Against ethics in law: the problems with applying ethics and integrity rules to doctrinal legal scholarship

Expanding Conflicts of Interest in Public Health Research

Conflict of interest in medical publishing exists when a participant’s private interests compete with his or her responsibilities to the scientific community, readers, and society. While conflict of interest is common, it reaches the level of concern when “a reasonable observer might wonder if the individual’s behavior or judgment was motivated by his or her competing interests”1. Having a competing interest does not, in itself, imply wrongdoing. But it can undermine the credibility of research results and damage public trust in medical journals. 
 In recent years, the extent of conflict of interest in medical journal articles has been increasingly recognized. Medical journals and the popular media have published numerous examples of competing interests that seemed to have biased published reports 2,3,4. Organizations have expressed concern for the effects of conflicts of interest on research 5, publication 1,6,7 teaching8 and continuing medical and nursing education9.
 The World Association of Medical Editors (WAME) is one of the institutions engaged in this discussion. WAME was established in 1995 10, 11 to facilitate worldwide cooperation and communication among editors of peer-reviewed journals, improve editorial standards, and promote professionalism in medical editing 12. Membership in WAME is open to all editors of peer-reviewed biomedical journals worldwide; small journals in resource-poor countries are well represented. As of December 2009, WAME had 1595 individual members representing 965 journals in 92 countries. WAME has broad participation as there are no dues and WAME activities are largely carried out through the member list serve and the member password-protected website.
 In March 2009, WAME released an updated policy statement, “Conflict of Interest in Peer-Reviewed Medical Journals” 1. It details the issues WAME believes journals should address when establishing their own policies for conflict of interest. The editors of this journal thought that the issues were important enough to share with its readers. A summary of the statement is presented in the Table and the full statement 1 can be found on WAME’s website 12.
 How Does This Statement Differ From Earlier Conflict–of-Interest Statements?
 First, WAME expands the scope of competing interests. Other statements have been concerned almost exclusively with conflicts of interest related to financial ties to industry – companies that sell healthcare products. The assumption is that financial incentives are especially powerful and are not readily recognized without special efforts to make them apparent. WAME has extended the concept of financial conflict of interest to include the effects of clinical income. For example, physicians who earn their livelihood by reading mammograms or performing colonoscopies may be biased in favor of these technologies. WAME has also included non-financial conflicts of interest (or the appearance of one) related to scholarly commitment: “intellectual passion,” (the tendency to favor positions that one has already espoused or perhaps even established); personal relationships (the tendency to judge the works of friends/colleagues or competitors/foes differently because of the relationship); political or religious beliefs (the tendency to favor or reject positions because it affirms or challenges one’s political or religious beliefs); and institutional affiliations (the tendency to favor or reject results of research because of one’s institutional affiliations).
 Second, WAME did not prescribe a universal standard for when meaningful conflict of interest exists. Rather, it defined and recommended elements of conflict of interest policies and encouraged journals to establish their own standards. WAME left operational definitions and standards on the basic issues to member journals, recognizing that journals exist in very different contexts across the globe, standards for conflict of interest are evolving, and some journals already have well-established policies and standards. WAME does not presume to judge which conflicts require action and what the appropriate action may be, although its policy does offer factors to consider 1. Obviously, excessive concern for these and more comprehensive lists of possible competing interests could paralyze the peer review and publication process and is not feasible. Editors must make judgments as to the strength of the conflict, but to do so must have uncensored information. Similarly, readers need transparency about conflicts, and therefore editors should publish with every article all relevant author disclosures 1. 
 Third, WAME confirms the seriousness of failure to disclose conflict of interest by indicating that editors have a responsibility for investigating, and if relevant acting, if competing interests surface after a manuscript is submitted or published. The intent is that allegations of failure to declare conflicts of interest must be taken seriously by journals.
 Finally, WAME has addressed in a single statement the conflicts of interests threatening all participants in the research and publication continuum, including authors, peer reviewers, and editors. Conflicts between editors and journal owners, which might affect both the accuracy of articles and the credibility of journals, have been addressed in another WAME policy statement 13.
 What Can Be Done About Conflict of Interest in Medical Journals?
 Conflicts of interest cannot be eliminated altogether but it can be managed so that it has the smallest possible effects on journal content and credibility. The backbone of managing conflicts of interest is full written disclosure; without it, nothing else is possible. Currently, authors may not reveal all of their competing interests and even if they do, journals too often do not publish them 14, so there is plenty of room for improvement. Even so, disclosure alone is an imperfect remedy; editors still must determine whether a conflict has sufficient potential to impair an individual’s objectivity such that the article should not be published. Even more work may be needed on reviewers’ and editors competing interests, given their critical role as gatekeepers for the medical literature.
 No statement will solve the conflict of interest problem, nor will it ever be solved altogether. As understanding of the problem and its management evolves, journals should be given latitude to establish their own standards, matching their policies to the best standards of their discipline and culture. WAME believes journals should make these policies readily accessible to everyone. All of us—editors, authors, reviewers, and readers--should be paying more attention to conflict of interest than we have been. We hope this statement serves that purpose.
 
