Conflicts of Interest in Medicine: Should We Contract, Conserve, or Expand the Traditional Definition and Scope of Regulation?

Abstract

The conflict-of-interest concept has had long had a clear, agreed-upon meaning in law and public policy. Nevertheless, to help explain the concept, Dennis Thompson and the Institute of Medicine (IOM) developed alternative definitions which stray from standard legal usage and introduce potential sources of confusion. Following the IOM, other writers proposed changes that redefine the concept to include so-called intellectual or non-financial conflicts. These new definitions include situations that have not been considered conflicts of interest until now. When redefined to include intellectual/non-financial conflicts, every potential source of bias becomes a conflict of interest, which reduces the conceptual clarity and dissipates efforts to counter and cope with conflicts of interest. Many proponents of redefinition propose greater tolerance for all conflicts of interest, but at least one holds that because we regulate financial conflicts, we should also regulate intellectual conflicts. This article describes how the term conflict of interest has been traditionally used in the law and new uses of the term. Adopting the new definitions would proliferate situations considered to give rise to conflicts of interest, introduce unneeded categories, and confuse analysis. We should conserve the traditional legal definition and maintain policies to avoid and manage conflicts of interest in medicine.