Yesterday, the Journal of the American Medical Association (JAMA) released an editorial entitled “Confluence, Not Conflict of Interest: Name Change Necessary.” The authors argue that the phrase “conflict of interest is pejorative,” and a better term “would be confluence of interest, implying an alignment of primary and secondary interests.” “Disclosure is necessary but insufficient,” they write. “It can serve to mitigate, but not to avoid bias.”
The editorial authors, Anne Cappola and Garret Fitzgerald, report that their conclusions are the result of discussions from a recently convened international meeting on conflict of interest held by the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania.
Cappola and Fitzgerald write that conflict of interest is overly “confrontational and presumptive of inappropriate behavior,” while confluence of interest “ represents a complex ecosystem that requires development of a uniform approach to minimize bias in clinical research across the academic sector.”
They explain that many potential sources of bias escape disclosure policies. For example, researchers may be motivated and biased by academic fame, emotional attachment to their work, and pressure from departments, universities, nonprofit funders, and journals.
They call for a “terrain-mapping approach to potential sources of bias” that “ would express and give weight to elements of fame and fortune on the y-axis, charted against individuals and entities on the x-axis that are likely to gain from the endeavor.”
The authors conclude: “Such a policy must be at once simple and accessible, capturing the complexity of the relationships while being sufficiently flexible at the individual level not to intrude on the process of innovation.”
Both authors report funding from industry and institutional sources in their disclosure statement.
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Cappola AR, FitzGerald GA. Confluence, Not Conflict of Interest: Name Change Necessary.JAMA. Published online September 24, 2015. doi:10.1001/jama.2015.12020 (Full Text)