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Conflict of Interest in Medical Research, Education, and Practice
financial statements was considered an important enough goal—given the huge financial stakes involved—to warrant federal legislation and the establishment of a federal oversight body, the PCAOB. A second important lesson is that maintaining objective and independent judgment is not easy. Accountants primarily maintain their objectivity by avoiding most situations that present a conflict of interest. They also maintain their independence by avoiding most situations that could reasonably appear to present a conflict of interest.
During the decade and a half before World War I, AMA organized medicine as a modern profession. Among the milestones in that process were not only the rethinking of medical education (set forth in the 1910 Flexner Report) but also the abandonment in 1903 of AMA’s mandatory Code ofEthics of 1847 for the “suggestive and advisory” Principles of MedicalEthics. That was followed in 1912 by the abandonment of the 1903 principles for another code (with the same name) binding on all physicians (and surgeons). At about that time (1909), the American Institute of Architects (AIA) adopted its first code of ethics. That code applied only to members of the organization and not to all architects, but the code (like AMA’s 1847 code) was binding on all architects. The AIA kept this feature when it adopted a new code in 1977, one organized—like the ABA’s 1969 code (which was to be abandoned soon after)—into canons (broad statements of principle), ethical standards (more specific goals that AIA members should aspire to), rules (mandatory standards, the violation of which would justify formal discipline, including expulsion from the AIA), and commentary (when necessary to avoid a common misinterpretation of a rule).55
The 1909 AIA code reached all architects, not just AIA members, through its adoption by state licensing boards as local standards of practice. That simple arrangement ended in the 1970s, when the courts declared the AIA’s code to be an unreasonable restraint on trade. While the AIA was rewriting its code to avoid another lawsuit (a process that did not end until 1990), the National Council of Architecture Registration Boards (NCARB) wrote its own code.56
Because the states’ licensure of architecture is generally similar to the states’ licensure of accountants (and, in some states, lawyers), continuing education requirements are also similar. Courses must be accredited to satisfy the continuing education requirements. The AIA itself offers some online courses that satisfy continuing education credit. Some of these courses