Conflict Resolution
others agreed . According to the IOM report , disclosure of these potential secondary interests – and the ICMJE considers only financial interests , although they allow that COIs can occur for other reasons – is important for maintaining “ public trust in the scientific process and the credibility of published articles .”
The ICMJE electronic COI template is the standard form in the industry , used by hundreds of peer-reviewed journals .
While the ICMJE ’ s definition pertains only to financial interests , the IOM report ’ s authors allow that these secondary interests extend beyond monetary gain . COIs can take the form of professional advancement and recognition , favors to others , or self-dealing ; financial conflicts are the focus of these definitions , the authors wrote , because they are “ relatively more objective , fungible , and quantifiable .”
“ Although there are continuing disagreements about whether and when individuals with COI [ s ] should be excluded from such activities as writing opinion or review articles for medical journals or serving on federal advisory committees , the minimum standard in medicine for years has been full disclosure ,” Dr . Steinbrook wrote in a 2017 editorial published in JAMA Internal Medicine . 3 “ That includes both financial and ‘ appearance issues ,’” he added . “ Perceptions of COI are important .” and the ethical requirements to reveal COI to patients when referrals are made for diagnostic services at facilities in which the referring doctor has a financial stake . 4 , 5
Spoiler alert : Salary-based payment systems reduce COI and might also reduce physician burnout . Patients reported having more trust in physicians who are upfront about their financial arrangements .
Two Sides of the Industry Coin
“ It ’ s pretty clear that if you take money from anybody , you are more likely to come up with biased results regarding the product for which you are taking money ,” Shannon Brownlee , MSc , senior vice president of the Lown Institute , told ASH Clinical News .
The data would seem to support her position . A 2012 Cochrane review analysis of 48 studies evaluating drugs and devices showed that industry-sponsored studies were “ more favorable to the sponsor ’ s products than non – industry-sponsored drug and device studies , due to biases that cannot be explained by standard risk-of-bias assessment tools .” 6 When the researchers updated the data in 2017 to include 27 new papers , for a total of 75 papers , “ [ COI is ] just a statement of a situation ... that needs to be disclosed . This is a hard distinction to get people to accept .”
— ROBERT STEINBROOK , MD
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This may seem straightforward , but undisclosed and unmanaged COIs result in a never-ending game of whack-a-mole . In May 2017 , an issue of JAMA attempted to address some of the many facets of COI , exhaustively covering the topic in 23 essays and review articles . As an example of the omnipresence of COIs in medicine , two of the many topics covered in this wide-ranging issue were an examination of the COI pressures inherent in fee-for-service or volume-based payment models ,
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