Why Conflicts Of Interest May Not Be As Bad As You Think (And Besides, We All Have Them)

In medicine and healthcare, financial conflicts of interest are typically seen as eroding the credibility of one’s message.

The logic is as follows:

If someone has a financial interest in the answer to a question then, of course, their answer will be biased by their financial interest.

This simplistic thinking has guided a generation of doctors and scientists and policy-makers.

But can conflicts of interest also represent depth of perspective?

Individuals with conflicts (also known as experience and interest) also have knowledge.

Knowledge that can be helpful in answering important questions.

Could someone who has developed medicines have something useful to say about how we should regulate pharmaceutical manufacturers?

Could someone who works for an insurance company have something insightful to say about reform of industry practices?

Might they even be more helpful than individuals with only an arms-length familiarity with the work at hand?

As someone who has worked in both industries—but is also mission-driven—I’d like to think so.

Could it be that the ubiquitous, reflexive intent to invalidate anyone with conflicts is self-defeating?

Or are we destined to be guided by people so dispassionate that they may have an uninformed perspective on the issue at hand?

When I was in medical school at Harvard in the early 2000s, the culture dictated that anyone who had a conflict of interest couldn’t be trusted (or invited to lecture at the school) and people who worked for companies that developed and commercialized medicines had gone over to the “dark side.”

Never mind that drug development was an important way to serve humanity.

When I was in government during the Obama administration from 2009-2011, there was a cultural tendency to overvalue the opinions of academics and researchers over practitioners in the field.

Objectivity—or at least the patina of objectivity—rules the day.

To be clear, I’m not advocating for devaluing the perspectives of so-called objective critics as I am recommending we be more inviting of perspectives of people whose proximity to issues gives them a high degree of knowledge and investment in the outcome.

We can merely acknowledge the conflict and place the perspectives voiced in the right context.

And while I’m at it.

We should also be careful to acknowledge lesser discussed conflicts that are more nebulous and so rarely “disclosed.”

Could it be that the person who has made his career on studies lambasting the ethics of the pharmaceutical industry might lose objectivity and be endlessly invested in lambasting the pharmaceutical industry?

Even if he or she lacks a financial conflict.

His/her identity may in fact be tied to it.

Or the person whose life’s work has been tied to demonstrating the value of a particular protein might over time lead him to overstate or overinvest in the value of that protein?

Dare I say, identity can be a far more powerful source of bias than money.

Identity that the so-called objective critic assumes, over time, assails their objectivity.

And there’s rare acknowledgement of one’s ideological or identity-based biases.

But maybe there should be.

Unself-aware critics who think that a lifetime of experiences and opinions leaves them unbiased might want to think again; maybe journals should include in disclosure forms “potential idealogic conflicts” alongside financial ones.

More likely than not those fields will be left blank.

For who believes that their opinion might be tainted or skewed by their perspectives?

Remarkably, almost no one. And therein lies the most important acknowledgement of all: whether we like it or not, we are all conflicted in some way or another.

It’s a feature—and a bug—of the human condition.