Resolving Conflicts of Interest in Medicine

What should we do about the conflicts of interest in medicine? Innovation has meant an open door to conflicted clinicians invested in the development of drugs, devices and technologies. The fragmentation and commercialisation of healthcare systems have accompanied conflicted commissioning decisions, distorted guidelines and created perverse incentives with poor or absent testing. The rush of drugs and devices to the market has created an evidence void and consequently not protected patients.

In 2005, the House of Commons Health Committee recommended that registers of conflicts of interests should be held by professional regulators and updated by registrants. This has not happened.  We now practice in a lax liberal environment with confusing, multiple partial or complete declarations of interest on temporary websites, and no clear definition of what a conflict of interest is, leading some to deny they exist and others to disagree that they do. The current state of conflicted affairs in medicine cannot persist.

Some breakthroughs have occurred: Great Ormond Street Hospital, for instance, now excludes those with a “significant” investment in a product from being in charge of its evaluation. John Hopkins University prohibits researchers with equity or IP from being the trial investigator in their technologies unless the research cannot progress without them.  The US Sunshine Act ensures payments over $5000 to US doctors are disclosed

These breakthroughs in transparency and disclosure are, however, few: in many cases, attempts to reduce conflicts have been inadequate, poorly policed and not delivered benefits beyond providing academics with adequate cover to hide them from the real truth.

Not all conflicts are avoidable and not all bad: intellectual conflicts are hard to avoid, and technological discoveries can create individuals and institutions with academic and commercial conflicts that do benefit patients and society.

There are multiple questions about how to improve practice: should doctors with commercial interests lead research on their products? Should we forget the term ‘conflict’ and start discussing ‘declarations of interest’ instead?  Who should hold and maintain conflicts of interest registers for doctors? Should practicing doctors work with the pharma industry as well as serve on guideline committees? Should researchers with extensive financial interests be disqualified from studies of their own products?

At EBMLive 2019, we will review the history of a conflict of interest; discuss how to reduce Questionable Research Practices, Bias, and Conflicts of Interests and Develop a conflict of interest statement in research

Prior to EBMLive, we want your help in providing a road map for a conflict of interest statement in research

Tell us your thoughts on the EBMLIVE COI questionnaire

During EBMLive we’d like you to participate in the debate to reduce conflicts – or declarations – of interest and develop a conflict of interest statement in research.

After EBMLive we’d like you to help in disseminating the statement in research and resolve the conflicts in medicine for better healthcare for all.

Carl Heneghan  has received expenses and fees for his media work (including payments from BBC Radio 4 Inside Health). He has received expenses from the WHO, FDA, and holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR BRC Oxford and the WHO. He has received financial remuneration from an asbestos case and given free legal advice on mesh cases. On occasion, he receives expenses for teaching EBM and is also paid for his GP work in NHS out of hours.  He is Director of CEBM, which jointly runs the EvidenceLive Conference with the BMJ and the Overdiagnosis Conference with international partners, based on a  non-profit making model. He is Editor in Chief of BMJ EBM and an NIHR Senior Investigator.

Margaret McCartney is a GP partner and senior Fellow for Evidence and Values at the RCGP. She is an author, freelance writer and broadcaster for the lay and medical press and the BBC. She is an honorary Fellow at the CEBM. She gives a small amount of money regularly to Keep Our NHS Public. She has had travel and occasionally locum expenses paid to give talks to healthcare professionals and the public but has never been hosted by a technology/pharmaceutical/PR company. Her DOI is at whopaysthisdoctor.org.uk