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White paper: statement on conflicts of interest

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Bion J1, Antonelli M2, Blanch L3, Curtis JR4, Druml C5, Du B6, Machado FR7, Gomersall C8, Hartog C9, Levy M10, Myburgh J11, Rubenfeld G12, Sprung C13. Intensive Care Med. 2018 Sep 6. doi: 10.1007/s00134-018-5349-8. [Epub ahead of print]

Abstract

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1 University Department of Intensive Care Medicine, University of Birmingham, Ground Floor East Wing, Queen Elizabeth Hospital (Heritage Site), Birmingham, B15 2GW, UK. J.F.Bion@bham.ac.uk.

2 Department of Intensive Care Medicine, Anesthesiology and Emergency Medicine, Fondazione Policlicnico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.

3 Parc Tauli University Hospital, CIBER Enfermedades Respiratorias, Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.

4 Cambia Palliative Care Center of Excellence at UW Medicine, A. Bruce Montgomery-American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.

5 UNESCO Chair on Bioethics of the Medical University of Vienna, Ethics, Collections and History of Medicine, Waehringerstrasse 25, 1090, Vienna, Austria.

6 Medical Intensive Care Unit, Peking Union Medicine College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China.

7 Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil.

8 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.

9 Department of Anaesthesiology and Intensive Care Medicine, Centre for Sepsis Care and Control, Jena University Hospital, 07747, Jena, Germany.

10 Pulmonary and Critical Care Medicine Alpert Medical School of Brown University, Rhode Island Hospital, Providence, USA.

11 The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia.

12 Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Avenue, Room D108c, Toronto, ON, M4N 3M5, Canada.

13 Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Abstract

INTRODUCTION: Conflicts of interest are a normal part of human social intercourse. They become problematic when there is a power differential between participants in the setting of relationships requiring a high degree of trust, as in healthcare. In this white paper we consider how these conflicts may be detected and mitigated.

METHODS: Following Medline search and reference chaining, we undertook a narrative review of the literature with iterative discussion.

RESULTS: Conflicts of interest may be financial, professional or personal, and may operate at the level of the individual or the organisation. Unmanaged, they become a source of bias which places the interests of the professional or the organisation before those of the patient. Reported with increasing frequency, conflicts damage trust, harm patients, and defraud the health system. We make 15 recommendations for minimising conflicts of interest.

CONCLUSIONS: Nationally funded open-access registries should be established to permit complete disclosure of financial, professional, and personal relationships with the potential for driving bias in research, clinical practice, or health management. Governance of disclosure should be the responsibility of employing organisations through annual staff appraisals, audited by national research integrity committees. Research fraud should incur suspension of the license to practice. Organisations should monitor staff perceptions of ethical climate to enhance awareness of staff behaviours and the potential for misconduct driven by academic pressures. Clear separation of advisory and voting roles is needed in best practice guideline panels. Professional societies and scientific journals should display conflict of interest policies for their own staff and officers as well as for speakers and authors. Undergraduates should not be exposed to pharmaceutical promotions masquerading as education. Undergraduate and postgraduate training programmes should include teaching about managing conflicts of interest and identifying research misconduct.