A conflict of interest exists when a person entrusted with the interests of a client, dependent or the public violates that trust. When applied to medicine, a conflict of interest ensues when there is a set of conditions “...in which professional judgment concerning a primary interest (such as a patient's welfare or the validity of research) tends to be unduly influenced by a secondary interest...”;1 such secondary interests might include financial gain, personal relationships, academic competition or intellectual passion.

Conflicts of interest are usually defined by detrimental patient outcomes, either intentional or subconscious, if the physician has subordinated the best interests of the patient. Broader examples of conflicts occur when a physician's judgment or decision-making process is compromised, even if there is no mistake or incompetence. Furthermore, the concept of a conflict of interest has been expanded to include the potential for detrimental outcomes or compromised judgment without actual harm, or, if there is a perceived conflict that damages trust in a doctor or undermines the profession.

Although academic medicine, the pharmaceutical industry and, most recently, the NIH (National Institutes of Health) and the FDA (Food and Drug Administration), have worked together to bring forth numerous life-saving and life-altering therapies, the alliance has become “uneasy”.2 Bodenheimer described how authors of papers supporting the safety of a therapy had a higher frequency of financial relationships with manufacturers than negative trials, and that reports favoring new therapies versus traditional therapies were more likely to be reported if the study was funded by a manufacturer. In addition, articles from industry-sponsored symposia were found to be more likely to report favorable outcomes than those without corporate support, and significantly less industry-sponsored pharmacoeconomic studies of cancer drugs were unfavorable compared with studies with nonprofit funding.

We must be particularly cautious to avoid instances in which our judgment, policies or actions could be dissuaded from our oath to maintain the patient as our primary interest

Most recently, the NIH Blue Ribbon Panel on Conflicts of Interest Policies provided a series of policy proposals regarding the outside activities of government employees. These proposals include: creating an NIH Ethics Advisory Council to review all consulting agreements with pharmaceutical or biotechnology companies; prohibiting employees from holding stock in biotechnology or pharmaceutical companies; limiting the acceptance of awards to those predetermined to be bona fide awards; encouraging consultation with industry, but prohibiting compensated consultation by senior employees and those involved with extramural funding decisions; prohibiting consultation with grantee institutions; prohibiting membership on corporate boards of pharmaceutical and biotechnology companies; increasing the number of employees who must publicly disclose compensated outside activities and amounts received; and implementing training and communication programs for employees with centralized management and tracking systems for outside activities.3

The Accreditation Council for Continuing Medical Education (ACCME), has recently updated its “Standards for Commercial Support” to “Ensure the Independence of CME Activities”.4 Included in this report are standards to resolve personal conflicts of interest that include disclosure of any financial relationship and the mechanism to identify and resolve all conflicts of interest prior to the educational activity.

In this era of potential conflicts of interest affecting the fields of clinical medicine, medical research, medical education, and government agencies (e.g. the NIH and the FDA), we must be particularly cautious to avoid instances in which our judgment, policies or actions could be dissuaded from our oath to maintain the patient as our primary interest.

Supplementary information, in the form of a reference list, is available on the Nature Clinical Practice Gastroenterology & Hepatology website.