Abstract
Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types—financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of ‘market failure’ in the economic theory. Since health cannot be considered a ‘consumer good’, the economic paradigm of ‘free market’ does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.
References
Annane D, Charpentier B (2018) Do I have a conflict of interest? Yes. Intensive Care Med 44(10):1741–1743
Purdy S, Little M, Mayes C, Lipworth W (2017) Debates about conflict of interest in medicine: deconstructing a divided discourse. J Bioeth Inq 14(1):135–149
Morciano C, Basevi V, Faralli C, Hilton Boon M, Tonon S, Taruscio D (2016) Policies on conflicts of interest in health care guideline development: a cross-sectional analysis. PLoS One 11(11):e0166485
Bero L, Grundy Q (2016) Why having a (Nonfinancial) interest is not a conflict of interest. PLoS Biol 14(12):e2001221
Steinbrook R, Kassirer JP, Angell M (2015) Justifying conflicts of interest in medical journals: a very bad idea. BMJ 350:h2942
Bauchner H, Fontanarosa PB, Flanagin A (2018) Conflicts of interests, authors, and journals: new challenges for a persistent problem. JAMA 320(22):2315–2318
Wernerman J (2018) Do I have a conflict of interest? Note sure. Intensive Care Med 44(10):1746–1747
Bero L (2017) Addressing bias and conflict of interest among biomedical researchers. JAMA 317(17):1723–1724
Lenzer J (2016) When is a point of view a conflict of interest? BMJ 355:i6194
Lo B, Grady D (2017) Payments to physicians: does the amount of money make a difference? JAMA 317(17):1719–1720
Vincent JL, Christopher KB, McLean A (2018) Do I have a conflict of interest? No Intensive Care Med 44(10):1744–1745
Fineberg HV (2017) Conflict of interest: why does it matter? JAMA 317(17):1717–1718
Gold A, Appelbaum PS (2011) Unconscious conflict of interest: a Jewish perspective. J Med Ethics 37(7):402–405
Kelly T (2016) Conflicts about conflict of interest. Camb Q Healthc Ethics 25(3):526–535
Stossel TP (2007) Divergent views on managing clinical conflicts of interest. Mayo Clin Proc 82(8):1013–1014
Cappola AR, FitzGerald GA (2015) Confluence, not conflict of interest: name change necessary. JAMA 314(17):1791–1792
Garattini L, Padula A (2019) Conflict of interest disclosure: striking a balance? Eur J Health Econ 20(5):633–636
Garattini L, Padula A (2018) Competition in health markets: is something rotten? J R Soc Med 112(1):6–10
Grundy Q, Habibi R, Shnier A, Mayes C, Lipworth W (2018) Decoding disclosure: comparing conflict of interest policy among the United States, France, and Australia. Health Policy 122(5):509–518
Garattini L, Padula A (2018) Dual practice of hospital staff doctors: hippocratic or hypocritic? J R Soc Med 111(8):265–269
Funding
No sources of funding were used to conduct this study or prepare this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
Livio Garattini, Anna Padula and Pier Mannuccio Mannucci have no conflicts of interest directly relevant to this article.
Statements on human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Garattini, L., Padula, A. & Mannucci, P.M. Conflicts of interest in medicine: a never-ending story. Intern Emerg Med 15, 357–359 (2020). https://doi.org/10.1007/s11739-020-02293-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-020-02293-4