Reducing medication has become a privilege of wealth in western settings

In 20th century healthcare in affluent settings, generating awareness of the hazards of medication followed a rotten apple script. Find patients with a problem, find the documents that a drug company knew about the problem in private but denied it in public, mention the ghost-writing that concealed the problem and lack of access to trial data, perhaps using a clinician or an ‘insider’ to provide dramatic focus and expose the company to media or legal questioning. The sight of a rotten apple being thrown out of the barrel reassured the public that healthcare was now more ethical than before, and gave bioethicists a case example to use in teaching (1). But what if we have a whole rotten barrel as outlined in this case study? What are the ethics then?

Whistleblowing without names is hearsay

Peter Gøtzsche’s proposal to provide anonymity to certain people reporting bad practices within the pharmaceutical industry, regulatory apparatus or health systems is superficially appealing but likely to generate more problems in the longer run than it might solve in the short term. We need to analyse what features of our systems generate problems and correct those, rather than rely on insiders to report on the resulting problems, as all these reports do is offer a false sense of security that things are safer now that one problem has been identified.