counting, architecture, and engineering are professions in which one might expect much less concern with conflicts of interest than in medicine.
Although these are the chief differences between medicine and the professions discussed here, they are not the only ones. These other professions differ substantially in size from medicine—and from each other. Physicians outnumber architects in the United States by about 10 to 1, engineers outnumber physicians by about 3 to 1, and the numbers of individuals in the other professions fall somewhere in between. Importantly, only one profession, engineering, does much that physicians would recognize as scientific research.
The professions evaluated here were chosen because none is a close analogue of medicine. Medicine tends to be the model for adjacent professions (osteopathy, dentistry, pharmacy, nursing, and so on). The comparison of medicine with an adjacent profession would provide less contrast and therefore less understanding of conflict of interest as a general problem for professions. All of the professions discussed here have substantial experience with employment in large organizations. Two of the professions—engineering and accounting—have a long history of employment in such organizations. Only a small minority of engineers has ever been self-employed in the way that most physicians, except those in research and teaching, were until recently. Even self-employed architects, lawyers, and accountants often work for and in large organizations in a way that physicians have only recently begun to do in large numbers. Looking at how these nonmedical professions respond to the conflicts of interest that are more likely to arise in large organizations should help physicians both look critically at present arrangements and anticipate the future. Finally, these professions all recognize conflicts of interest as posing a threat to the integrity of the profession and have developed ethics rules to address the threat.
“Conflict of interest” is not an old term. The first court case to use it in something like the sense that is now standard occurred in 1949.1 Federal legislation first addressed conflict of interest in the late 1950s.2 The Index of Legal Periodicals had no heading for “conflict of interest” until 1967; Black’s Law Dictionary had none until 1979. No ordinary dictionary of English seems to have had an entry for “conflict of interest” before 1971. The term also began to appear in codes of ethics in the 1970s, although related terms, such as “adverse interest,” “conflicting interest,” “bias,”