Conflict of interest within the medical context describes situations in which a doctor’s ability to act in the best interest of the patient is influenced by an outside relationship with a person, group, or business.
Underlying ethical principles
- Trust: The physician, investigator, and/or institution is entrusted with a patient’s well-being; a conflict of interest violates trust by placing another party’s interests above the patient’s interests.
- Fidelity to the patient: the faithfulness of 1 person to another
How conflicts of interest arise
A conflict of interest most commonly arises in medicine when a physician has the potential for financial gain. The conflict can happen when the physician:
- Has a relationship (either personally or professionally) with drug or medical-device companies:
- Physicians may develop or invent new drugs or medical devices.
- Physicians may invest in drug or biotechnology companies, or specific treatment facilities.
- Owns the testing or treatment facility
- Is involved in industry-sponsored research:
- Research requires funding: The funding source can lead to bias within the study.
- Research activities may impact a physician’s compensation either from their employer or from the industry sponsor.
- Physicians may be compensated for enrolling patients into clinical trials, which may impact a patient’s willingness to enroll.
Examples of external influence
Many outside influences may constitute a conflict of interest, including the potential for:
- Financial gain (most prevalent):
- 43% of researchers have received gifts, discretionary funding, and/or consulting fees.
- Almost 33% of researchers have personal financial ties with industry sponsors.
- Professional recognition and promotion
- Successful acquisition of research funding: 23%–28% of academic investigators have received funding from the industry.
- Quest for knowledge (may occur at the expense of the patient)
- Political implications (e.g., personal values, affiliation, political agenda)
Positions at risk of developing conflicts of interest
- Physicians/individual researchers, especially with:
- Long-standing relationships with pharmaceutical companies
- Significant financial relationships with involved parties
- People involved in clinical research
- Journal editors and reviewers
- University faculty members, trustees, and department chairs
Consequences of Conflicts of Interest
The consequences of conflicts of interest can have a significant impact on both patient care and research outcomes.
Medical care and medical education
- Prescription of newer and/or more expensive drugs, equipment, or procedures with no clear advantage when compared to older/generic alternatives:
- May be unintentional on the part of the physician and the result of a highly effective marketing/influencing activity on a subconscious level
- Referral to specific testing or treatment centers owned by the physician (may not be the best option for the patient):
- Studies show more tests are ordered when the physician or practice owns the lab or imaging equipment.
- Biased training of medical students and residents
Conflicts of interest may result in:
- Biased study results in favor of the sponsor’s product
- Study designs favoring positive conclusions
- Publication delays
- Raw-data and interpretation manipulation:
- Data deletion, withholding, and/or tweaking
- Compromises in internal validity (e.g., unaccounted-for confounding factors, inadequate control of other variables)
Solutions, Disclosures, Limitations, and Funding
- Limitations: The physician/investigator should limit ties to industry as much as possible:
- Limits subconscious bias in prescribing/referring patterns
- Researchers may associate with impartial institutions (e.g., universities or governmental agencies).
- Preference can be given to funding from university or government grants over unrestricted industry donations.
- Disclosures: The physician/investigator is obligated to report sponsors and/or financial ties:
- Includes any presentations, courses, and/or manuscripts submitted for publication
- Different journals have distinct policies regarding external ties (some reject work by authors with potentially conflicting interests).
- Sources of funding must be disclosed prior to publication.
- Gives readers/learners a lens to view the information and assess potential biases
- All potential biases should be adequately addressed
- All readers should ask if the information is presented by a paid spokesperson (more like an advertisement)
- Muth, C.C. (2017). Conflict of interest in medicine. JAMA. 2017;317(17):1812. Retrieved June 10, 2021, from https://jamanetwork.com/journals/jama/fullarticle/2623608
- Shmerling, R.H. (2018). Conflict of interest in medicine. Harvard Health Publishing. Retrieved June 10, 2021, from https://www.health.harvard.edu/blog/conflict-of-interest-in-medicine-2018100114940
- MacKenzie, C. R., & Cronstein, B. N. (2006). Conflict of interest. HSS journal: the musculoskeletal journal of Hospital for Special Surgery, 2(2), 198–201. https://doi.org/10.1007/s11420-006-9016-1
- Celentano, D., Szklo, M. & Gordis, L. (2019). Gordis epidemiology. Philadelphia, PA: Elsevier.