Between two cultures: the expert clinician and the pharmaceutical industry

Expert clinicians, valued for their academic status and independence, are used by the pharmaceutical industry for advice, for contract research, and as a means of conveying their message to other clinicians. Both academics and industry depend upon this interaction, but there is a fundamental clash of cultures at the interface between the two. Independence cannot be marketed for a fee, opinion too easily shades into advocacy, and secrecy and science do not mix. Formal guidelines and declarations of interest are inadequate as a means of policing an interface where undisclosed amounts of money change hands so freely. In the absence of effective sanctions, each of us must seek a personal solution to the professional and ethical issues involved.