It is time to move beyond a culture of unexamined assumptions, recrimination, and blame to one of systematic analysis and ethical dialogue

Abstract

Conflicts of interest are a big topic in medicine today. There is a proliferation of articles, guidelines, and rules providing advice about how to address what is widely regarded as a rampant problem (Zinner et al. 2010; Rockey et al. 2010; Licurse et al. 2010). Despite the large quantity of materials, however, the quality of thinking and analysis is generally very poor. In part, this is because the whole field is dominated by a few basic assumptions that are simply incorrect. The article by Brody (2011) exemplifies this literature and these errors. In this commentary we draw attention to these mistaken assumptions and present a more rigorous and, we believe, more effective approach to the identification and management of conflicts of interests. What are the mistaken assumptions? Starting from the rather perplexing assertion that “medicine is a social role,” Brody asserts that a conflict of interest entails a physician “unnecessarily” entering into “a set of social arrangements” that are “morally blameworthy,” in that they carry the risk of “tempting” him or her away from “patient-centred duties,” or “patient advocacy,” in favour of a personal (or third party’s) interest, and thereby threatening public trust (Brody 2011). Each of these assumptions is wrong: The circumstances under which conflicts of interests occur may or may not be avoidable; they need not be blameworthy; they may have nothing to do with “patient-centeredness,” advocacy, or any other specific value; they need not assume any particular moral hierarchy; and they may have nothing to do with public trust.