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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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