Institute of Medicine report on conflict of interest (created 2009-05-24)

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The National Academies Press has announced the release of a report, Conflict of Interest in Medical Research, Education, and Practice, prepared by a special committee of the Institute of Medicine.

The report (page 38) offers the following definition:

A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest.

The primary interest is something like providing the best quality of care for the patient you are currently seeing, offering the best recommendation for clinical practice, or insuring the safety of patients in a research study. A secondary interest could involve  financial considerations, personal favors, or desire for recognition, awards, or prestige.

The report distinguishes conflict of interest with conflict of obligations, where a physician may have to balance two competing primary interests (such as obligations to insure safety of patients in a research study and to insure the scientific integrity of the study), and conflicts of commitment, where a physician has to balance interests of one's employer with interests of ones interests outside of work (such as charitable efforts). The report also discusses the nebulous concept of the appearance of a conflict of interest.

There are numerous recommendations for how to manage conflict of interest, in the arenas of medical research, medical education, and medical practice. These are difficult to summarize here. The New England Journal of Medicine has a nice summary: