White paper: statement on conflicts of interest
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CONFERENCE REPORTS AND EXPERT PANEL
White paper: statement on conflicts of interest Julian Bion1* , Massimo Antonelli2, LLuis Blanch3, J. Randall Curtis4, Christiane Druml5, Bin Du6, Flavia R. Machado7, Charles Gomersall8, Christiane Hartog9, Mitchell Levy10, John Myburgh11, Gordon Rubenfeld12 and Charles Sprung13 © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Abstract Introduction: Conflicts of interest are a normal part of human social intercourse. They become problematic when there is a power differential between participants in the setting of relationships requiring a high degree of trust, as in healthcare. In this white paper we consider how these conflicts may be detected and mitigated. Methods: Following Medline search and reference chaining, we undertook a narrative review of the literature with iterative discussion. Results: Conflicts of interest may be financial, professional or personal, and may operate at the level of the individual or the organisation. Unmanaged, they become a source of bias which places the interests of the professional or the organisation before those of the patient. Reported with increasing frequency, conflicts damage trust, harm patients, and defraud the health system. We make 15 recommendations for minimising conflicts of interest. Conclusions: Nationally funded open-access registries should be established to permit complete disclosure of financial, professional, and personal relationships with the potential for driving bias in research, clinical practice, or health management. Governance of disclosure should be the responsibility of employing organisations through annual staff appraisals, audited by national research integrity committees. Research fraud should incur suspension of the license to practice. Organisations should monitor staff perceptions of ethical climate to enhance awareness of staff behaviours and the potential for misconduct driven by academic pressures. Clear separation of advisory and voting roles is needed in best practice guideline panels. Professional societies and scientific journals should display conflict of interest policies for their own staff and officers as well as for speakers and authors. Undergraduates should not be exposed to pharmaceutical promotions masquerading as education. Undergraduate and postgraduate training programmes should include teaching about managing conflicts of interest and identifying research misconduct. Keywords: Conflict of interest, Bias, Professionalism, Research governance, Medical education Introduction Fiduciary relationships lie at the heart of medicine: only healthcare professionals are accorded the confidentiality of the confessional, permission to touch through *Correspondence: [email protected] 1 University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site), Birmingham B15 2GW, UK Full author information is available at the end of the article
examination or surgery, and the privilege of self-regulation.
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