 Acknowledgment
 The authors wish to warmly thank the World Association of Medical Editors (WAME) Officers for their helpful comments on an earlier version of this editorial. Many thanks to President Margaret Winker (USA); Past President Michael Callaham (USA); Vice-President John Overbeke (Netherlands); Treasurer Tom Lang (USA); and Secretary Farrokh Habibzadeh (Iran). 
 The WAME Statement on Conflict of Interest in Peer-Reviewed Medical Journals was approved by the WAME Board in March 2009. Many thanks to the members of the WAME Ethics Committee and to the WAME Editorial Policy Committee for their insightful and helpful comments on an earlier version of the statement. Warm thanks to the WAME Board for their input and comments: Margaret Winker; Michael Callaham; John Overbeke; Tom Lang; Farrokh Habibzadeh; Adamson Muula (Malawi) and Rob Siebers (New Zealand).
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Resolving conflict of interest in public service is one of the key mechanisms for combating corruption. Its principles are defined in international legal documents. The United Nations (UN) Convention Against Corruption states that each State Party should strive, in accordance with the fundamental principles of its domestic law, to establish, maintain and strengthen systems that promote transparency and prevent the appearance of conflict of interest. All State Parties shall endeavour to establish, maintain and strengthen measures that promote transparency and prevent conflicts of interest, in accordance with the fundamental principles of their domestic law. The article raises the problem that the confusing legal regulation and the variety of situations that arise in public service result in public servants not always correctly identifying conflicts of interest, not avoiding conflicts of public and private interests, and persons who have ceased to work in the public service not complying with restrictions on work, restrictions on concluding contracts or using individual benefits, and restrictions on representation. The aim of this article is to reveal the peculiarities of the legal regulation of conflict of interest, to analyse means of resolving conflicts of interest in the public service and restrictions for post-public servants in Ukraine and Lithuania. The authors set out a number of tasks in the article: (i) to define the concept of conflict of interest in the public service; (ii) to identify means of resolving conflicts of interest in the public service in Ukraine and Lithuania; (iii) to compare the restrictions (limitations) for post-public servants in each country. The research methods employed included: (i) comparative method, comparing the regulations on conflict of interest in each country; (ii) generalisation method, to formulate conclusions; (iii) document analysis method, focusing on the legal acts and documents of Ukraine and Lithuania; (iv) statistical method, to reveal the number of investigation identifying conflicts of interest in public officials' activities. Keywords: Conflict of Interest, Public Service, Post-public Servants, Withdrawal from Decision-making, Restrictions, Limitations, Liability.

