Why Having a (Nonfinancial) Interest Is Not a Conflict of Interest

Bero, Lisa; Grundy, Quinn

doi:10.1371/journal.pbio.2001221

Cited by 103 publications

(91 citation statements)

References 29 publications

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“…Non-financial conflicts of interest in medical research and practice, which include those of a political, ideological, individual, or religious nature,12 are often overlooked, denied, and even defined out of existence 34. The focus is directed instead towards financial interests, such as those stemming from drug industry sponsorship of research, or payments to doctors.…”

Section: Yes—miriam Wiersma Ian Kerridge Wendy Lipworthmentioning

confidence: 99%

Should we try to manage non-financial interests?

Wiersma

Kerridge

Lipworth

et al. 2018

BMJ

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Section: Yes—miriam Wiersma Ian Kerridge Wendy Lipworthmentioning

confidence: 99%

Should we try to manage non-financial interests?

Wiersma

Kerridge

Lipworth

et al. 2018

BMJ

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“…Bero, for example, expresses the view that only financial COIs produce bias in research that extends beyond an individual,1 whereas what she refers to as non-financial ‘interests’ only affect discrete decisions or situations 9. However, while it is true that non-financial COIs may be more difficult to detect, measure and evaluate,13–15 it does not follow that they are any less distorting of biomedical research, policy-making or patient care.…”

Section: Distinguishing Financial From Non-financial Coismentioning

confidence: 99%

Dangers of neglecting non-financial conflicts of interest in health and medicine

2017

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Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest. IntroductionThe issue of "conflict of interest" (COI) in biomedicine is an enduring one, characterised by ongoing-and often heated-debates about what "counts" as an interest or conflict of interest, what (if anything) causes a COI, who (if anyone) is to blame; and how (if at all) COIs should be managed. Overwhelmingly, these debates have focused on financial interests and the COIs that may arise from them -as evident in a recent issue of JAMA dedicated to COIs in medicine. Of over 24 articles, only two articles addressed non-financial interests in depth (1, 2) -with one article dismissing non-financial COI, and reiterating the significance of bias arising from financial COI. (1, 2) While several articles acknowledged the presence, (3) and potentially problematic nature of non-financial COI, (1) (4) for the most part, the issue focused on financial COI across different medical settings -including biomedical research, medical education and guideline development. (5, 6) (7, 8) This focus on financial COI reflects the wider discourse within medicine -in which financial COIs are granted primacy, while non-financial COIs are merely acknowledged and dismissed as too complex to warrant further investigation, or alternatively defined out of existence. (2,9)

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“…In biology, cascade refers to a process that once started proceeds stepwise to its full, seemingly inevitable conclusion 76 Primary catalysts for the cascade are CoIs: Frequently, financial and nonfinancial interests co-occur. 28,77 Some argue that nonfinancial interests are not CoIs, 78 while others differ: All agree that nonfinancial interests can also bias opinion. 50,[77][78][79][80][81] CoIs catalyze self-serving bias, a strong innate evolutionary trait; self-serving bias risks self-deception and rationalization, which in turn can catalyze ethical violations.…”

Section: Cognitive-affective Biases Plus (+) Cascadementioning

confidence: 99%

“…28,77 Some argue that nonfinancial interests are not CoIs, 78 while others differ: All agree that nonfinancial interests can also bias opinion. 50,[77][78][79][80][81] CoIs catalyze self-serving bias, a strong innate evolutionary trait; self-serving bias risks self-deception and rationalization, which in turn can catalyze ethical violations. 25,26,28,[82][83][84][85][86] The cascade is reinforced by other elements of cognitive-affective biases plus.…”

Section: Cognitive-affective Biases Plus (+) Cascadementioning

confidence: 99%

Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety

Seshia

Young

Makhinson

et al. 2017

Evaluation Clinical Practice

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IntroductionAlthough patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care–related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement.HypothesisA model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive‐affective biases plus cascade could advance the understanding of cognitive‐affective processes that underlie decisions and organizational cultures across the continuum of care.MethodsThematic analysis, qualitative information from several sources being used to support argumentation.Discussion Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive‐affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive‐affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive‐affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error‐provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error‐provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive‐affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to optimize organizational cultures and decisions.LimitationsThe concept is abstract, the model is virtual, and the best supportive evidence is qualitative and indirect.ConclusionsThe proposed model may help enhance rational decision making across the continuum of care, thereby improving patient safety globally.

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Why Having a (Nonfinancial) Interest Is Not a Conflict of Interest

Cited by 103 publications

References 29 publications

Should we try to manage non-financial interests?

Should we try to manage non-financial interests?

Dangers of neglecting non-financial conflicts of interest in health and medicine

Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety

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