The troublesome semantics of conflict of interest

The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be applied to bias, not conflicts.     

The Troublesome Semantics of Conflict of Interest

The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be applied to bias, not conflicts.     

Intrinsic conflicts of interest in clinical research: a need for disclosure

Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, public standards, and government regulation, but "intrinsic conflict of interest"--conflicts of interest inherent in all clinical research--have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest.     

Medical journals' conflicts of interest in the publication of book reviews

The purpose of the study was to assess medical journals’ conflicts of interest in the publication of book reviews. We examined book reviews published in 1999, 2000, and 2001 (N=1,876) in five leading medical journals: Annals of Internal Medicine, British Medical Journal (BMJ), Journal of the American Medical Association (JAMA), Lancet, and New England Journal of Medicine. The main outcome measure was journal publication of reviews of books that had been published by the journal’s own publisher, that had been edited or authored by a lead editor of the journal, or that posed another conflict of interest. We also surveyed the editors-in-chief of the five journals about their policies on these conflicts of interests. During the study period, four of the five journals published 30 book reviews presenting a conflict of interest: nineteen by the BMJ, five by the Annals, four by JAMA, and two by the Lancet. These reviews represent 5.8%, 2.7%, 0.7%, and 0.7%, respectively, of all book reviews published by the journals. These four journals, respectively, published reviews of 11.9%, 25.0%, 0.9%, and 1.0% of all medical books published by the journals’ publishers. Only one of the 30 book reviews included a disclosure statement addressing the conflict of interest. None of the journals had a written policy pertaining to the conflicts of interest assessed in this study, although four reported having unwritten policies. We recommend that scientific journals and associations representing journal editors develop policies on conflicts of interest pertaining to book reviews. Disclosure: R.M. Davis was North American editor of the BMJ from 1998 to 2001, and is a member of the Board of Trustees of the American Medical Association, which publishes JAMA. The opinions expressed in this paper are those of the authors and do not reflect the official policy of any organization with which the authors have been affiliated.     

适宜技术选择中的利益冲突及其化解途径

适宜技术的选择要考虑简、便、廉、验,要从大多数患者的需求出发,要始终定位在医患等利益关系的结合点上,它是一种动态发展的技术或技术体系。然而,正是基于各种利益的结合点,在实际选择适宜技术中常常因为利益冲突的多主体性而变得复杂多样,并衍生出各种各样的利益冲突。分析利益冲突的产生根源对于寻求利益冲突的化解途径具有重要意义,同时也为各种途径提供了理论支持。     

Researcher Perspectives on Conflicts of Interest: A Qualitative Analysis of Views from Academia

The increasing interconnectedness of academic research and external industry has left research vulnerable to conflicts of interest. These conflicts have the potential to undermine the integrity of scientific research as well as to threaten public trust in scientific findings. The present effort sought to identify themes in the perspectives of faculty researchers regarding conflicts of interest. Think-aloud interview responses were qualitatively analyzed in an effort to provide insights with regard to appropriate ways to address the threat of conflicts of interest in research. Themes in participant responses included disclosure of conflicts of interest, self-removal from situations where conflict exists, accommodation of conflict, denial of the existence of conflict, and recognition of complexity of situations involving conflicts of interest. Moral disengagement operations are suggested to explain the appearance of each identified theme. In addition, suggestions for best practices regarding addressing conflicts of interest given these themes in faculty perspectives are provided.     

