Independence. A word that is overused, in the field of health care and elsewhere. In 2022, there are still healthcare professionals and educators who proclaim their independence, while at the same time receiving – or delivering – education funded by industry or by organisations with vested commercial or financial interests. These professionals and educators assert, for example, that such funding would never interfere with their intellectual independence or lead to self-censorship; they assert that funding from multiple sources would tend to cancel out the influence of individual funders; or that there is no risk of influence when the funder is a public organisation, such as a national health insurer. Patient groups adopt a similar line of reasoning.

It takes more than calling oneself independent to be credible. And recognising one's own susceptibility to influence makes one less easily influenced. Anyone who wants to take sustained action that requires financial resources is inevitably dependent… on whoever provides this financing. This means choosing upon whom to be dependent. Hence the Prescrire team has chosen to depend solely upon professionals whose aim is to improve care, primarily for the benefit of patients, i.e. subscribers. By adopting an organisational structure that includes the following features: a non-profit organisation, with a General Assembly composed of colleges (one each for subscribers, editors, advisors and founders); generous budgets to finance documentary research; a well-thought-out, collaborative editorial process that is traceable and transparent, to guard against giving undue sway to any individual opinions or to the position of any particular school; and an annual declaration confirming that every member of the editorial staff and management team is free from conflicts of interest.

Transparency. Another word that is overused today, so much so that its very use often indicates some degree of opacity. Association Mieux Prescrire, the legal entity responsible for Prescrire's publications and continuing education programmes, takes transparency as far as publishing its financial statement every year, to show how the funds received from subscribers are used (see "Prescrire's finances: 2021 annual report" > HERE). Which is not that common.

Advances have been made in the field of health in the past 20 years, in France and elsewhere, in terms of choices about which financial sources to depend upon, and choices about transparency, which are compatible with reliable information and education. Student groups and unions are taking action to ensure that their education is independent from parties with priorities other than the quality of patient care; France's national committees of deans of medical schools and dentistry schools have adopted a code of ethics; associations of healthcare professionals and patient groups are refusing to depend financially on companies that operate in the health sector; and so on.

As ever, Prescrire intends to contribute to these advances.

©Prescrire 1 June 2022

Source: "Not that common" Prescrire International 2022; 31 (238): 143. Free

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