Conflict of Interest in Medicine

Conflict of interest describes a situation in which a person is or appears to be at risk of acting in a biased way because of personal interests.

Conflict of interest can occur in many different settings; this article focuses on conflicts of interest in medicine that affect doctors in particular.

The most important duty of doctors is to provide care that is in the best interests of patients. However, in addition to caring for patients, many doctors also participate in other activities. Doctors often teach medical students or supervise doctors in training. They may conduct research studies, and through their research, they may help develop or invent new drugs or medical devices. They may invest in drug or biotechnology companies, and they may also own testing facilities or treatment centers that provide health care services. Doctors must also participate in educational activities in order to stay up to date with changes and advances in the field of medicine.

Through these activities, doctors often develop relationships with various people, businesses, and organizations. Although their underlying goals may be to improve medicine and patient care, doctors may also benefit financially from some of these relationships. For example, a doctor who is involved in developing a new medical device may receive payment from the medical device company, or a doctor who has invested in a treatment center may profit when people go there for treatments.

When a doctor’s ability to act in the best interests of a person or group could be affected by relationships with other people, groups, or businesses, then a conflict of interest exists. Even when doctors think they are acting without bias, their judgments and actions may still be influenced by conflict of interest. For example, doctors’ relationships with drug companies (including any payments or gifts received from the companies) might affect how they report results of research studies, what they teach medical students about particular drugs, or what treatments they recommend for patients. Furthermore, doctors who own testing facilities or treatment centers may preferentially refer patients to these facilities for care and may benefit financially from doing so.

The various relationships that exist between doctors and other entities are not necessarily bad; in fact, these relationships can be important for physician education and new drug and medical device development. However, if conflicts of interest arise, doctors should clearly state their relationships with all people, companies, and organizations involved. Depending on the situation, this disclosure may occur in person or through statements published online or in print. Being open about conflict of interest allows everyone (including patients and the public) to judge for themselves whether a particular relationship may be influencing a doctor’s actions.

To facilitate this openness, multiple public reporting programs list payments and other gifts that doctors have received from drug and medical device companies. Some medical centers provide information on their websites about doctors’ conflicts of interest. Patients can also ask doctors directly about their relationships with various entities. Ultimately, doctors’ primary responsibilities are to patients, and clear discussions about conflict of interest can help ensure that patients receive objective and unbiased care.

Sources: National Academy of Medicine, Association of American Medical Colleges

Fontanarosa P, Bauchner H. Conflict of interest and medical journals. JAMA. doi:10.1001/jama.2017.4563