Conflict of interest in medical research in Estonia

An area where conflicts of interest can take place in Estonia is in the conduct of clinical trials. The paper lists the main areas where such conflicts of interest can occur. The author also briefly discusses Estonia’s current position with regard to regulating genetic information and the commencement of the Estonian Genome Project. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Authors and publication practices

Although authors are usually considered to be the main perpetrators of research and publication misconduct, any person involved in the process has the potential to offend. Editors may breach ethical standards particularly with respect to conflicts of interest. In the same way that authors are now required to declare competing interests, notably commercial affiliations, financial interests and personal connections, so must editors. Editors can influence the chances of acceptance or rejection of a paper by reviewer selection. Reviewers should also be ready to disclose conflicts of interest. They must ensure that their reviews are evidence based and free from destructive criticism driven by self interest. It seems likely that ultimately we will progressively move towards 'open' peer review in which both the authors and the reviewers are known to each other. There is an urgent need for increased transparency of the relationship between editors and owners. The events of the last few years indicate that unless this interface is fully understood by all parties, conflicts may arise. There is also a need for a radical overhaul in the relationship between journals, journal editors and the biomedical industry. It is now increasingly accepted that all clinical trials should be registered in a centrally held database and that protocols should include the primary and secondary outcome measures and the intended approach to data analysis thereby avoiding opportunistic post hoc analyses. However, the even more radical proposal that journals should cease to publish clinical trials sponsored by industry deserves wider debate.     

Climate Change,Nuclear Economics,and Conflicts of Interest

Merck suppressed data on harmful effects of its drug Vioxx, and Guidant suppressed data on electrical flaws in one of its heart-defibrillator models. Both cases reveal how financial conflicts of interest can skew biomedical research. Such conflicts also occur in electric-utility-related research. Attempting to show that increased atomic energy can help address climate change, some industry advocates claim nuclear power is an inexpensive way to generate low-carbon electricity. Surveying 30 recent nuclear analyses, this paper shows that industry-funded studies appear to fall into conflicts of interest and to illegitimately trim cost data in several main ways. They exclude costs of full-liability insurance, underestimate interest rates and construction times by using “overnight” costs, and overestimate load factors and reactor lifetimes. If these trimmed costs are included, nuclear-generated electricity can be shown roughly 6 times more expensive than most studies claim. After answering four objections, the paper concludes that, although there may be reasons to use reactors to address climate change, economics does not appear to be one of them.     

Cinematic depiction of conflicts of interest in romantic relationships

Conflicts of interest resulting from a romantic relationship, just like conflicts of interest of a financial nature, have the potential to negatively affect professional decisions. For this reason, many companies, universities, and government agencies have policies designed to prevent conflicts of interest at the expense of personal liberties. In addition, the feminist literature in the last two decades has added the specter of sexual harassment to the evaluation of conflicts, of interest. A few academic authors have voiced opposition to this state of affairs. In an effort to enrich the debate with viewpoints from outside of academia, I analyze six popularly acclaimed motion pictures that address the issue of conflicts of interest in romantic relationships. All six films convey the idea that people are aware of potential complications but regularly avoid these complications. This suggests that restrictive policies on conflicts of interest may not be justified.     

Conflict(s) of Interest in Peer Review: Its Origins and Possible Solutions

Scientific communication takes place at two registers: first, interactions with colleagues in close proximity—members of a network, school of thought or circle; second, depersonalised transactions among a potentially unlimited number of scholars can be involved (e.g., author and readers). The interference between the two registers in the process of peer review produces a drift toward conflict of interest. Three particular cases of peer review are differentiated: journal submissions, grant applications and applications for tenure. The current conflict of interest policies do not cover all these areas. Furthermore, they have a number of flaws, which involves an excessive reliance on scholars’ personal integrity. Conflicts of interest could be managed more efficiently if several elements and rules of the judicial process were accepted in science. The analysis relies on both primary and secondary data with a particular focus on Canada.     

Researcher Views About Funding Sources and Conflicts of Interest in Nanotechnology

Dependence in nanotechnology on external funding and academic-industry relationships has led to questions concerning its influence on research directions, as well as the potential for conflicts of interest to arise and impact scientific integrity and public trust. This study uses a survey of 193 nanotechnology industry and academic researchers to explore whether they share similar concerns. Although these concerns are not unique to nanotechnology, its emerging nature and the prominence of industry funding lend credence to understanding its researchers?? views, as these researchers are shaping the norms and direction of the field. The results of the survey show general agreement that funding sources are influencing research directions in nanotechnology; many respondents saw this influence in their own work as well as other researchers?? work. Respondents also agreed that funding considerations were likely to influence whether researchers shared their results. Irrespective of their institutional affiliation or funding status, twice as many researchers as not considered financial conflicts of interest a cause for concern, and three times as many respondents as not disagreed financial conflicts of interest in nanotechnology were uncommon. Only a third was satisfied with the way that conflicts of interest are currently managed and believed current procedures would protect the integrity of nanotechnology research. The results also found differences in views depending on researchers?? institutional affiliation and funding status.     

