LAUSR

Over the last few decades, awareness of the importance of managing conflicts of interest among health-related policymaking, professional, research, and clinical institutions has greatly increased. The visibility of the issue—and the widespread use of the expression “conflict of interests”—may give the impression that the underlying concepts have been clearly defined and that there is widespread consensus about processes and practices. Sadly, this is not the case. In reality, conflicts of interests are far more complex than is commonly appreciated and, because of their importance, require ongoing detailed, rigorous analysis and debate. Early analyses of conflict of interest (COI) focused on the conceptualization of COI, how to determine when COIs are “unethical,” and how they should be managed (Thompson 1993; Goldrick et al. 1994; Marshall 1992; Levinsky 2002; Pellegrino 1992; Horrobin 1999). Evidence has now clearly revealed the adverse impact that financial COIs may have on the integrity of research, development of clinical guidelines, clinical care, and continuing medical education (CME) (Lundh et al. 2017). Attention has been paid in particular to the relationships between clinicians, researchers, and the pharmaceutical and medical device industries; and management strategies, such as the disclosure of financial ties or recusal where necessary, have been implemented across multiple biomedical domains, including in publication, the development of clinical guidelines, and in some areas of clinical practice. The weakness of “disclosure” alone as a management strategy has been recognized, and the necessity of the development of sophisticated management strategies for financial COIs remains an ongoing focus of academic inquiry. The significance of non-financial COIs in contrast, continues to be debated, with varying views as to whether they should be regarded as a type of “conflict of interest” and whether they are simply too widespread and diverse to be managed effectively (Bero 2017; Wiersma, Kerridge, and Lipworth 2018; Wiersma Bioethical Inquiry https://doi.org/10.1007/s11673-020-09987-6