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Comment & Response
April 26, 2016

Conflict or Confluence of Interest?

Author Affiliations
  • 1Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
  • 2Institute for Occupational Epidemiology and Risk Assessment, Evonik Industries AG, Essen, Germany
  • 3Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
JAMA. 2016;315(16):1793. doi:10.1001/jama.2016.0324

To the Editor A recent Viewpoint1 suggested that “the term conflict of interest is pejorative” and proposed using “confluence of interest” instead, along with visually mapping the complex system of biases within and around research. The material is thought-provoking but problematic.

To us it is far from clear that conflict of interest is a depreciative term. Although there are biasing factors other than conflicts of interest,2 the phrase captures the difficult nature of the topic and is not pejorative when correctly used to speak of perceived or potential—not actual—conflicts. Furthermore, confluence of interest is itself a problematic term. It implies that interests flow together, whereas reality suggests that some interests can counteract or outweigh others. The authors seem to believe that “implying an alignment of primary and secondary interests” for which biasing factors are not seen as problematic would be preferable to admitting that potential conflicts exist, but they did not offer any arguments for this position. The objective might be to minimize biasing factors, but renaming the term used to refer to biases while the objective is far from being met could undermine all the work done toward encouraging researchers to declare potential conflicts.3,4 To take a different example, if there was a problem with the terminology “fabrication of results,” would it be renamed “full and transparent reporting” simply because the latter is the ultimate aim in combating the former? This would not seem appropriate, and the same applies to conflict of interest.

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