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Conflict of Interest in Medical Research, Education, and Practice
with the problem of conflict of interest can undermine efforts to address the other serious challenges that medical professionals and researchers face today.
This chapter develops a conceptual framework for identifying and assessing conflicts of interests.1 In addition to defining the concept of conflict of interest and clarifying some common misunderstandings about its applications, the chapter presents principles to guide the formulation and implementation of conflict of interest policies. The principles take the form of (1) statements of the purposes of conflict of interest policies, (2) criteria for assessing the content of these policies, and (3) criteria for evaluating the implementation of policies. The principles do not directly yield decisions in particular cases or even rules that could be directly enforced, nor do they determine in advance the relative importance of all the values involved in making decisions. In applying them to particular policies and individual cases, there is no substitute for judicious practical judgment sensitive to the institutional context. However, the principles provide an essential framework for formulating and implementing any conflict of interest policy. They focus attention on the most important factors that should be considered when professionals and institutions make decisions and policies regarding conflicts of interest, select the agents who should be responsible for implementing and enforcing those policies, and choose the methods that they will use to regulate conflicts of interest.
WHAT IS A CONFLICT OF INTEREST?
Although conflict of interest policies are now widespread in many areas of medicine, the meaning and purposes of these policies are not always clearly understood. The term “conflict of interest” is used in many different and often inconsistent ways. Nonetheless, institutional and public policies on conflicts of interest need to define what the policies cover and what they do not cover.
The definition that the committee adopted is consistent with the core meaning of the concept as it is used in many institutional policies. It is, however, formulated to clarify key elements that are sometimes obscured in discussions of those policies.
The discussion in this chapter draws on work by Thompson (1993) and Emanuel and Thompson (2008). The committee also consulted other definitions and frameworks, including those of Davis (1998), AAMC (2001), Davis and Stark (2001), NIH (2004), Moore et al. (2005), Lurie (2007), Sage (2007), AAMC-AAU (2008), and Beauchamp and Childress (2009).