White paper: statement on conflicts of interest

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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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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Keywords

  • Conflict of interest
  • Bias
  • Professionalism
  • Research governance
  • Medical education