Memory, merit, and the machinery of silence: Reconstructing integrity in systems that do not disclose

Abstract

Background

Financial conflicts of interest (FCOI) are not always visible through misconduct they often operate through omission, invisibility, and routine repetition, often through unexamined speaking roles or symbolic visibility. In healthcare systems lacking formal disclosure mechanisms or institutional memory, FCOI are less an exception and more a design feature, distributing academic visibility and symbolic authority disproportionately.

Objective

This perspective aims to critically analyze how the absence of systemic transparency in certain medical environments including transitional or under-regulated systems such as Turkey facilitates a reputational economy where authority is constructed through repetition rather than scholarly merit.

Methods

Drawing on conceptual parallels with existing international disclosure models (Open Payments, EFPIA Code), this essay contrasts systems of declared, searchable FCOI with those where neither institutional structure nor academic culture demand accountability. Using Turkey’s oncology field as a case-in-point, it demonstrates how visible engagement can obscure epistemic contribution (i.e., the actual production of original scientific knowledge) and suppress structural reform.

Results

In systems where authorship does not shape clinical influence or academic appointment, FCOI becomes embedded in symbolic practices: recurrent speaking roles, unexamined moderator positions, and honoraria-driven visibility. These patterns normalize a closed loop of validation, where symbolic authority reproduces itself and resists self-correction.

Conclusion

Restoring integrity requires more than individual virtue it demands institutional tools that remember what systems have ignored. Transparency must be procedural, not performative. Ethics must evolve into structure. Conflict cannot be managed if it cannot be mapped. Only then can ethics move from aspiration to architecture. In systems that forget, memory must be rebuilt as an instrument of reform.