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Revolving door between the public and private sectors: conflict of interest

 Editorial  In Europe, as in the United States, senior public officials sometimes go on to occupy positions in the private, for-profit sector, and vice versa. The blurring of roles and conflicts of interest this situation engenders are detrimental to the public interest. There are many such examples in the health sector.

The month after the director of the European Medicines Agency left the position he had held from 2001 to 2010, he joined the board of a firm lobbying on the behalf of pharmaceutical companies (1). On his LinkedIn page, as of mid-2022, he portrays this situation as perfectly natural: "Based on my extensive experience and knowledge of drug/device regulation, approval, market access, management, strategy and leadership I currently advise pharmaceutical companies worldwide on drug development with a focus on regulatory and market access" (1).

In spring 2022, the European Ombudsman published her conclusions following an inquiry into 100 cases where staff members had moved from a European institution to the private sector between 2019 and 2021 (2). She considers that the European Commission has been too lax in its handling of these situations: "The movement of regulators into sectors they formerly regulated has become a problematic issue in Brussels, yet this is not fully reflected in how the EU administration deals with the matter. (…) There is a tendency to underestimate the corrosive effects of officials bringing their knowledge and networks to related areas in the private sector" (2). The Ombudsman has proposed several strategies for improving the situation, such as temporarily forbidding former staff members from taking up jobs if restrictions would not be sufficient to prevent the blurring of roles and conflicts of interest (2).

The blurring of roles reached unprecedented heights with the consulting firm McKinsey, which was advising the US Food and Drug Administration (FDA) at the same time as it was advising opioid manufacturers, in particular on how to circumvent… FDA regulations (3). The firm boasted to its private-sector clients that it had intimate knowledge of the FDA's plans and staff, and congratulated itself on having influenced a speech made by the then FDA commissioner (3). In retrospect, once the scandal over the promotion of opioids in the United States had broken, McKinsey acknowledged that its work for opioid manufacturers, "while lawful, fell short of the high standards we set for ourselves" (3). The prescription opioid crisis led to 250 000 deaths from opioid overdoses in the United States between 1999 and 2019 (4).

In practice, those who profit from the revolving door or offer consulting services to all and sundry seem to have trouble recognising how it could possibly be perceived as wrong. It is not just roles that have become muddled, but minds as well.

1- "Thomas Lönngren" LinkedIn accessed 23 June 2022: 2 pages.
2- European Union "Ombudsman: EU administration at critical point in treatment of "revolving doors"". Press release 18 May 2022: 2 pages.
3- Dyer O "Top consulting firm hid opioid conflicts of interest from the FDA, says congressional report" BMJ 2022; 377: o1024: 2 pages.
4- Prescrire Editorial Staff "Consultants on anything and everything" Prescrire Int 2021; 30 (231): 277.

©Prescrire 1 January 2023

Source: "Revolving door between the public and private sectors: conflict of interest" Prescrire International 2023; 32 (244): 3. Free

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