Blog | Tuesday, April 15, 2014

Conflicts of interest--we all have them


We have developed a conflict of interest obsession. At many meetings I have to report anything that might be a conflict of interest: how I invest my money, how my wife invests, where I get research dollars, am I on any boards, have I given talks for industry (either directly or indirectly).

But we exclude other conflicts of interest from these discussions. If I am a subspecialist, do I not have a conflict of interest? If I am in private practice or work in academics or work for a large entity like Kaiser, does that not constitute a conflict of interest?

We have singled out financial arrangements with pharmaceutical companies or device manufacturers or other corporations. But where we work actually constitutes a conflict as does our job description.

Wikipedia has this interesting definition: A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.

So what does this mean to physicians or guidelines or editorials or perspectives?

Since we can postulate that we all have varying degrees of conflict, then we must seek to balance various conflicts. These conflicts all work insidiously. Conflicts work in various ways including through our estimation of risks and benefits. I have written previously about the affect heuristic. This heuristic works because when we like something we overestimate the benefits and underestimate the risks.

Thus conflicts and heuristics explain the ongoing debates about guidelines. No one can look at a clinical question and have complete objectivity. We must accept our conflicts and do our best to adapt to them.

Nietzsche said, “There are no facts, only interpretations.” And our conflicts influence those interpretations.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.