Managing Conflicts of Interest Should Begin with Dialogue and Education, Not Punitive Measures

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The case study presented by Winch and Sinnott (2011) shows not only how difficult it is for clinicians and researchers to identify conflicts of interest (COI), but also how damaging it can be when there are uninformed and uncoordinated policy responses by senior administrators. The final decision by the Chief Probity Officer (CPO) proves that he lacked experience in ethical decision making, as he incorrectly weighed the harms associated with a real and apparent COI on the part of Dr. B and his technology company against the benefits of the technology for improving clinician safety and medical practice. Further, the CPO was clearly working on the assumption that the only means of managing COI was recusal; no other means of reducing the potential harm—that is, bias and lack of objectivity in the clinical studies and a subsequent loss of patient or public confidence in Dr. B and/or his technology—were envisaged. Finally, an apparent unwillingness to engage in dialogue with the Research Ethics Committee (REC) or the clinician-researcher shows an authoritarian approach on the part of the CPO that gives the message that Dr. B is engaging in misconduct because “COI is simply bad, by definition”! This approach should make one wonder whether the actual goal of the CPO’s report was not the appropriate management of COI, but instead the avoidance of potential scandal and so preservation of institutional reputation (Williams-Jones 2011). This case also highlights the problems that arise when there is a widespread lack of understanding by institutional entities—namely the Research Governance Officer (RGO), the CPO, and the REC—and clinicianresearchers of what constitutes COI and how these should be managed effectively. Dr. B and the REC were most likely operating in good faith, but with an incomplete understanding of the nature and scope of the COI—which was both real and apparent— and the risks posed for trust and confidence. By deciding there was no actual COI and by not checking with other relevant institutional agents for advice (i.e., the RGO), the REC missed an important opportunity to learn about the U.S. Institute of Medicine’s (Lo and Field 2009) recently revised definition of COI and so improve its review of Dr. B’s project. To make matters worse, the RGO, after communicating with Dr. B, did not confer with the REC Bioethical Inquiry (2012) 9:221–222 DOI 10.1007/s11673-012-9358-y