Clarifying the costs of conflicts of interest

Over the past two decades, a deep suspicion has emerged in the healthcare community about the influence of private industry – particularly the pharmaceutical industry – over doctors, researchers, regulators and policymakers [1, 2]. In response to the perceived threats posed by conflicts of interest (COI), there have been calls for a range of measures including stricter disclosure statements, more transparency, and tighter regulation of medical and industry interactions [3]. Not surprisingly, such demands tend to be resisted by the pharmaceutical industry, and by a subset of clinicians and researchers who believe that claims of adverse industry influence are overblown [4]. One such example is the recent article by Barton, Stossel and Stell in the International Journal of Clinical Practice [5]. Barton et al. argue that concerns about COI are exaggerated and unsupported by empirical evidence, and that demands for regulation and transparency distract medical professionals, researchers and policymakers from their primary task – improving patient outcomes. Furthermore, they suggest that if there is no evidence that patient outcomes are negatively affected by COI, then there is no cause for concern. They claim that the ‘conflict of interest movement has failed to substantiate its central claim that interactions between physicians, researchers and the medical products industry cause physicians to make clinical decisions that are adverse to the best interests of their patients.’ The medical community and bioethicists in particular, should therefore stop worrying about COI.NHMRC Project Grant (APP1059732