JAMA Theme Issue Tackles Conflicts of Interest in Medicine

A new themed issue of JAMA delves into the complicated relationships and practices that can result in conflicts of interest (COIs) for physicians, medical journals, schools, and other healthcare entities.

The issue, which includes 23 viewpoint articles, 3 editorials, and 2 original investigations, is outlined and summarized in one of the editorials, aptly titled “The Complex and Multi-Faceted Aspects of Conflicts of Interest.” Author William Stead, MD, explains that the vast majority of medical professionals want to do the right thing, but the many roles they take on within the healthcare system (eg, clinicians, educators, researchers, policy makers, or advocates) make them subject to a wide array of relationships that can lead to COIs.

One of the original investigations garnering the most attention was the one that examined the relationship between physician prescribing and policies regulating pharmaceutical sales visits, called “detailing.” The researchers found that 8 of the 11 academic medical centers that prohibited salesperson visits and gifts to their clinicians saw a significant reduction in prescribing rates of the detailed drugs, while just 1 of the 8 medical centers that did not enact such restrictions observed a change in prescribing.

Another study making headlines found that nearly half of all physicians in the United States accepted payments from the biomedical and pharmaceutical industries in 2015, for a total payout of $2.4 billion. The researchers found that surgeons were more likely to receive payments and had a higher average payment value than primary care doctors, and that men in each specialty were more likely than women to receive both general and license or royalty payments.

One viewpoint looked at COIs in a larger context, as it discussed the potential for institution-wide conflicts in schools of public health when they accept outside funding. The authors recommended increasing transparency and instituting a robust mechanism of unbiased experts to review the appropriateness of funding.

Some of the other topics discussed in the issue were:

• Teaching Medical Students About Conflicts of Interest. This viewpoint argued that future clinicians must be educated about what exactly constitutes a COI and taught skills to help them handle potentially sensitive situations.
• What Do Patients Think About Physicians’ Conflicts of Interest? This viewpoint called for more research onto whether disclosing physician COIs would meaningfully change patient behavior.
• Conflict of Interest and the Role of the Food Industry in Nutrition Research. This viewpoint cautioned that the food industry’s participation in funding nutrition research creates a multitude of opportunities for bias and skewed findings.
• Medical Journals, Publishers, and Conflict of Interest. This viewpoint encouraged journals to keep editorial and business decisions independent and separate so as to avoid potential COIs that could weaken credibility.

Overall, the viewpoints, editorials, and research articles in the issue emphasize how important it is for the medical field to preserve its integrity and trustworthiness by minimizing or avoiding COIs and potential bias. Specifically, Stead’s editorial noted that the viewpoints “suggest a systematic approach in which all stakeholders in the health professions and biomedical sciences work together to protect professional judgment and integrity while advancing progress.”

Among these stakeholders are medical professionals, who “should think critically about conscious and unconscious biases affecting their judgment and the limitations of information resources,” and researchers, who can “advance measurement of bias and incorporation of information about COIs and bias into context-relevant decision aids for physicians and patients.”