As Editor-in-Chief, International Surgery, I dedicate this editorial letter to the immense importance of conflict of interest policy. A conflict of interest policy statement exists for International Surgery and is fully observed. Conflict of interest procedures relate to the trust that authors place on the publishing practices of International Surgery, and no ambiguity should exist in reference to this trust.The definition of conflict of interest is that a conflict of interest exists when there is a divergence between an individual's private interests and their responsibilities to scientific and publishing activities. This is the definition of conflict of interest for International Surgery.The scope of conflicts of interest in relation to International Surgery includes the areas of financial relationships, academic commitments, personal relationships, political and religious beliefs, and institutional affiliations.In reference to declaring and managing conflicts of interest, the goal of International Surgery is not to eliminate all possible conflicts of interest, but to manage constructively by stipulating that authors of submitted manuscripts openly declare in writing any potentially perceived conflicts of interest at the time of submitting a manuscript for the consideration of the Editor-in-Chief and editorial staff of International Surgery. Authors are also to understand that additional questions may be asked by the Editor-in-Chief and editorial staff pertaining to possible conflicts of interest.The consequences of author(s) failing to declare a conflict of interest include no (further) consideration of the manuscript, exclusion of those persons with a conflict of interest from the review process, abstaining from decisions where a conflict of interest might evolve, and/or investigation by impartial observers.The responsibilities of participants in the publishing process are direct and significant. Authors are asked to report any financial conflicts of interest related to research and written presentations of their work, as well as any other competing interests. Reviewers are asked if they have any conflicts of interests in reference to the manuscript under review. Editors will not make any editorial decisions, if they have any financial or other types of interest in a particular manuscript.Conflicts of interest in scientific medical publishing affect everyone with a stake in research integrity. The Editor-in-Chief and editorial staff of International Surgery have the goal of publishing with the highest possible integrity.Sincerely,Professor Christopher ChenEditor-in-ChiefInternational Surgery

Although both financial and intrinsic conflicts of interest can exist throughout the drug development process, little is known about how advanced cancer patients enrolled onto early phase clinical trials perceive investigator conflicts of interests. We interviewed 102 advanced cancer patients enrolled onto phase I clinical trials using a standardized survey that addressed multiple issues related to conflicts of interest and research participation. Fifty-five percent of patients would not be concerned if physicians involved in running a clinical trial had financial conflicts of interest, whereas 65% of patients would be concerned if physicians involved in running a trial had intrinsic conflicts of interest. Most patients reported that potential conflicts of interest should be disclosed to patients on research trials (52% for financial conflicts of interest and 61% for more intrinsic conflicts of interest). Most patients would be willing to participate in trials after learning conflict of interest information (63%). Younger patients expressed more concern regarding financial conflict of interest than older patients (odds ratio, 6.22; 95% CI, 1.41 to 27.24). Patients with advanced cancer are equally, if not more, concerned about traditional intrinsic conflicts of interest as compared with financial conflicts of interest. Patients generally believed that conflict of interest information should be disclosed to research participants. The fact that younger patients expressed more concern about financial conflicts of interest may have the potential to influence clinical trial participation rates. The actual impact of conflict of interest disclosure to research subjects needs to be evaluated more carefully.

