Conflicted by conflicts of interest.

Abstract

Views: Commentary 601 I a recent commentary, Dr. Michael Kotlikoff argues that the AVMA should divest itself of the Council on Education (COE) not because of any concerns with the policies or procedures the council uses in accrediting colleges of veterinary medicine, but simply because of “obvious real and apparent conflicts of interest.” His argument rests on three main premises: that conflicts of interest are evidence of bias or wrongdoing, that individual COE members share the same conflicts held by the AVMA or Association of American Veterinary Medical Colleges (AAVMC) as a whole, and that conflicts of interest can be eliminated. However, all three of these premises are demonstrably false. The term conflict of interest is frequently used, but often in inconsistent ways. In 2009, the Institute of Medicine (IOM) released its comprehensive review on conflicts of interest and conflict of interest policies in medicine. The definition adopted for that review was that “a conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.” Notice, then, that a conflict of interest represents a certain set of circumstances. It is not a behavior; is not indicative of improper actions, wrongdoing, or misconduct; and is not a judgment about the individual who finds himself or herself in that situation. From this definition, it follows that it does no good simply to state that a conflict of interest exists or to argue that the AVMA should divest itself of the COE because the association has conflicts of interest. The same logic would lead to the conclusion that one should never ride in an automobile simply because there is a possibility of being involved in a deadly crash. The crucial factor, both in assessing whether to drive an automobile and whether to be concerned about a conflict of interest, is the magnitude of the risk (or, the severity of the conflict). In this regard, the IOM has recommended that the severity of a conflict be assessed on the basis of the likelihood that professional decisions would be unduly influenced by a secondary interest and the seriousness of the harm or wrong that could result from such influence. Even if we were to stipulate that allowing accreditation decisions to be influenced by financial considerations would cause great harm, we must still evaluate whether any of the financial arrangements the AVMA has with outside entities would be likely to affect those decisions. If, as Dr. Kotlikoff alleges, the Conflicted by conflicts of interest