Conflict of interest (COI) arises when a person’s professional responsibilities are, or are at risk to be, compromised by outside biases, interests or obligations.1,2 In medicine, this means that the primary interest of physicians—i.e., to heal patients—is influenced by a secondary interest, such as money or fame.3 COI in medicine can be categorized based on source (individual or group), authority level of involved parties and secondary interest factor (money, time or loyalty).3 COI situations can be complex and come in many forms, ranging from subtle biases to tangible financial transactions.3
COI involves various types of stakeholders, and can be based on financial, academic or personal factors.4 Stakeholders in medical COI include individuals, such as clinical practitioners, research investigators, academic professors and medical administrators; institutions, such as medical schools, research organizations, health advocacy groups, scientific journals and grant commissions; and public groups, such as society in general, patients, research participants, law experts, media sources or nonprofit organizations.3 In medicine, types and examples of COI include—but are not limited to—gifts from drug companies to physicians; visits to physicians’ offices by drug and medical device company representatives, who often provide samples; research support and funds from industry; scientific, marketing and consulting services provided to companies by physicians; and funding from industry for continuing education programs.5 Unfortunately, many of these COI situations can become alarming. For example, physicians may fail to disclose payments from drug companies, researchers may choose not to publish negative results from industry-sponsored clinical trials or academic leaders may put their names on journal articles that were written by individuals in industry.5 On an institutional level, professional organizations may even create clinical practice guidelines based on industry funding.5 Thus, it is possible for COI situations to escalate enough that public confidence in medicine is undermined.5
In particular, COI in anesthesiology usually relates to drugs, devices and novel techniques in the practice, and it can occur in clinical practice, research, training or education.3 In clinical practice of anesthesiology, there is a relative lack of a physician-patient bond due to the patient’s compromised state.6,7 Therefore, the anesthesiologist may not feel pressured to have honorable motives and the patient may not question the anesthesiologist, giving rise to the potential for COI.3 In research, anesthesiologists may receive funding from industry leaders, thus creating bias in their studies or leading to promotion of certain devices.3 In educational contexts, an anesthesiology trainee may be compelled to write on a topic that appeals to his or her advisor, regardless of the trainee’s own interest.3 In all three contexts, COI can occur in financial and non-financial ways. Additionally, anesthesiologists may serve as consultants for industry developers, hold stock in companies or allow certain companies to produce and sell patented technologies in exchange for monetary benefit (i.e., patent-licensing agreements).8 COI can also cause anesthesiologists to administer anesthesia differently to similar patients or to have frequent (and unnecessary) follow-ups with patients to make a profit.3 Whether in practice, research or education, anesthesiologists are susceptible to COI and may need to acknowledge the influence of potential secondary interests.
Given the considerable potential for COI in anesthesiology, it is important to establish specialty-wide guidelines regarding COI. There is ample research on COI in medicine in general,5 as well as in anesthesiology. Some researchers have argued for reduction of COI in anesthesiology research,9 while others have suggested standards for managing COI in the specialty.10,11 Though anesthesiology is faced with many opportunities for COI, members of the anesthesiology community have shown significant efforts to regulate secondary motivations, and thus to put patients’ interests first.
1. Institute on Medicine as a Profession. Conflicts of Interest Overview. 2019; http://imapny.org/about-imap/contact-us/.
2. Muth CC. Conflict of Interest in Medicine. JAMA. 2017;317(17):1812.
3. Dutta A, Choudhary P. Conflict-of-Interest in Anesthesiology. Yearbook of Anesthesiology-7. New Delhi, India: JP Medical; 2018.
4. Bion J. Financial and intellectual conflicts of interest: confusion and clarity. Current opinion in critical care. 2009;15(6):583-590.
5. Lo B, Field MJ. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
6. Egbert LD, Jackson SH. Therapeutic benefit of the anesthesiologist-patient relationship. Anesthesiology. 2013;119(6):1465–1468.
7. Ribeiro CS, Mourão JI. Anesthesiologist: The patient’s perception. Brazilian Journal of Anesthesiology (English Edition). 2015;65(6):497–503.
8. Policy Statement Regarding Application of Harvard University’s Conflict of Interest Policies to the Granting of Licenses [press release]. Cambridge, MA February 4, 2008.
9. Barnes R. Unacceptable conflicts of interest. British Journal of Anaesthesia. 2018;121(5):1183.
10. Brimacombe Joseph R, Berry A. Conflict of Interest and the COPA Anesthesiology: The Journal of the American Society of Anesthesiologists. 1999;90(4):1235–1236.
11. Waisel DB. Ethics and Conflicts of Interest in Anesthesia Practice. In: Longnecker DE, Brown DL, Newman MF, Zapol WM, eds. Anesthesiology, Second Edition. New York, NY: McGraw-Hill Education; 2012.