The situation of conflict of interest may appear in activity of every professional irre­spective of affiliation to public, private or nongovernmental sector. The consequences of conflict of interests is biased, subjective and nontransparent decision, improper fulfillment of prescribed duties, falling standards and decreased public trust not just in politicians or civil servants but in public institutions and government. The notion of conflict of interests varies but in this paper the following definition is used. Conflict of interest is a situation in which a person (in this paper politician or public official) has a private or other interest which is such as to influence, or appear to influence, the impartial and objective performance of his / her official duties. Research of this problem can be described as moving from legalistic towards more general understanding. The topic is interdisciplinary and can be analyzed from the political science, public administration, ethics or management perspective. Analy­ses of the practice allowed researchers to distinguish the third type of such conflict of interest – the apparent conflict-to the existing or potential conflict of interests. De­velopment of society and changed surrounding of government activity increased the potential risk areas (gift giving, hospitality, bribery, contracts, trading information, etc.) for such situation to appear. In the past few decades increasing perceptions of falling ethical standards in legislatures, executive or ordinary public officials activity (scandals, misbehavior) have led in many advanced democracies to the introduction of ethics frameworks for elected or appointed officials. In order to give priority to public interest and properly perform public duties some regulation can be applied. 1) Prohibitions on the perform­ance of certain functions, and/or the holding of certain positions or certain interests by public officials. 2) The establishment of duties of public officials to declare inter­ests they have, either generally or in specific cases. 3) Exclusion or self-exclusion of public officials from participation in decision-making processes or matters where they are subject to a conflict of interest. These regulations are generally established and implemented through three main instruments: civil service legislation, conflict of interest legislation and codes of ethics / codes of conduct. The historical development of Lithuanian society in XIX and XX century was not in favor to develop clear sense of drawing the line between public and private interest but during the interwar Lithuanian Republic period few attempts to prohibit such conflict of interest were taken. The legislation prohibited holding a few offices and to employ relatives. Some current Lithuanian legislation directly some indirectly (Public Service Act, Seimas’ Statute, etc.) try to control similar situation which may turn into corrupt acti-vity or misuse of public office for private or other interests. The first special legisla­tion prohibiting conflict of interests was issued in 1997. The Law on the Compatibil­ity of Public and Private Interests in the Public Service underwent three main correc­tions. The analysis of this legislation allows concluding that the main weakness was not corrected. The usage of the term “adjust” instead of “separation” might be under­stood as a compromise instead of taking the stricter position dealing with the issue. The Law seeks “to adjust private and public interests, to ensure that priority is given to public interests, to strengthen impartiality of decisions and to prevent corruption in public service” and applies to both public servants and politicians. Meanwhile in other countries legislative has more ambitious goal to ensue public interest priority. The analyses of seventeen codes of ethics and codes of conduct existing in vari­ous Lithuanian public institutions showed that their authors paid some attention to this issue. Some codes refer to existing legislation; some describe general principles for conduct or try to explain how to behave in such uneasy situations. There are fundamental differences between elected officials and civil servants which have major implications for conflict of interest regulation first of all due to their different roles, term of service. Some Lithuanian legislation regulating conflict of interests apply to politicians and civil servants, some differ. As in other democra­cies activity of civil servants are more regulated (Public service act, law on Pub­lic administration, Ethical rules of conduct, etc.). But existing legislation does not change the situation and can not increase public trust if is not understood and properly implemented.

To assess the extent to which peer reviewers and journals editors address study funding and authors' conflicts of interests (COI). Also, we aimed to assess the extent to which peer reviewers and journals editors reported and commented on their own or each other's COI. We conducted a systematic survey of original studies published in open access peer reviewed journals that publish their peer review reports. Using REDCap, we collected data in duplicate and independently from journals' websites and articles' peer review reports. We included a sample of original studies (N = 144) and a second one of randomized clinical trials (N = 115) RCTs. In both samples, and for the majority of studies, reviewers reported absence of COI (70% and 66%), while substantive percentages of reviewers did not report on COI (28% and 30%) and only small percentages reported any COI (2% and 4%). For both samples, none of the editors whose names were publicly posted reported on COI. The percentages of peer reviewers commenting on the study funding, authors' COI, editors' COI, or their own COI ranged between 0 and 2% in either one of the two samples. 25% and 7% of editors respectively in the two samples commented on study funding, while none commented on authors' COI, peer reviewers' COI, or their own COI. The percentages of authors commenting in their response letters on the study funding, peer reviewers' COI, editors' COI, or their own COI ranged between 0 and 3% in either one of the two samples. The percentages of peer reviewers and journals editors who addressed study funding and authors' COI and were extremely low. In addition, peer reviewers and journal editors rarely reported their own COI, or commented on their own or on each other's COI.

The conceptual framework system of public administration instills increasingly in terms of actual meaning towards the concept of “conflict of interest” as one of the most important legal means to combat corruption. The article examines the forms and methods of conflict of interests. The authors argue that the primary duty of a person, who sits in for an office that involves the obligation to take measures to prevent and resolve conflicts of interest (the side of conflict of interest), is to notify the representative employer about a risen conflict of interest or the possibility of its occurrence. These persons should carry out their state and official activities in a way to anticipate the risks of conflict of interest and to do it as efficiently as possible to try to “manage conflicts” that may arise. The article substantiates the need to clarify the notice forms of conflict of interests. Along with the assignment of certificates of income, property and property obligations it is suitable to assign a declaration of private interests to the employer representative taking into account the experience of these types of notices in foreign countries. The article analyzes in detail the powers of the representative of employer to prevent and resolve conflicts of interest, including the obligation to inform the person who is a party to the conflict of interests, the existence of dangerous conflict situation and the inadmissibility of certain actions. Preventing or resolving conflicts of interest by the employer representative may consist of: a change in the official position or status of the person who is a party to the conflict of interest; his removal, rejection or disqualification of the notice and other processes for resolving conflicts of interests. The authors propose further improvement of prevention methods and conflict of interests’ settlement based on the foreign countries experience.

ObjectivesTo assess the extent to which peer reviewers and journals editors address study funding and authors’ conflicts of interests (COI). Also, we aimed to assess the extent to which peer reviewers and journals editors reported and commented on their own or each other’s COI.Study design and methodsWe conducted a systematic survey of original studies published in open access peer reviewed journals that publish their peer review reports. Using REDCap, we collected data in duplicate and independently from journals’ websites and articles’ peer review reports.ResultsWe included a sample of original studies (N = 144) and a second one of randomized clinical trials (N = 115) RCTs. In both samples, and for the majority of studies, reviewers reported absence of COI (70% and 66%), while substantive percentages of reviewers did not report on COI (28% and 30%) and only small percentages reported any COI (2% and 4%). For both samples, none of the editors whose names were publicly posted reported on COI. The percentages of peer reviewers commenting on the study funding, authors’ COI, editors’ COI, or their own COI ranged between 0 and 2% in either one of the two samples. 25% and 7% of editors respectively in the two samples commented on study funding, while none commented on authors’ COI, peer reviewers’ COI, or their own COI. The percentages of authors commenting in their response letters on the study funding, peer reviewers’ COI, editors’ COI, or their own COI ranged between 0 and 3% in either one of the two samples.ConclusionThe percentages of peer reviewers and journals editors who addressed study funding and authors’ COI and were extremely low. In addition, peer reviewers and journal editors rarely reported their own COI, or commented on their own or on each other’s COI.

What does the French public consider to be a conflict of interest for medical researchers?

In conditions of complexity and expansion of state influence on various spheres of society, there is an increase in the number of relationships between state authorities and various entities, which leads to interwoven interests resulting in a conflict of interests in the civil service when personal interests take priority over official duties. The importance of studying the conflict of interests lies in the fact that an unresolved conflict of interests causes a set of problems, one of which is corruption, which in turn results in a large number of negative consequences that are reflected in all spheres of society. Also, owing to the unresolved conflict of interests, the interests of society are ignored in order to satisfy the narrow interests of a civil servant. It undermines the credibility of public authorities in the public eye. The article reveals the relevance of studying the conflict of interests in the civil service, analyzes the normative definition of the concepts of "conflict of interests", "personal interest", considers the shortcomings in the legislation concerning these concepts, and also suggests ways to eliminate them. The article identifies the causes of the spread of a conflict of interest, considers the negative consequences associated with its occurrence and ways to prevent it in the civil service. The study proposes a set of measures to resolve the conflict of interests aimed at its primary prevention. A conclusion is made about the necessity of introducing new measures to resolve the conflict of interests in the civil service system in order not only to manage the conflict of interests that has already arisen, but also to prevent and avoid it, which will lead to better performing duties in the civil service.

Introduction. This paper addresses the specificities of conflicts of interest within the sphere of local self-government. One of the most common situations where a conflict of interest arises is through relationships with individuals and/or legal entities that may give rise to a private interest. Moreover, it distinguishes between the concepts of «authority» and «private interest». Purpose. To define the concept of conflict of interests in local self-government bodies, its signs, features, methods of settlement, possible consequences and to find out the variability of actions of officials in solving this problem in accordance with anti-corruption legislation. Results. Through an analysis of current legal documents and academic literature, the unique characteristics associated with the legal management and prevention of conflicts of interest within the functions of local government bodies are identified. It is determined that a conflict of interest may arise not only when a contradiction has already affected the objectivity and/or impartiality of decision-making or performance of actions, but also when there is a potential opportunity to influence them. This paper also investigates the essence of conflicts of interest and their manifestations in the sphere of local self-government. By analyzing various situations in which conflicts of interest arise in the system of local self-government, the paper describes the consequences of such conflicts and highlights certain shortcomings of the regulatory and legal framework of Ukraine regarding the notification of conflicts of interest and the algorithm of behavior in their presence. Conclusion. The paper concludes that persons entrusted with the responsibility of preventing and resolving conflicts of interest in the sphere of local self-government and other state authorities should take several measures. Firstly, they should take measures to prevent possible conflicts of interest and their actual manifestation. Secondly, they should report a conflict of interest by providing information about an actual or possible situation where a conflict may arise between their personal interests and the interests of another person. Thirdly, they should avoid taking actions or making decisions in situations of real conflicts of interest. Lastly, they should take measures to resolve potential or existing conflicts of interest, which depend on the situation. It is important to note that a person can take any measures independently, as long as they do not violate the law.

