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Conflict or Confluence of Interest?

Conflict or Confluence of Interest? To the Editor A recent Viewpoint1 suggested that “the term conflict of interest is pejorative” and proposed using “confluence of interest” instead, along with visually mapping the complex system of biases within and around research. The material is thought-provoking but problematic. To us it is far from clear that conflict of interest is a depreciative term. Although there are biasing factors other than conflicts of interest,2 the phrase captures the difficult nature of the topic and is not pejorative when correctly used to speak of perceived or potential—not actual—conflicts. Furthermore, confluence of interest is itself a problematic term. It implies that interests flow together, whereas reality suggests that some interests can counteract or outweigh others. The authors seem to believe that “implying an alignment of primary and secondary interests” for which biasing factors are not seen as problematic would be preferable to admitting that potential conflicts exist, but they did not offer any arguments for this position. The objective might be to minimize biasing factors, but renaming the term used to refer to biases while the objective is far from being met could undermine all the work done toward encouraging researchers to declare potential conflicts.3,4 To take a different example, if there was a problem with the terminology “fabrication of results,” would it be renamed “full and transparent reporting” simply because the latter is the ultimate aim in combating the former? This would not seem appropriate, and the same applies to conflict of interest. Moreover, although details of the terrain-mapping approach and its usefulness remain unclear, it is surprising that the authors think placing a 3-dimensional terrain mapping ‎of fame and fortune resembling a heat map on consent forms would be a “simple and accessible” approach. Consent forms are already overlong and overcomplicated without giving potential study participants visual representations of how fame and fortune may bias investigators, institutions, funders, and journals in the complex interplay5 of research. Ultimately, renaming conflicts of interest “confluence of interest” would do more harm than good and the proposed terrain mapping may complicate the issue beyond reasonable limits. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: David M. Shaw, PhD, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland (david.shaw@unibas.ch). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Cappola AR, FitzGerald GA. Confluence, not conflict of interest: name change necessary. JAMA. 2015;314(17):1791-1792.PubMedGoogle ScholarCrossref 2. Shaw DM. Beyond conflicts of interest: disclosing medical biases [A Piece of My Mind]. JAMA. 2014;312(7):697-698.PubMedGoogle ScholarCrossref 3. Shaw DM, Erren TC. Ten simple rules for protecting research integrity. PLoS Comput Biol. 2015;11(10):e1004388.PubMedGoogle ScholarCrossref 4. Erren TC. Competing interests: judged in perpetuity. Nature. 2012;488(7413):590.PubMedGoogle ScholarCrossref 5. Erren TC, Shaw DM, Morfeld P. Analyzing the publish-or-perish paradigm with game theory: the prisoner's dilemma and a possible escape. [published online September 12, 2015]. Sci Eng Ethics. doi:10.1007/s11948-015-9701-x. PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Conflict or Confluence of Interest?

JAMA , Volume 315 (16) – Apr 26, 2016

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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2016.0324
Publisher site
See Article on Publisher Site

Abstract

To the Editor A recent Viewpoint1 suggested that “the term conflict of interest is pejorative” and proposed using “confluence of interest” instead, along with visually mapping the complex system of biases within and around research. The material is thought-provoking but problematic. To us it is far from clear that conflict of interest is a depreciative term. Although there are biasing factors other than conflicts of interest,2 the phrase captures the difficult nature of the topic and is not pejorative when correctly used to speak of perceived or potential—not actual—conflicts. Furthermore, confluence of interest is itself a problematic term. It implies that interests flow together, whereas reality suggests that some interests can counteract or outweigh others. The authors seem to believe that “implying an alignment of primary and secondary interests” for which biasing factors are not seen as problematic would be preferable to admitting that potential conflicts exist, but they did not offer any arguments for this position. The objective might be to minimize biasing factors, but renaming the term used to refer to biases while the objective is far from being met could undermine all the work done toward encouraging researchers to declare potential conflicts.3,4 To take a different example, if there was a problem with the terminology “fabrication of results,” would it be renamed “full and transparent reporting” simply because the latter is the ultimate aim in combating the former? This would not seem appropriate, and the same applies to conflict of interest. Moreover, although details of the terrain-mapping approach and its usefulness remain unclear, it is surprising that the authors think placing a 3-dimensional terrain mapping ‎of fame and fortune resembling a heat map on consent forms would be a “simple and accessible” approach. Consent forms are already overlong and overcomplicated without giving potential study participants visual representations of how fame and fortune may bias investigators, institutions, funders, and journals in the complex interplay5 of research. Ultimately, renaming conflicts of interest “confluence of interest” would do more harm than good and the proposed terrain mapping may complicate the issue beyond reasonable limits. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: David M. Shaw, PhD, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland (david.shaw@unibas.ch). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Cappola AR, FitzGerald GA. Confluence, not conflict of interest: name change necessary. JAMA. 2015;314(17):1791-1792.PubMedGoogle ScholarCrossref 2. Shaw DM. Beyond conflicts of interest: disclosing medical biases [A Piece of My Mind]. JAMA. 2014;312(7):697-698.PubMedGoogle ScholarCrossref 3. Shaw DM, Erren TC. Ten simple rules for protecting research integrity. PLoS Comput Biol. 2015;11(10):e1004388.PubMedGoogle ScholarCrossref 4. Erren TC. Competing interests: judged in perpetuity. Nature. 2012;488(7413):590.PubMedGoogle ScholarCrossref 5. Erren TC, Shaw DM, Morfeld P. Analyzing the publish-or-perish paradigm with game theory: the prisoner's dilemma and a possible escape. [published online September 12, 2015]. Sci Eng Ethics. doi:10.1007/s11948-015-9701-x. PubMedGoogle Scholar

Journal

JAMAAmerican Medical Association

Published: Apr 26, 2016

References