interest is more complex than is often appreciated. As a result, both critics and defenders of conflict of interest policies sometimes misunderstand or misapply them.

A conflict of interest is not an actual occurrence of bias or a corrupt decision but, rather, a set of circumstances that past experience and other evidence have shown poses a risk that primary interests may be compromised by secondary interests. The existence of a conflict of interest does not imply that any individual is improperly motivated. To avoid these and similar mistakes and to provide guidance for formulating and applying such policies, a framework for analyzing conflicts of interest is desirable.

This chapter has presented principles for assessing conflicts of interest and evaluating policies designed to deal with such conflicts. Conflicts should be assessed by considering various factors that determine their likelihood and seriousness. Likelihood depends on the value of the secondary interest, the scope of the relationship between the professionals and the commercial interests, and the extent of discretion that the professionals have. Seriousness depends on the value of the primary interest, the scope of the consequences that affect it, and the extent of accountability of the professionals. Conflict of interest policies should be evaluated by considering their effectiveness, transparency, accountability, and fairness.

A better understanding of the nature of conflicts of interest and the clearer and fairer formulation of rules can support greater confidence in the medical profession and thereby enable physicians, educators, and investigators to concentrate on their primary missions of treating patients, teaching students, and conducting research. With robust conflict of interest policies in place, they can continue to carry out their respective activities not in wary confrontation but in beneficial cooperation with the representatives of industry.

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