Frequency and Type of Conflicts of Interest in the Peer Review of Basic Biomedical Research Funding Applications: Self-Reporting Versus Manual Detection

Despite the presumed frequency of conflicts of interest in scientific peer review, there is a paucity of data in the literature reporting on the frequency and type of conflicts that occur, particularly with regard to the peer review of basic science applications. To address this gap, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of conflict of interest data from the peer review of 282 biomedical research applications via several onsite review panels. The overall conflicted-ness of these panels was significantly lower than that reported for regulatory review. In addition, the majority of identified conflicts were institutional or collaborative in nature. No direct financial conflicts were identified, although this is likely due to the relatively basic science nature of the research. It was also found that 65 % of identified conflicts were manually detected by AIBS staff searching reviewer CVs and application documents, with the remaining 35 % resulting from self-reporting. The lack of self-reporting may be in part attributed to a lack of perceived risk of the conflict. This result indicates that many potential conflicts go unreported in peer review, underscoring the importance of improving detection methods and standardizing the reporting of reviewer and applicant conflict of interest information.     

Clarifying conflict of interest

As the debate over how to manage or discourage physicians' financial conflicts of interest with the drug and medical device industries has become more heated, critics have questioned or dismissed the concept of "conflict of interest" itself. A satisfactory definition relates conflict of interest to concerns about maintaining social trust and distinguishes between breaches of ethical duty and temptations to breach duty. Numerous objections to such a definition have been offered, none of which prevails on further analysis. Those concerned about conflicts of interest have contributed to misunderstandings, however, by failing to demonstrate when social arrangements leading to temptations to breach duties are in themselves morally blameworthy. Clarifying "conflict of interest" is important if we are eventually going to develop productive modes of engagement between medicine and for-profit industry that avoid the serious ethical pitfalls now in evidence.     

Conflict of interest in Croatia: doctors with dual obligations

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical profession that address problems of conflict of interest. An earlier version of this paper entitled was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

人际冲突中失望的个人效应及冲突类型的调节作用

通过两个计算机情景模拟实验, 分别采用“保证游戏”与“最后通牒博弈”范式, 考察了人际冲突中失望的个体对于威胁评价与冲突行为的影响。在此基础上进一步探讨了冲突类型对人际冲突中失望个人效应的调节作用。结果发现：(1)失望个体相比无情绪个体的威胁评价更高, 冲突行为更多。(2)冲突类型影响处于失望状态的个体的威胁评价, 即价值观冲突中失望个体的威胁评价要高于利益冲突中失望个体的威胁评价; 但是冲突类型并不影响失望个体的冲突行为。     

Strangers at the benchside: research ethics consultation

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program.     

A BIOLOGICAL INTERPRETATION OF MORAL SYSTEMS

Abstract. Moral systems are described as systems of indirect reciprocity, existing because of histories of conflicts of interest and arising as outcomes of the complexity of social interactions in groups of long-lived individuals with varying conflicts and confluences of interest and indefinitely iterated social interactions. Although morality is commonly defined as involving justice for all people, or consistency in the social treatment of all humans, it may have arisen for immoral reasons, as a force leading to cohesiveness within human groups but specifically excluding and directed against other human groups with different interests.     

Conflicts of Interest,Selective Inertia,and Research Malpractice in Randomized Clinical Trials: An Unholy Trinity

Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior (or even comparable), that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual (not potential) harm.