![handle is hein.journals/ajbio11 and id is 1 raw text is:
The American Journal of Bioethics, 11(1): 1-2, 2011
Copyright (c) Taylor & Francis Group, LLC
ISSN: 1526-5161 print / 1536-0075 online
DOI: 10.1080/15265161.2010.534534
Beyond a Pejorative Understanding of
Conflict of Interest
Bryn Williams-Jones, Universit6 de Montreal, Bioethics Programs
In seeking to clarify the concept of conflict of interest (COI)
in debates about physician-industry relationships, Howard
Brody (2011) highlights the extent to which the prob-
lem turns on a common pejorative understanding of COI.
Whether it is the academic or public policy pharmapolo-
gists or pharmascolds talking about COI, there is often a
straightforward and overly simplistic correlation made: that
is, a conflict of interest-by definition-leads to fraudulent
or corrupt behavior. The same type of reasoning is com-
monly found in discussions about COI outside the health
sciences, most notably in news stories about the awarding
of government contracts or the behaviour of corporate ex-
ecutives (see the businessethicsblog.com for discussion of
some examples). The problem is that in focusing on dra-
matic failures to manage COI (e.g., around Vioxx), there is
a tendency to strongly associate COI with extreme forms of
financial and even criminal misconduct, leaving the public,
policymakers, academics, and professionals with a skewed
and limited understanding of the concept. The implication
is that the only interests at stake are financial so there is no
room to consider the influence of nonfinancial personal (e.g.,
career advancement) or institutional (e.g., reputation) inter-
ests. Those people who find themselves in a COI must be bad
or unethical; it is not possible to reflect on the circumstances
or institutional structures that might have contributed to the
conflict, or perhaps even made it inevitable. This conception
of COI is so value-laden and pejorative that it gets used as a
trump card-Stop, there's a conflict of interest!-and all
conversation or debate about the interests at stake or how to
manage any conflicts ceases instantly. We are left with prej-
udicial assumptions of the form that person is bad (but not
me) and inadequate judgments such as I've been transpar-
ent so there's no more COI (Cain, Loewenstein, and Moore
2005). As a result, individuals may be likely to hide their
COI (if they even recognize it), scared of the consequences
that disclosure could bring to their career and reputation,
or they may try, often unsuccessfully, to manage alone their
COI. Open discussion is simply not an option.
Brody's call for more clarity in the use of the concept of
COI is important and should, I suggest, be an opportunity
for those of us in the bioethics community to take a closer
look at the issue. Financial COIs are clearly a significant
challenge in medicine and the health sciences (although
they are not exclusive to these domains), and something
that has rightly received enormous academic and public
policy attention (Rochon et al. 2010; Boyd and Bero 2007). It
is essential to have in place policies to help identify and mit-
igate those financial interests that put at risk the confidence
of colleagues, students, and the public in health sciences
and academic research. But financial interests are not the
only source of conflicts, even if they are the most visible
and discussed; personal or institutional interests may also
lead to COI, situations made all the more challenging by the
fact that such interests are often completely ignored.
As I've commented in my blog (conflict-of-interest.net)
and elsewhere (MacDonald and Williams-Jones 2009), COIs
are not inherently unethical; sometimes professional and in-
stitutional arrangements make COI likely, even inevitable.
For example, as a professor I both evaluate (e.g., grade) my
graduate students and promote them through letters of rec-
ommendation (for scholarships, positions), and I arguably
have an interest (e.g., building my academic curriculum
vitae [CV], promotion) in seeing my students succeed in
their studies and future careers. These responsibilities and
nonfinancial interests could well bias my judgment (Sugar-
man 2005). But they are also often unavoidable (who better
to write letters for students than their supervisor?), so we
must reflect on the associated risks or harms of such COI,
and then compare these with the benefits and harms of
various approaches to managing them (transparency? self-
critique or group critique? removal from decision making?).
What matters, ethically speaking, is that individuals and in-
stitutions have at their disposal effective tools to help them
deal appropriately with COIs when they arise (Davis and
Stark 2001). In practice, however, such tools for identifying
and managing COI may be all too limited in terms of their
usefulness.
In the academic community, a primary source of guid-
ance comes in the form of national, regional, and institu-
tional policies, sometimes as specific documents (e.g., jour-
nal or institutional COI policies) but also often under the
heading of research integrity and research ethics guide-
lines. My study of formal university COI policies found
that these documents were often too narrow (focused on
ajob 1
Address correspondence to Bryn Williams-Jones, Programmes de bioethique, Departement de medecine sociale et preventive, Universite
de Montreal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, H3C 3J7 Canada. E-mail: bryn.williams-jones@umontreal.ca](ViewImageLocal?handle=hein.journals/ajbio11&div=1&collection=&method=preview&ext=.png&size=3)
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