Conflict of Interest

Conflicts of interest (COI) arise when the professional responsibilities of individuals or organizations are, or have the potential to be, compromised by other, external obligations. The failure of fiduciary responsibility is the key concept in defining conflict of interest situations.

Today, conflicts of interest are recognized in fields as varied as law, medicine, journalism, academia, business, and government. In medicine, such compromises are especially threatening, as they can undercut the health and well-being of patients. Physicians and medical organizations may compromise their professional responsibilities by pursuing private financial gain.

Although the pharmaceutical industry and medical device manufacturers have made vital contributions to research and patient care, the ultimate responsibility of for-profit entities is to maximize returns to shareholders. In contrast, the medical profession should put patients’ interests first, regardless of financial considerations. The potential for conflict of interest is, therefore, inherent in industry-medicine relationships. Collaborations must be carefully regulated–and, in some cases, prohibited–to protect patients' well-being, promote scientific integrity, and ensure public trust.

Medical institutions must set conflict of interest policies that recognize these obligations. An effective and responsible conflict of interest policy should clearly specify the relationships and activities that are acceptable, those that are prohibited, and provide clear guidelines on how to make certain all such arrangements are transparent.

The Institute on Medicine as a Profession studied how various health care institutions address the concept of conflict of interest on a policy level, and the Division will continue this work. Thus far, our work has focused on the following key types of organizations: Academic Medical Centers, Professional Medical Centers, Pharmaceutical and Medical Device Companies, and Health Advocacy Organizations.

Defining the Problem of Conflict of Interest

Conflict of interest can be defined as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest,” where the primary interests include “promoting and protecting the integrity of research, the welfare of patients, and the quality of medical education;” and secondary interests include “not only financial gain, but also the desire for professional advancement, recognition for personal achievement, and favors to friends and family or to students and colleagues.” (Conflict of Interest in Medical Research, Education, and Practice. Institute of Medicine, 2009, page 38-39)

Conflicts of interest in clinical care can arise at the level of the individual physician or that of the institution. Academic medical centers and professional medical societies are only now beginning to address many of the critical issues involved in institutional conflicts of interest (Rothman DJ, JAMA, 2008). “Institutional conflicts of interest arise when an institution’s own financial interests or the interests of its senior officials pose risks to the integrity of the institution’s primary interests and missions.” (Conflict of Interest in Medical Research, Education, and Practice. Institute of Medicine, 2009, page 176)