is a critical but limited first step in the process of identifying and responding to conflicts of interest.

• Conflict of interest policies and procedures can be strengthened by engaging physicians, researchers, and medical institutions in developing policies and consensus standards.

• A range of supporting organizations—including accrediting groups and public and private health insurers—can promote the adoption and implementation of conflict of interest policies and promote a culture of accountability that sustains professional norms and public confidence in medicine.

• Research on conflicts of interest and conflict of interest policies can provide a stronger evidence base for policy design and implementation.

• If medical institutions do not act voluntarily to strengthen their conflict of interest policies and procedures, the pressure for external regulation is likely to increase.

Physicians and researchers must exercise judgment in complex situations that are fraught with uncertainty. Colleagues, patients, students, and the public need to trust that these judgments are not compromised by physicians’ or researchers’ financial ties to pharmaceutical, medical device, and biotechnology companies. Ties with industry are common in medicine. Some have produced important benefits, particularly through research collaborations that improve individual and public health. At the same time, widespread relationships with industry have created significant risks that individual and institutional financial interests may unduly influence professionals’ judgments about the primary interests or goals of medicine. Such conflicts of interest threaten the integrity of scientific investigations, the objectivity of medical education, and the quality of patient care. They may also jeopardize public trust in medicine.

Surveys show the breadth and diversity of relationships between industry and physicians, researchers, and educators in academic and community settings. For example,

• gifts from drug companies to physicians are ubiquitous;

• visits to physicians’ offices by drug and medical device company representatives and the provision of drug samples are widespread;

• many faculty members receive research support from industry, and industry funds the majority of biomedical research in the United States;

• many faculty members and community physicians provide scientific, marketing, and other consulting services to companies; and some serve on company boards of directors or on industry speakers bureaus; and

• commercial sources provide about half of the total funding for accredited continuing medical education programs.