and may even be inevitable, but must always be addressed by full disclosure” (Citation7). Disclosure, by establishing transparency, is widely believed to help immunize readers to bias (Citation1–7), but does the evidence support that it does?
Two psychological mechanisms exist by which disclosure increases biased communications: strategic exaggeration (advice is more biased under the assumption that it will be discounted) and moral licensing (a sense of absolution from moral obligations to readers) (Citation8–10). While disclosure attempts to discourage bias, empirical evidence suggests disclosure results in communications becoming more biased toward self-interests (Citation2–8). A study that mimicked aspects of the patient-physician relationship involved estimators and advisors. Estimators assessed some quantity and received input from advisors; advisors were paid more when estimators overestimated values. Consistent with strategic exaggeration and moral licensing, bias was substantially greater when advisors disclosed their conflict. Disclosures did enable estimators to discount certain advice, but it was insufficient to compensate for the increased bias given by advisors (Citation8).
Disclosures sometimes influences readers’ perception of bias by creating greater trust based on the belief that disclosure indicates honesty. In a randomized trial using mailed financial disclosure letters to patients, nearly one in four patients reported that knowing financial disclosure increased their trust (Citation2). Disclosures also significantly reduced individuals’ perception of researchers’ ethics, but only marginally affected perceptions of a researchers’ objectivity (Citation10). Disclosures appear at least sometimes to create a false sense of security, contrary to their intended purpose of increasing awareness for potential author bias.
While the development and implementation of disclosure guidelines seems like a wonderful, compelling idea that offers peace of mind, it is empty reassurance. The evidence to support implementation of disclosure suggests that disclosure may worsen the problem of interpreting author bias. Disclosure policies make us feel good but have the potential for paradoxical consequences. The available evidence, much of which comes from outside the medical literature, suggests that perhaps we would be better off without disclosure and simply encouraging readers to beware. More research on the effects of disclosure in medicine is needed before any firm conclusion can be drawn.
Finally, a note from the senior author who has tons of conflicts of interest. Do I believe that conflicts can affect my perceptions? Yes, absolutely. Do I believe that by being transparent about this that I’ve solved the potential conflict of interest issue? Heavens, no.
Disclosure statement
Feldman has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment.
Emily Chea, Emily Unrue, Abigail Cline have no interests to disclose.
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