What Is and What Is Not a Conflict of Interest in the Sphere of Public Health
A conflict of interest is a set of circumstances or relationships that create the risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. Secondary interests may be internal, meaning limited to the personal sphere, or external, linked to the interests of third parties or institutions. Internal interests are related to individual identity and personality, and tend to be perfectly aligned with the primary professional interest. Therefore, we usually only speak of a conflict of interest when external secondary interests, usually of a financial nature, are opposed to the primary professional interest (preserving the health of the population in the case of public health). In addition, biases due to internal interests are bidirectional and difficult to quantify, while those deriving from financial conflicts of interest are predictable, unidirectional and large-scale. Although they are different phenomena, they are often mixed up with one another to create confusion and divert attention from financial conflicts of interest. In public health, conflicts of interest can arise in the field of research when studies are conducted on the health effects of pharmaceuticals, chemicals, tobacco, alcohol or food and in decision-making regarding policies related to these same products. In this chapter we present several examples of conflicts of interest in public health and a series of recommendations for their management, beyond their public declaration, which is necessary but insufficient. All public health organizations should adopt standards to avoid, detect, eliminate or minimize the impact of conflicts of interest and ensure that these are put into practice.
KeywordsConflict of interest Ethics Public health Public health policies Research
This is an independent research, and the opinions expressed are those of the authors and not those of the Institute of Health Carlos III.
- Acheson, D. (1988). Public health in England. London: Department of Health.Google Scholar
- Agencia Española de Seguridad Alimentaria. (2005). Estrategia NAOS. Agencia Española de Seguridad Alimentaria. Accessed January 12, 2018, from http://www.aecosan.msssi.gob.es/AECOSAN/docs/documentos/nutricion/estrategianaos.pdf
- American Psychological Association. (2009). Task force on appropriate therapeutic responses to sexual orientation. Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Accessed December 20, 2017, from https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
- Bero, L. (2013). Industry sponsorship and research outcome: A Cochrane review. Journal of the American Medical Association Internal Medicine, 173(7), 580–581.Google Scholar
- Bes-Rastrollo, M., Schulze, M. B., Ruiz-Canela, M., & Martínez-González, M. A. (2013). Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: A systematic review of systematic reviews. PLoS Medicine, 10(12), e1001578.CrossRefGoogle Scholar
- Ditto, P. H., Liu, B. S., Clark, C. J., Wojcik, S. P., Eric, E. C., Grady, E. H., et al. (2017, April 13). At least bias is bipartisan: A meta-analytic comparison of partisan bias in liberals and conservatives. Available at SSRN. Accessed January 12, 2018, from https://ssrn.com/abstract=2952510
- Flynn, P. (2010). Social, Health and Family Affairs Committee, Parliamentary Assembly of the Council of Europe. The handling of the H1N1 pandemic: More transparency needed. AS/Soc, 12. Accessed January 8, 2018, from http://assembly.coe.int/CommitteeDocs/2010/20100329_MemorandumPandemie_E.pdf
- González-Rubio, R., Escortell-Mayor, E., & Del Cura González I. (2017). The pharmaceutical industry and specialised medical training: Residents’ perceptions in Madrid, Spain. Gac Sanit. https://doi.org/10.1016/j.gaceta.2017.07.015.
- Gupta, A., Holla, R., & Suri, S. (2015). Conflict of interest in public health: Should there be a law to prevent it? Indian Journal of Medical Ethics, 12(3), 172–177.Google Scholar
- Harris, D., & Patrick, M. (2011, June 21). Is ‘Big Food’s’ big money influencing the science of nutrition? ABC NEWS. Accessed January 12 2018, from http://abcnews.go.com/US/big-food-money-accused-influencing-science/story?id=13845186
- Hernandez-Aguado, I., & Zaragoza, G. A. (2016). Support of public-private partnerships in health promotion and conflicts of interest. British Medical Journal Open, 6(4), e009342.Google Scholar
- Institute of Medicine. (2009). Conflict of interest in medical research, education, and practice. Washington, DC: National Academies Press.Google Scholar
- Kuhn, T. S. (1970). The structure of scientific revolutions (2nd ed. enlarged). Chicago, IL: The University of Chicago Press.Google Scholar
- Raymond, N. (1998). Confirmation bias: A ubiquitous phenomenon in many guises review of general. Psychology, 2(2), 175–220.Google Scholar
- Royo-Bordonada, M. Á. (2017). Desafíos de las políticas nutricionales en España: de la responsabilidad individual a la responsabilidad colectiva. La Revista Española de Nutrición Humana y Dietética, 21(Suppl. 1), 56–58.Google Scholar
- Schopenhauer. (2014). Parerga and paralipomena. Short philosophical essays (Vol. I). Cambridge: Cambridge University Press.Google Scholar
- Serra Majem, L. (2016). Conflictos de interés en la investigación en nutrición: ¿mucho ruido o muchas nueces? Revista Española de Comunicación en Salud, S121–S128.Google Scholar
- World Health Organization. (2016). Report of the Commission on Ending Childhood Obesity. Geneva: WHO. Accessed January 12, 2018, from http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf