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Conflicts of Interest

As Beauchamp et. al. [1] point out, "A conflict of interest occurs whenever a personal interest or role obligation of an investigator conflicts with an obligation to uphold another party's interests, thereby compromising normal expectations of reasonable objectivity and impartiality...". The dividing line between what is and what is not a conflict of interest often is less than clear. In part, this is because there is a difference between those that are real, potential, and perceived. EpiWitWisdom

Real Conflicts

In the context of epidemiology, a real conflict occurs when the investigator compromises study design, data collection, interpretation, or information dissemination in order to support a preconceived position. It matters little whether this is done to support a policy of an agency, the public image of an industry, or a pet concept of investigator. It also matters little whether the epidemiologist actively subverts the scientific process or simply acquiesces and thereby passively lends his or her credibility to the action of others. What does matter is whether distortion of information is intentional. Often the only individual who can make that judgment is the self-same epidemiologist.

Potential Conflicts

Closely related are potential conflicts of interest. Various role obligations may be in opposition, but a true conflict is unlikely unless the epidemiologist allows it to occur. Some have suggested that a conflict condition exists any time the epidemiologist is in position to realize a personal gain. This is usually equated to financial gain as fingers are pointed at consultants, but Grayson [2] has suggested that gain can come in many forms. Aside from money, we all must confront the seduction of tenure, security, power, privilege and prestige, to name a few. He pointed out, somewhat tongue-in-cheek, that while all of his publications were related to his sheer love of knowledge, they also were responsible for his promotions. And by advancing in rank, he had gained financially from his productivity. As an ethical scientist, his conclusion was he could either stop doing research, or continue doing it but stop publishing.

Perceived Conflicts

As for perceived conflicts, they (like beauty) are in the eyes of the beholder. While situations where conflicts are likely to occur should be avoided, too often the attitude seems to be, "All but thee and me succumb conflicts of interest - and I sometimes wonder about thee." It is certainly possible that a perceived conflict is in fact real, but among trained scientists most probably are not. Furthermore, a disagreement between two epidemiologists over the interpretation of the same study results does not automatically equate to conflict of interest by one or both. Since each of us is unique, influenced by what Robbins has referred to as our own set of experiences or "priors," they might be simply interpreting the data from the perspective of different underlying paradigms. And the ongoing testing of paradigms is the essence of scientific progress.

None of us has the convenience of acting exclusively in the role of epidemiologists. We are in turn parents, employees, scientists, and - on occasion and sometimes quite appropriately, advocates - but it must be obvious to all (including ourselves) when we are operating in what role. To avoid professional conflicts of interest, we cannot retreat into a shell but rather we must acknowledge their potential and actively prevent them from becoming real. This must be an exercise in which we each individually participate, but Koshland [3] in a recent editorial in Science suggests the profession itself also must develop procedures to address this issue and these procedures should be subject to the scrutiny of those outside the profession. He concludes that "such a system can be destroyed by excessive  suspicion or excessive neglect. A spirit of compassionate skepticism is needed to make it work."

Ralph R. Cook

The Dow Chemical Company

Notes

1.        Beauchamp, T.L., Cook R.R., Fayerweather, W.E., Raabe, G.K., Thar, W.E., Cowles, S.R., and Spivey, G.H.: Ethical Guidelines for Epidemiologists: Jour of Clin Epid, 44 Supplement 1, 1991

2.        Grayson, D.K.: "Financial Benefit from Research." Science, Volume 243, pages 991-2, 24 February 1989

3.        Koshland, D.E.: "Conflict of Interest." Science, volume 249, page 109, 13 July 1990.

 


 
 
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