Conflicts of Interest: can a physician serve two masters?

Conflicts of interest (COIs) exist when someone who has a fiduciary responsibility for another's welfare acts, or has the potential to act, in a manner inconsistent with their charge's best interests. COIs exist in all professions as well as in public service; however, in medicine, COIs pose a unique problem, given the responsibilities and special status that society grants to physicians. In this commentary, I explore conflicts of interest in various contexts: medical practice, continuing medical education, practice guidelines, medical journals, academic institutions and researchers, and medical professional societies and associations. I define the term "conflicts of interest" and review its ethical basis, offer common examples of COIs, discuss the importance of disclosure, and suggest ways beyond disclosure to minimize or limit COIs in the various settings in which physicians work. Ideally, physicians should try to avoid COIs, but when situations arise where physicians have COIs, how they manage them will depend on a combination of physicians' personal conscience and professional ethics, professional society ethics codes, and governmental regulation.