evidence can happen beneath the individual’s level of awareness, such that a biased individual will sincerely claim objectivity. Application of this research to medical conflicts of interest suggests that physicians who strive to maintain objectivity and policy makers who seek to limit the negative effects of physician-industry interaction face a number of challenges. This research explains how even well-intentioned individuals can succumb to conflicts of interest and why the effects of conflicts of interest are so insidious and difficult to combat.

The section Unconscious and Unintentional Bias describes the psychological research on bias in more detail, and its relevance to financial conflicts of interest will be made clearer. The section Parallel Evidence in the Medical Literature then provides a brief review that demonstrates the correspondence between the findings from studies of conflicts of interest in the medical field and the findings from basic studies of bias in the field of psychology. The section Implications for Policies Dealing with Medical Conflict of Interest details for policy makers how approaches including educational initiatives, mandatory disclosure, penalties, and limiting the size or type of gifts can be informed by the psychological bias literature. The Methods and Limitations of the Data briefly addresses the propriety of applying psychological experiments to professionalism in medicine. Finally, a conclusions section summarizes what can be learned from the psychological literature.

UNCONSCIOUS AND UNINTENTIONAL BIAS

One intuitive view of financial conflicts of interest is that the physicians who are swayed by them are corrupt. Physicians have taken an oath to put their professional obligations first, so that if they are indeed influenced by private financial incentives, they have chosen not to uphold that oath. Although there may indeed be a minority of individuals who are fundamentally corrupt, most physicians certainly try to uphold ethical standards. This intuition is implicit in the guidelines set forth by the American Medical Association, the American College of Physicians, and the self-imposed guidelines of the Pharmaceutical Manufacturers Association, all of which stress that gifts accepted by physicians should primarily entail a benefit to patients and should not be of substantial value, suggesting that the temptation to provide or accept large or personal gifts is a concern. This view perhaps suggests that physician relationships with the pharmaceutical industry are problematic and can elicit hostility from some physicians. Understandably, most physicians see themselves as ethical people who would not place their objectivity for sale, and so they believe that they can be trusted to navigate these conflicts when dealing with industry. Compounding matters, many enticements from industry are of relatively small



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