Financial and intellectual conflicts of interest: confusion and clarity

To examine the literature on competing interests for individuals and organizations involved in healthcare and to determine the nature and extent of the problem, and the most effective methods of management.

A Medline search from 1950 to August 2009 identified 6803 publications (605 in languages other than English) on the subject of conflict of interest or competing interests. Of these, 1073 were letters, 785 editorials, 434 reviews and 212 referred to competing interests in the context of clinical guidelines. Conflicts of interest (competing interests) and bias are ubiquitous. In medicine, they may have the potential to cause harm to patients or obstruct research and new treatments. Competing interests may arise from financial, academic or personal factors. Most interventions relate to managing competing financial interests derived from relationships with the pharmaceutical industry.

Transparency is a necessary, but not a sufficient component in managing bias. Organizations should develop integrated systems for declaring, monitoring and managing financial interests; insight into other forms of bias could be improved through educational programmes. Marketing masquerading as education should be prohibited for undergraduates and trainees, and by professional organizations. Universities and journals should separate their conflicted roles as regulators and beneficiaries in commercial relationships.