Conflicts of Interest: Real, Important, and Undeniable

Today, on Dr. Yoni Freedhoff’s Weighty Matters blog, public health ethicist Daniel S. Goldberg (of the Center for Bioethics & Humanities at the University of Colorado Anschutz Medical Campus) shares his thoughts on why conflicts of interest in academia should be acknowledged, rather than dismissed.

Highlights:

• “During her opening talk at last week’s Academy of Nutrition and Dietetics conference, President Lucille Beseler opined on the rising concerns over financial conflicts of interest among nutritionists and dietitians [by saying]: “I’m not so weak-minded that I would make a decision on receiving a pen.”

• “In the course of researching, writing, and teaching about conflicts of interest among health professionals for over a decade, what I have come to marvel at the most is the apparent ease with which leading health professionals insist on a kind of willful ignorance regarding the cognitive science underlying concerns over conflicts of interest (COI).”

• “This is amazing to me because of the irony: members of professions presumably dedicated to basing their practice on the best evidence proceed to engage concerns over COI with almost no awareness whatsoever of what the best evidence actually suggests regarding the impact of conflicts of interest on human behavior.”

• “Reasonable people of good conscience can, of course, disagree on whether the behavior of partiality that occurs in the presence of COIs are morally justified, and on the appropriate remedies, if any, for such behavior. But the argument should proceed with all stakeholders fully aware of what the cognitive science actually suggests regarding the impact of COIs on health professional behavior.”

• “What does that evidence show? Beyond a shadow of a doubt, gifts almost certainly do influence health professionals’ behavior, at least in the aggregate. Not only have we documented this finding itself ad nauseum, we also have powerful causal explanations that elucidate the mechanisms by which even gifts of “de minimis” value influence health professional behavior.”

• “COIs have to be understood iteratively — the existence of a financial COI does not imply that bad behavior will necessarily take place in any given case. But over the long run of cases, the existence of financial COIs makes shenanigans much more likely — a conclusion which is — again — extremely well-documented in both experimental and uncontrolled (i.e., real-life) conditions.”

• “Ultimately, far too many stakeholders seem willing to wade into the fray with a perfect, almost studied indifference to the significant evidence base regarding COIs. This is itself an ethical problem — mistakes themselves are not ipso facto morally blameworthy — but mistakes made because health professionals did not bother to examine an available evidence base and ground their practice in that evidence come much closer to moral failure.”