The following thoughts originally appeared on Pharma Views, the blog of the European Federation of Pharmaceutical Industries and Associations (EFPIA).
I am not a healthcare professional, nor do I work in the pharmaceutical industry. I am a philosopher who researches trust, and a citizen who has, unfortunately, had more than his fair share of medical emergencies. As such, I am increasingly convinced that transparency is an incredibly important, but limited, tool for building trust where health is concerned.
As a citizen who (all too often) must count on those making and prescribing medicines, I am optimistic about transparency initiatives like EFPIA’s Disclosure Code, which aims to support trust between the pharmaceutical industry, healthcare professionals, patients and civil society. With increased transparency comes a reduction in opportunities for deception. And that reduction in the possibility of deception can help citizens like me feel more confident when we count on professionals.
However, as a philosopher who works on the topic of trust, I think something more must be said: while transparency can be an important part of building trust, being transparent is not necessarily the same as being trustworthy.
Transparency can help assure citizens that they are not being deceived. But deception is not the only thing that can damage trust. Distrust can also result when the information disclosed through transparency initiatives is taken to express a lack of trustworthiness (i.e. incompetence or a lack of integrity). Quite simply, if transparency means revealing the truth about one’s behaviour, trust will only be encouraged if that behaviour is taken to denote trustworthiness.
It would seem, then, that the way to build trust between citizens and those working in health is not only to increase transparency, but to insure that the information being shared shows that the professionals disclosing are in fact worthy of the public’s trust. However, the situation is not quite so straight forward.
If health professionals truly are trustworthy, and if there is good reason to think that the information they disclose is indicative of trustworthiness, society may still fail to perceive them as worthy of trust. This is because any distrust and scepticism that citizens hold can be self-reinforcing, causing citizens to interpret disclosed information more negatively than is, perhaps, justifiable. The result is that just as patients are vulnerable to the discretion of healthcare professionals, so too are those professionals vulnerable to the scepticism of society.
The limitations of transparency initiatives need not outweigh their benefits. It is still good for health professionals to be open with those counting on them. Rather, the limitations of transparency suggest that the responsibility for building trust does not lie solely with pharmaceutical and health professionals. Rather, citizens also have a role to play as they carefully ensure that both their trust and distrust is well-placed