Conflicts of Interest: Concepts, Conundrums, and Course of Action

Ronald W. Pies, MD


November 11, 2013

In This Article


The definition of a COI remains somewhat contested, but this much seems clear: If a physician feels uncomfortable because his or her professional obligations are in persistent tension with his or her personal advantage, it's best to assume that a COI exists and address it responsibly. Indeed, as Dr. Geppert observes, "Even the appearance of a COI can itself cause harm" (Personal communication; October 27, 2013). This is true whether the COI is financial or personal, and whether within, or outside, the doctor/patient relationship.

Academic and research-oriented psychiatrists must pay particular attention to the integrity and transparency of their teaching and publications. COIs are not at all uncommon and by themselves do not represent a breach of medical ethics. In fact, as Dr. Geppert comments, COIs "...are really another form of the classic ethical dilemma in which one must choose from among several 'goods.' COIs are unavoidable; what matters is their disclosure and management." (Personal communication; October 27, 2013). Ironically, as David Healy has commented, "The only people with no conflicts of interest when it comes to clinical care are those with nothing to offer. But these biases must be open to scrutiny for which access to data is critical."[13]

Acknowledgments: I wish to thank Cynthia M.A. Geppert MD, PhD; Diane P. Toby PhD; and Glen Gabbard MD, for their very helpful comments and suggestions on earlier versions of this paper. Thanks also to David Healy, MD, for providing his paper on COI.


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