The article continues the scientific and legal discourse surrounding the definition of «conflict of interests». The relevance of this topic stems from the growing incorporation of the concept into public administration systems in countries integrating into the international community. At the national level, mechanisms for preventing and managing conflicts of interest are developed by implementing international treaties and adopting methodological recommendations from international organizations, which provide the organizational and legal framework. However, the specific features of state governance and legal traditions influence how the concept is applied within a country’s existing political and legal system. While many scholars have explored the issue of conflicts of interest, the approach to its conceptual implementation within national legal frameworks, in our view, remains underdeveloped. The definition of «conflict of interests» and the approaches to its application in law-making and law-enforcement activities remain subjects of debate. This article examines current approaches to defining the definition of «conflict of interests» and explores modern strategies for creating a legal framework to address conflicts of interest in Ukraine. It also highlights the law­enforcement aspect of the issue. The article argues that the integration of anti-corruption laws with professional ethics standards into a unified legal system in Ukraine is largely declarative. Moreover, it is noted that the current legal definition of «conflict of interests» lacks the precision, clarity, and certainty required for legal norms. In conclusion, the article emphasizes that a clear conceptual understanding the definition of «conflict of interests» is essential for shaping national policies aimed at preventing and managing conflicts of interests. The article emphasizes the importance of mechanisms for regulating the professional behavior of officials as an essential aspect of the concept of conflict of interests.

This paper is split into two parts. The first half analyzes conflicts of interests’ effects on judgment, the harms these effects threaten, and our current policies and practices for handling conflicts of interest. This analysis relies on scholarship in several fields, most prominently psychology, all of which have reasons to worry about conflicts of interest. This analysis will show that our current classifications of conflicts of interest and our current strategies for handling conflicts of interest are confusing, of dubious benefit, or both. The second half provides some tools for helping us to limit or avoid the harms of conflicts of interest. These simple tools focus on how we think about and classify conflicts of interest. Specifically, I recommend beginning to classify conflicts of interest in a new way: as either severable or systemic. These new classifications are not intended to be heavy conceptual machinery, but simple and valuable tools. These new classifications, even though they are not meant to be exhaustive or comprehensive, help delineate tractable strategies and help determine the distribution of responsibilities for addressing specific conflicts of interest.

The purpose of the study was to assess medical journals' conflicts of interest in the publication of book reviews. We examined book reviews published in 1999, 2000, and 2001 (N = 1,876) in five leading medical journals: Annals of Internal Medicine, British Medical Journal (BMJ), Journal of the American Medical Association (JAMA), Lancet, and New England Journal of Medicine. The main outcome measure was journal publication of reviews of books that had been published by the journal's own publisher, that had been edited or authored by a lead editor of the journal, or that posed another conflict of interest. We also surveyed the editors-in-chief of the five journals about their policies on these conflicts of interests. During the study period, four of the five journals published 30 book reviews presenting a conflict of interest: nineteen by the BMJ, five by the Annals, four by JAMA, and two by the Lancet. These reviews represent 5.8%, 2.7%, 0.7%, and 0.7%, respectively, of all book reviews published by the journals. These four journals, respectively, published reviews of 11.9%, 25.0%, 0.9%, and 1.0% of all medical books published by the journals' publishers. Only one of the 30 book reviews included a disclosure statement addressing the conflict of interest. None of the journals had a written policy pertaining to the conflicts of interest assessed in this study, although four reported having unwritten policies. We recommend that scientific journals and associations representing journal editors develop policies on conflicts of interest pertaining to book reviews.