Because the evidence on many issues is limited, the committee had to rely on its experience and judgment in evaluating the analyses and arguments presented in the literature and in statements submitted to the committee. During its work, the committee kept in mind the core goals of medical research, education, and practice and practice guideline development, which include serving the best interests of patients and society through the generation of valid scientific knowledge, the independent evaluation of evidence and the application of critical thinking, and the creation and use of evidence-based recommendations for patient care.
Reflecting concerns that were raised during the planning of the project and the central issues in debates and policies on conflicts of interest in medicine, the committee focused on financial relationships involving pharmaceutical, medical device, and biotechnology companies. Although it did not investigate in depth the conflicts of interest associated with different physician payment arrangements or with physician referral of patients to facilities in which they have an ownership interest, the committee recognized the seriousness of those types of conflicts and the difficulties that policy makers have encountered in trying to eliminate or manage them. It also recognized other sources of conflicts of interest, for example, desires for professional advancement and recognition.
After examining a wide array of evidence, analyses, and perspectives on conflicts of interest, the committee reached several overarching conclusions. They are as follows:
The goals of conflict of interest policies in medicine are primarily to protect the integrity of professional judgment and to preserve public trust rather than to try to remediate bias or mistrust after they occur.
The disclosure of individual and institutional financial relationships 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 conflict of interest policies and consensus standards.
A range of supporting organizations—public and private—can promote the adoption and implementation of conflict of interest policies and help create a culture of accountability that sustains professional norms and public confidence in professional judgments.
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.