Disclosing conflicts of interest
Authors: Mildred Cho
Journal: The Lancet (1997)

In his commentary on conflicts of interest in clinical research, Richard Horton (April 19, p 1112)1Horton R Conflicts of interest in clinical research: opprobrium or obsession?.Lancet. 1997; 349: 1112-1113Summary Full Text Full Text PDF PubMed Scopus (56) Google Scholar laments that “the research community has become extremely exercised by this issue” and argues against disclosure. Disclosure has its drawbacks2Rodwin M Physicians' conflicts of interest.N Engl J Med. 1989; 321: 1405-1407Crossref PubMed Scopus (69) Google Scholar but that does not mean it is unnecessary. It is time for the discussion to go beyond disclosure and focus on whether so many scientists should have avoidable conflicting interests in the first place. Disclosure is only possible when there is a forum for it, such as a publication or oral presentation. When investigators are restrained by industry sponsors3Rennie D Thyroid storm.JAMA. 1997; 277: 1238-1243Crossref PubMed Google Scholar from presenting their work, the sponsorship cannot be revealed. Even when studies are published, financial ties of authors are not always disclosed; Krimsky et al found that in 34% of articles in leading biomedical journals with a Massachusetts-based lead author, that author had at least one disclosed financial interest.4Krimsky S Rothenberg L Stott P Kyle G Financial interests of authors in scientific journals: a pilot study of 14 publications.Sci Eng Ethics. 1996; 2: 395-410Crossref PubMed Scopus (65) Google Scholar A more important reason for actions beyond disclosure stems from a moral obligation. Researchers have an obligation to fellow scientists and to the public to do the best science possible. Professionals are accorded a great deal of trust (and economic and social status) by society, on the understanding that they will strive for excellence and hold the public's interests above personal ones.5Buchanan A Is there a medical profession in the house?.in: Spece R Shimm D Buchanan A Conflicts of interest in clinical practice and research. Oxford University Press, New York1996: 105-136Google Scholar Because academic institutions receive large amounts of funds from the public as taxpayers, university researchers are especially obligated to uphold the public interest. Disclosure should not be considered a healer of wounds after the fact, but as a prophylactic against loss of public confidence. Paradoxically, if financial conflicts and the disclosure of them become the norm rather than the exception, public confidence in biomedical research could be undermined. This is why reliance on disclosure as the sole mechanism for managing conflicts of interest is an abrogation of professional duty. Horton's use of “dual commitment” instead of “conflict of interest” is a step in the right direction because it suggests the notion of obligation, but it is also dangerous, to the extent that it suggests that financial interests are equal to others. Financial interests are always secondary to the quality and integrity of clinical research. It may be very difficult for some researchers to do any science at all without some industry funding but is it necessary for them to simultaneously hold stock in or be paid consultants' arrangements or advisory board memberships from the funding company? Financial interests become morally problematic when they are not absolutely necessary to the conduct of research. Furthermore, introducing additional potential sources of bias through financial interests is not good science.