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Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice; Lo B, Field MJ, editors. Conflict of Interest in Medical Research, Education, and Practice. Washington (DC): National Academies Press (US); 2009.

Cover of Conflict of Interest in Medical Research, Education, and Practice

Conflict of Interest in Medical Research, Education, and Practice.

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Preface

Hardly a week goes by without a news story about conflicts of interest in medicine. While this committee met, colleagues and friends sent me many news reports and journal articles on the topic. These reports—even if one expects that initial news reports may not always have the stories quite straight—served as continual reminders that conflicts of interest create deep concerns about the integrity of medicine and medical research and raise questions about the trustworthiness of physicians, researchers, and medical institutions.

As I look back over our deliberations, several themes stand out. First, as with all Institute of Medicine (IOM) reports, the committee was charged with making recommendations that were based on evidence and convincing reasons. Although the committee members were aware of powerful anecdotes and had personal beliefs about the issues, we repeatedly asked whether the evidence supported our conclusions and recommendations. If it did not, we developed a reasoned case on the basis of the committee’s experience and the judgment of the committee members about the arguments for the use of different approaches presented in the literature or in statements submitted to the committee. Second, it is a challenge to craft policy recommendations that strike the right balance between addressing egregious cases and creating burdens that stifle relationships that advance the goals of professionalism and generate knowledge to benefit society. The committee tried to consider the possibility that well-intentioned policies may have unintended adverse consequences. Third, regulation alone may have limited effectiveness in the absence of a culture of professionalism and other incentives that are aligned to promote professional behavior. The committee considered how a variety of organizations—including those that accredit health care institutions and license health care professionals, publish the findings of medical research, use practice guidelines, and pay for medical care—can buttress the conflict of interest policies implemented by institutions that carry out medical research, provide education and patient care, and develop practice guidelines.

This report cannot and did not attempt to resolve all issues related to conflicts of interest in medicine. In view of our expansive charge, we tried to address central questions rather than the many details of this complex topic. For example, we focus on conflicts that involve financial interests because they are at the heart of concerns and debates about conflicts of interest. Furthermore, because relationships with pharmaceutical, medical device, and biotechnology companies have created the greatest concern and were central in the discussions that led the IOM to pursue this study, we focused on those relationships. The committee expects that many of the recommendations and analyses in our report will also apply more generally to professional and institutional relationships with other commercial entities, such as insurers and vendors of nonmedical products.

The committee could not resolve some important issues like harmonizing the different requirements for the disclosure of financial relationships because they would require much more time and additional expertise. Instead, to standardize aspects of disclosure policies and procedures, the committee recommended a focused consensus development process that would involve multiple stakeholders on the issue.

Our committee was diverse, involving members with different professional backgrounds and areas of expertise. These different perspectives led to spirited discussions and debates. Each of us listened to points of view and information that we had not previously considered. We tried to listen to and understand other viewpoints and be open to new perspectives, even if in the end we did not agree on all issues. Appendix F describes the different views on one issue, a proposal by some committee members for broader requirements for public disclosure. In general, the committee hoped that by explaining our reasoning on difficult issues our audiences would better appreciate the multiple considerations that a sound conflict of interest policy should address.

As chair, I want to personally thank the committee members for their hard work and their willingness to engage on difficult topics. I am deeply grateful to them for the time and effort that they took from their busy schedules to devote to this project. This report is truly a collaborative effort and is much the better, I think, for the back-and-forth discussions. I also want to personally thank our IOM staff for their tremendous efforts in making this report possible. Robin Parsell skillfully handled meeting and other logistics, and Franklin Branch provided research assistance in many areas. Marilyn Field was unstinting in her background research, drafting and revising of the manuscript, and high standards for our work. And I want to thank Lindsay Parham, my research assistant at the University of California at San Francisco, for her expert help with background research.

Bernard Lo, M.D., Chair

Committee on Conflict of Interest in Medical Research, Education, and Practice

Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK22947

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