Conflicts of interest in medicine: taking diversity seriously

Conflicts of interest (COI) are considered ubiquitous in many healthcare arrangements,(1) but there is disagreement on how COI should be defined, whether non-financial conflicts deserve attention and the relationship between COI and harm. We conducted a study of Australian healthcare professionals and students to gain a better understanding of the way that COI are understood in practice. In this paper, we outline an empirically derived taxonomy of the understanding of, and attitudes towards, COI. We carried out 25 semistructured interviews with clinicians working in several fields across Australia and held six focus group discussions with medical students in New South Wales. Interviewees and focus groups followed similar question routes investigating participants' understanding of COI and views of management. All data were compared and analysed using a matrix of pre-determined questions. There were, broadly, two views of COI: that COI were potentially harmful and morally compromising and another that saw COI as less serious and easily managed through existing structures. Definitions of COI varied widely and were both financial and non-financial. Causes of COI were, variously, systemic, individual and/or relational. Some participants associated COI with moral wrongdoing, and a variety of potential harms was identified. Views on how COI should be managed were similarly varied. We found considerable heterogeneity in how COI are understood in practice. This has implications for management systems that are currently in place, and we suggest a more sophisticated system for considering and mitigating COI.