Beyond disclosure: the necessity of trust in biomedical research.

Biomedical research is experiencing a crisis in public trust. Although the vast majority of clinical studies are conducted in an ethical fashion, public perceptions are fueled by well-publicized examples of unethical practices. Mistrust is further encouraged by the duality of the role of the clinical researcher, who is charged with both caring for patients and answering a research question. Disclosure is not adequate to fully address conflicts of interest in biomedical research; instead, efforts to protect patients' interests and enhance trust should combine disclosure with an attempt to reduce conflicts in the first place as much as possible.