Let's Get Real About Conflict-of-Interest Disclosures

I'm Art Caplan. I am director of the Division of Medical Ethics at the NYU School of Medicine.

I should begin by saying that I have some conflicts of interest in the work that I do. I have a connection to a big pharmaceutical company. It is an unpaid position, but as chairman of a committee formed to help the company deal with the issue of how to use unapproved drugs that are in short supply, I give them advice about that problem. In the past, I have had relationships with other pharmaceutical companies, serving on data safety and monitoring boards, trying to determine whether a study should continue or be prematurely ended because of adverse events or good results. I know well the world of conflict of interest.

I know something else about conflict of interest, whether it is physicians trying to write up who contacted them from the pharmaceutical industry to market a product, or researchers trying to disclose conflicts to a journal. We are still back in the 20th century in terms of how we handle disclosure of conflicts of interest. We basically ask people to list their financial conflicts of interest and then, if it is a research study conflict, for example, journals will put in tiny type in an article, "Art Caplan has connections with these organizations and companies: Merck; Johnson & Johnson; Novartis; the American Almond Association"—whoever.

Is that enough?

I have told you two conflicts of interest that I have; in fact, I do not deem them to be much in the way of conflicts. I am rather proud of the work I do, trying to help the big pharmaceutical company ration access to scarce drugs. And I believe that serving on a data safety and monitoring committee to make decisions about whether a study should continue or end is something that ethicists should do; it does not create any kind of conflict for me, even though they may pay me a per diem to serve on the committee. There are conflicts and then there are conflicts, and they are not well managed just by saying, "Art works with drug company X, or Joe has a connection with agricultural entity Y."

Electronic Disclosure Gives Us Room to Explain the Relationships

I believe, and my colleagues at the NYU Division of Medical Ethics agree, that we should start using electronic disclosure for conflicts of interest. Rather than sending information off to journals or filing it with the Sunshine Act, each of us could build a website and disclose our relationships with any commercial entities, and even political and religious entities, there. I guess you could also include such things as, "I have worked with Art Caplan. I do not like him. He has been my enemy. I try to show that the things he says are false all day long." Any type of conflict you want to disclose or choose to disclose, why not put it into longer form, explain the nature of the work, and let people access it on the Web?

The notion that we write down conflicts on paper to send to a journal seems primitive to me. It is time to move ahead. We call it the Electronic Long-Form Conflict of Interest, and it says that you can build websites, anyone can disclose as much as they want in as much detail as they want, and then refer people there to see the conflicts of interest. I believe that it is way past time to do this.

Let's turn our conflict-of-interest disclosures electronic. You can go on to the extent that you want to, about financial and other forms of conflict of interest that do arise. You can explain why certain types of conflicts do not raise problems in your view, and then let other people make their judgments.

No more paper. Let's bring it into the 21st century. Conflict of interest ought to be a matter for electronic disclosure. That is the best way to proceed to handle complicated and often fairly nuanced problems of conflict of interest.

I'm Art Caplan from the NYU School of Medicine, and as I say, I have some conflicts. Thanks for watching.

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