The Learned Intermediary Reborn?

“Follow the money.”  Some times, Watergate seems like yesterday. It’s worth remembering, though, that June 17, 1972, the night of CREEP’s skullduggery, is further away from us in time than the opening of the Hoover Dam and the final shootout between the FBI and Ma Barker.  This reflection is prompted by John Tierney’s column in today’s New York Times suggesting that the long decline of the independent expert may be coming to an end.  We’ve been following the money for a long time.  Maybe we’ve come as far as we should.

The second half of the 20th century was undoubtedly the heyday of the unbiased professional.  In every field from medical science to investment advice, the ebb and flow of human activity was made possible by so-called “learned intermediaries” who were paid to render impartial opinion to help us to determine how to raise our children, which drugs to take and which bonds to invest in.  Conflicts of interest were narrowly drawn and it was assumed that adherence to conventional codes of ethics made disclosures about the remuneration involved unnecessary.  Then came the great unraveling, an erosion of the public trust in the impartiality of the experts.  It was a gradual process, punctuated by a few signature events — the perception that accounting firms had failed in their duty during the Savings & Loan crisis of the early 1990s; the 1999 concern that investment analysts were ramping high-tech IPOs of companies that had no real business plan; “Death Star” and the California energy crisis that shone suspicion on impartial pricing information; new drug approvals and side effects that were observed in clinical trials only seen by the FDA.  Department of Agriculture inspectors funded by fees from peanut butter factories who mysteriously failed to shut down plants with salmonella.

As this distrust accelerated, more and more conflict of interest provisions were put in place.  The Journal of  the American Medical Association, as Tierney points out, now requires at least one author on peer-reviewed papers it publishes to be free of all ties to the pharmaceutical industry.  Have we come too far?  We believe that more transparency helps, that, to quote the  oft-quoted Justice Brandeis, “sunlight is the best disinfectant.”  However, there may be limits to what is feasible or helpful.  The FCC’s new guidelines, for example, require every blogger to disclose the receipt of any “cash or in-kind payment” from the manufacturer of a product or service he or she blogs about including  T-shirts and coffee mugs.

In a world of increasing complexity, we need our learned intermediaries, and we need to hear from people with deep professional knowledge that can usually only be acquired through financial relationships with the marketers of products and services  on which they opine.  Caveat emptor was always a good principle.  Let us add to that “caveat lector,” let the reader beware and make up his own mind about the information provided by the experts.


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