The term “non-financial” conflicts of interest is inadequate to describe ethical challenges in biomedicine, according to data published in the Journal of Clinical Epidemiology. Interviews with the corresponding authors of sampled articles revealed that a wide range of personal and professional characteristics could be classified as non-financial conflicts of interest. Investigators accordingly advocated for more specific nomination of conflicts of interest to maintain equity in scientific literature.
Scholarly articles, which cited non-financial conflicts of interest, were identified through a systematic search of PubMed, Scopus, and Google Scholar. The corresponding authors for eligible studies were contacted and invited to complete qualitative interviews. Interviews were conducted between 2017 and 2019 by face-to-face, telephone, or video conference sessions. Interviews were comprised of 25-60 questions and prompted participants to share personal experiences in which a non-financial conflict of interest was relevant to their research. Interview responses and scholarly articles were analyzed to catalogue all policies regarding non-financial conflict of interest disclosure.
The literature sample was comprised of 99 articles, from which 16 authors were recruited for interviews. The majority of interview participants were men (63%; n=10) and the most commonly cited profession was physician (63%; n=10). Interviewees were based in North America (38%; n=6), Europe (31%; n=5), and the Asia-Pacific region (31%; n=5). A broad range of personal and professional attributes were labeled non-financial conflicts of interests by respondents. Overall, 20 disclosure policies were catalogued from published literature and interviews. Little consensus was found regarding what should be labeled a non-financial conflict of interest. However, 4 distinct themes emerged: (1) strong beliefs, (2) predetermined views, (3), experience, and (4) relationships.
Strong beliefs and predetermined views may affect a researcher’s ability to remain impartial, thus comprising an “intellectual” conflict of interest. Authors with a vested interest in a certain outcome may be reluctant to publish contradictory evidence. In the case of researcher “experience”, many participants noted that a researcher’s specialty, training, and background could unduly influence data interpretation. An interviewer cited recently published hypertension guidelines: if internal medicine clinicians, rather than specialists, had been involved, the recommendations “would be completely different.”
Finally, interviewees emphasized the influence of social relationships. An unbalanced hierarchy on an editorial committee, for example, could prevent equal contribution from members. One interview participant recounted the case of an unbalanced committee, in which certain members formed a voting “bloc” to ensure certain outcomes.
Non-financial conflicts of interests were defined variably by the literature and by interviewed experts. Investigators suggested that policymakers more explicitly define non-financial conflicts of interest in disclosure guidelines. However, authors also noted that describing all personal characteristics as “conflicts” may be inappropriate and ultimately exclusionary. Ultimately care must be taken to maintain appropriate research conduct in biomedicine.
Grundy Q, Mayes C, Holloway K, Mazzarello S, Thombs BD, Bero L. Conflict of interest as ethical shorthand: understanding the range and nature of ‘‘non-financial conflict of interest’’ in biomedicine. J Clin Epidemiol. 2020;120:1-7.