Debates about conflict of interest in medicine: Deconstructing a divided discourse.

Abstract

Rationale: The pharmaceutical industry plays an increasingly dominant role in health care, raising concerns about “conflicts of interest” (COI) on the part of the medical professionals who interact with the industry. These concerns have led to widespread calls for the management of COI. However, there is considerable disagreement over the extent to which COI is a problem and how it should be managed. Participants in debates about COI have become entrenched in their views and dismissive of those who have opposing views, which is not only unproductive, but also likely to be deeply confusing for the vast majority of medical professionals who are simply trying to get their work done in an increasingly commercialized biomedical environment. One way of understanding and advancing debates of this kind is to analyse the social locations and belief systems of people with opposing views, and look for areas of similarity and difference that are not immediately evident in more superficial analyses. Method: Modified meta-narrative review of debates about COI in the academic and grey literature, using the analytical framework of Discourse Models. Results: Debates about COI can be characterised by two distinct Discourse Models. The Critical Discourse Model is espoused by those who see COI in health and biomedicine as a major problem that both can and should be addressed, while the Defensive Discourse Model is espoused by those who would conclude that current efforts to control COIs are at best unnecessary, and at worst harmful. The two Discourse Models are underpinned by profoundly differing views about how society should be organised—in particular whether market forces should be encouraged or curtailed—and how the dangers associated with market forces should be managed. Conclusion: While there is scope for progress in debates about COI, debates will never be completely resolved. in order to make any headway, both academics and policymakers must recognize that these debates are underpinned by profoundly differing views about security and flourishing.