The true conflict of interest

✍ Scribed by Philip Cole

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 76 KB
• Volume: 28
• Category: Article
• ISSN: 0271-3586
• DOI: 10.1002/ajim.4700280509

✦ Synopsis

An editorial expresses an opinion in a controversy. But, the editorial "Disclosure of Interest: A Time for Clarity" (Landrigan, 1994) goes further and imposes the editor's will upon a large constituency with limited ability to object.

"A Time for Clarity" leaves two major issues unclear. For one, you state correctly that conflicts of interest may be "actual, potential, and perceived" Yet, the remainder of the editorial implies that all conflicts of interest are "actual." But even an actual conflict of interest usually can be resolved appropriately. Also unclear is the preoccupation with financial remuneration as the source of actual conflicts of interest. In fact, there are many sources of conflict. I suggest that ideology, not financial issues, produces the major conflicts of interest within our public health community.

Ideology as a source of conflict of interest is illustrated by the beliefs and practices of the staffs of administrative entities that have both regulatory and research mandates. Problems occur because these two mandates are inherently in conflict. Some of these staff persons believe that their research is intended to identify problems in need of regulation. In fact, the true purpose of research is to describe nature and to learn whether or not a problem exists. Will such a person interpret his research objectively? No, because he can not. Experience has led me to develop the term "inherently conflicted" to describe these people. Their interpretation of their research is influenced by their perceived need to produce a positive result. Furthermore, these honest but inherently conflicted persons cannot report their conflict of interest to you because they are oblivious to it.

You have diagnosed an illness: conflict of interest. You have prescribed a therapy for it: full disclosure of such conflicts. So be it, but I point out the privileged position of a journal editor who is not subject to the same review process as are contributors and who can cast his own words into stone. From that perspective, perhaps journal editors need a large dose of your therapy: an annual listing in the journal of items that pose actual conflicts seems reasonable. Finally, you suggest that primary prevention of the illness would be "achieved by authors not having