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White paper: statement on conflicts of interest

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A Correction to this article was published on 17 September 2018

This article has been updated

Abstract

Introduction

Conflicts of interest are a normal part of human social intercourse. They become problematic when there is a power differential between participants in the setting of relationships requiring a high degree of trust, as in healthcare. In this white paper we consider how these conflicts may be detected and mitigated.

Methods

Following Medline search and reference chaining, we undertook a narrative review of the literature with iterative discussion.

Results

Conflicts of interest may be financial, professional or personal, and may operate at the level of the individual or the organisation. Unmanaged, they become a source of bias which places the interests of the professional or the organisation before those of the patient. Reported with increasing frequency, conflicts damage trust, harm patients, and defraud the health system. We make 15 recommendations for minimising conflicts of interest.

Conclusions

Nationally funded open-access registries should be established to permit complete disclosure of financial, professional, and personal relationships with the potential for driving bias in research, clinical practice, or health management. Governance of disclosure should be the responsibility of employing organisations through annual staff appraisals, audited by national research integrity committees. Research fraud should incur suspension of the license to practice. Organisations should monitor staff perceptions of ethical climate to enhance awareness of staff behaviours and the potential for misconduct driven by academic pressures. Clear separation of advisory and voting roles is needed in best practice guideline panels. Professional societies and scientific journals should display conflict of interest policies for their own staff and officers as well as for speakers and authors. Undergraduates should not be exposed to pharmaceutical promotions masquerading as education. Undergraduate and postgraduate training programmes should include teaching about managing conflicts of interest and identifying research misconduct.

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Fig. 1

Change history

  • 17 September 2018

    The original version of this article unfortunately contained a mistake.

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Authors and Affiliations

  1. University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site), Birmingham, B15 2GW, UK

    Julian Bion

  2. Department of Intensive Care Medicine, Anesthesiology and Emergency Medicine, Fondazione Policlicnico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy

    Massimo Antonelli

  3. Parc Tauli University Hospital, CIBER Enfermedades Respiratorias, Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain

    LLuis Blanch

  4. Cambia Palliative Care Center of Excellence at UW Medicine, A. Bruce Montgomery-American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA

    J. Randall Curtis

  5. UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of Medicine, Waehringerstrasse 25, 1090, Vienna, Austria

    Christiane Druml

  6. Medical Intensive Care Unit, Peking Union Medicine College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China

    Bin Du

  7. Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil

    Flavia R. Machado

  8. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China

    Charles Gomersall

  9. Department of Anaesthesiology and Intensive Care Medicine, Centre for Sepsis Care and Control, Jena University Hospital, 07747, Jena, Germany

    Christiane Hartog

  10. Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA

    Mitchell Levy

  11. The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia

    John Myburgh

  12. Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Avenue, Room D108c, Toronto, ON, M4N 3M5, Canada

    Gordon Rubenfeld

  13. Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Charles Sprung

Authors
  1. Julian Bion
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  2. Massimo Antonelli
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  3. LLuis Blanch
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  4. J. Randall Curtis
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  5. Christiane Druml
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  6. Bin Du
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  7. Flavia R. Machado
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  8. Charles Gomersall
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  9. Christiane Hartog
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  10. Mitchell Levy
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  11. John Myburgh
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  12. Gordon Rubenfeld
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  13. Charles Sprung
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Corresponding author

Correspondence to Julian Bion.

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Names and title

Degrees

Affiliation, address

Email

Professor Julian Bion

OBE MBBS MRCP FRCP FRCA FFICM MD

University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site) Birmingham B15 2GW

J.F.Bion@bham.ac.uk

Professor Massimo Antonelli

 

2 Department of Intensive Care Medicine, Anesthesiology and Emergency Medicine, Fondazione Policlicnico Universitario A.Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome Italy

Massimo.Antonelli@unicatt.it

Professor LLuis Blanch

MD PhD

Parc Tauli University Hospital. CIBER Enfermedades Respiratorias. Institut de Investigació i Innovació Parc Taulí. Universitat Autònoma de Barcelona. Sabadell. Spain

lblanch@tauli.cat

Professor J. Randall Curtis

MD MPH

J. Randall Curtis, MD, MPH Professor of Medicine Director, Cambia Palliative Care Center of Excellence at UW Medicine; A. Bruce Montgomery - American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical Center, University of Washington 325 Ninth Avenue, Box 359762 Seattle, WA 98104

jrc@uw.edu

Professor Christiane Druml

 

UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of Medicine Waehringerstrasse 25 1090 Vienna

christiane.druml@meduniwien.ac.at

Professor Bin Du

 

Medical Intensive Care Unit, Peking Union Medicine Collage Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China

dubin98@gmail.com

Professor Flavia R Machado

PhD

Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil

frmachado@unifesp.br

Professor Charles Gomersall

BSc, MBBS, MRCP (UK), FRCA, FCICM, FHKCA (Intensive Care), FHKAM, FRCP (Glasg)

Department of Anaesthesia and Intensive Care

The Chinese University of Hong Kong

gomersall@cuhk.edu.hk

Professor Christiane Hartog

 

Department of Anaesthesiology and Intensive Care Medicine, Centre for Sepsis Care and Control, Jena University Hospital, D-07747 Jena, Germany

Christiane.Hartog@med.uni-jena.de

Professor Mitchell Levy

MD, MCCM, FCCP

Professor of Medicine and Division Chief, Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA

mitchell_levy@brown.edu

Professor John Myburgh

AO MBBCh PhD FCICM FAICD FAHMS

The George Institute for Global Health | AUSTRALIA

Level 5, 1 King St | Newtown NSW 2042 Australia

jmyburgh@georgeinstitute.org.au

Professor Gordon Rubenfeld

MD MSc FRCPC

Professor of Medicine Interdepartmental Division of Critical Care Medicine, University of Toronto 2075 Bayview Avenue, Room D108c Toronto, ON M4N 3M5

Gordon.Rubenfeld@sunnybrook.ca

Professor Charles Sprung

MD JD

Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel

charless@ekmd.huji.ac.il

Author

Financial

Professional

Personal

JB

Research advisor, Nestle Pharmaceuticals. £1000 per annum paid to hospital charity.

Co-chaired ESICM-SCCM Task Force on competing interests 2007

President ESICM 2006-8

Foundation Dean UK Faculty of Intensive Care Medicine 2010-13

Chief Investigator, NIHR-funded HiSLAC project (https://www.hislac.org)

Chief Investigator, NIHR-funded PEARL Project https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1415623#/

None

MA

GE Research Grant, honoraria from Orion and Fresenius, Board participation for Air Liquide

Co chair Surviving Sepsis Campaign 2018

President of the ESICM

None

LB

L.Blanch is inventor of one Corporació Sanitaria Parc Taulí owned US patent: “Method and system for managed related patient parameters provided by a monitoring device,” US Patent No. 12/538,940 and founder of BetterCare S.L. which is a research and development company, spin off of Corporació Sanitària Parc Taulí

Past President of the Spanish Society of Intensive and Critical Care Medicine (SEMICYUC)

None

JRC

None

Past President of the American Thoracic Society

None

CD

None

None

None

BD

None

Past President of Chinese Society of Critical Care Medicine (CSCCM)

Past President of Asia Pacific Association of Critical Care Medicine (APACCM)

None

FRM

None

Co-author of Surviving Sepsis Guidelines; Scientific Director of Associação de Medicina Intensiva Brasileira

None

CG

Chair of BASIC Collaboration which has received unrestricted educational grants from Maquet, Drager Medical, Hamilton Medical, Fisher Paykel, Pfizer, Vygon.

Chair of the Asian Critical Care Clinical Trials Group

None

CSH

None

Co-author of Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients 2012

None

ML

None

Past President of the Society of Critical Care Medicine

None

JM

None

His institution, the George Institute for Global Health, Sydney Australia, has received unrestricted grants and logistic support from CSL Bioplasma, Fresenius Kabi and Baxter Healthcare to conduct investigator-initiated trials in fluid resuscitation between 2002–2014 through the Australian and New Zealand Intensive Care Society Clinical Trials Group

Past-President of the College of Intensive Care Medicine of Australia and New Zealand

Research activities are supported by a Senior Practitioner Fellowship from the National Health and Medical Research Council of Australia

Non-conflicted author of the 2016 Surviving Sepsis Guidelines

None

GR

None

Co-author of Surviving Sepsis Guidelines

None

CS

None

Co-author of Surviving Sepsis Guidelines; Past- Treasurer ESICM, Co-author of Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients 2012, Co-author Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the ESICM, 2012; International Sepsis Forum Council, Data Safety and Monitoring Committee, Asahi Kasei Pharma America Corporation Phase III sepsis trial.

None

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Bion, J., Antonelli, M., Blanch, L. et al. White paper: statement on conflicts of interest. Intensive Care Med 44, 1657–1668 (2018). https://doi.org/10.1007/s00134-018-5349-8

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