FEATURE
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CONFLICT
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Research Under the Influence
In an ideal world, medical advances would result from an altruistic pairing of
outstanding translational science with well-designed and efficient clinical tri-
als, and the resulting conclusions could be applied for the betterment of global
health – all in a not-for-profit environment.
In reality, while industry doesn’t fund research for entirely altruistic
purposes, the benefits of academic-industry collaborations are incontro-
vertible. But do these relationships shake physician and public confidence
in the validity and impartiality of the resulting data? Despite the combative
connotations of the name, are conflicts of interest (COIs) always bad?
COI is pervasive in all areas of medicine, from research and publishing to
teaching and clinical care. The question is not how medicine can rid itself of
COI, but how it can best manage it. ASH Clinical News takes a closer look at
COI – its prevalence, manifestations, and inherently controversial nature.
Research Under the Influence
The broad definition of COI is standard across
all stakeholders: According to the Institute of
Medicine (IOM; now the National Academy of
Medicine), a COI comprises “a set of circum-
stances that creates a risk that professional
judgment or actions regarding a primary inter-
est will be unduly influenced by a secondary
interest.” 1
Similarly, the International Committee of
Medical Journal Editors (ICMJE) describes
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COI as a situation in which “professional
judgment concerning a primary interest (such
as patients’ welfare or the validity of research)
may be influenced by a secondary interest
(such as financial gain).” 2
The authors stress that a key issue is simply
that the COI exists “whether or not a particular
individual or institution is actually influenced
by the secondary interest.”
“The point to be made about the definition,
which people get confused about, is that the conflict
relationship exists at all,” Robert Steinbrook, MD,
a professor adjunct at Yale School of Medicine
in New Haven, Connecticut, who has written
extensively on the subject, told ASH Clinical
News. “It’s not that your opinion or actions will
necessarily be influenced one way or the other
by that relationship, because that’s impossible to
know.”
Dr. Steinbrook, an editor-at-large for
JAMA Internal Medicine, clarified that adding
the word “potential” to the phrase misses the
point: “Many people will say, ‘Well, I have all
this money from industry, but I’m not biased,’
or they’ll say that COI is a pejorative. When,
in fact, it’s just a statement of a situation that
exists that needs to be disclosed. This is a hard
distinction to get people to accept.”
In his view, there’s “absolutely nothing
wrong” with receiving research support from
companies that are doing real research. “If you
have bona fide scientific and clinical reasons
to have relationships with companies, then tell
people, and have the contracts written in ways
that preserve your independence,” he said.
Follow the Money, Not the Bias
Even when COIs are relatively benign, they can
erode readers’ confidence in research findings
if they are not disclosed, Dr. Steinbrook and
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