Not All Influences on Science Are Conflicts of Interest

In this issue of AJPH, Galea (p. XXX) suggests a typology for nonfinancial conflicts of interest in population health research. We propose that labeling nonfinancial interests as “conflicts of interest” currently serves as ethical shorthand for a variety of important issues that influence scientific research (C. Mayes, “After Conflicts of Interest: Does Medicine Have a Primary Interest in Commercial Health Care?” Sydney Health Ethics Conversations, unpublished, April 20, 2017). We call for empirical research into the situations in which nonfinancial interests are deemed relevant to identify the ethical, political, and social issues at stake. We argue that common strategies for managing financial conflicts of interest—namely, disclosure and recusal—are inappropriate for nonfinancial interests and call for investigation into the best strategies for managing the effect of these interests on research.

NOT ALL INFLUENCES ARE CONFLICTS

Galea’s proposed typology suggests that nonfinancial “conflicts” are associated with bias just as “conflicts of interest” are associated with bias. Conflict of interest refers to a situation in which a researcher’s primary interests, which have ethical priority, are dominated by secondary interests.¹ The interests labeled by Galea as “conflicts” are part of a scientist’s primary interest in conducting research and integral to this role. These “conflicts” are not problems for individuals but reflect broader, influential, and often systemic issues facing science today.

• Career interest conflict—Science cannot be conducted outside of the social, economic, and political structures supporting research.² Labeling these influences as “nonfinancial conflicts” individualizes the problem of systemic biases but leaves the problematic and often unequitable structures unaddressed. For example, are unambitious scientists the only ones who can be considered free of conflict? Instead, we should focus on building equitable, strong research institutions that foster and reward integrity in research.

• Network-based conflict—It has long been argued, and recently tested with citation analysis, that “science advances one funeral at a time.”³ In other words, prominent scientists dominate publications in their area, making room for new approaches only when they die or retire. The strong influence of scientific networks on publication is less an issue of conflict than it is a problem of representation and diversity in science. For example, a great deal of evidence supports the association between gender and citation rates, grant success, career success, collaboration, and so forth (e.g., West et al.⁴). However, to label being of a certain sex a “nonfinancial conflict” does not even begin to address the root causes of this important social influence on science.

• Ideological conflict—We live in an age in which scientific expertise is consistently undermined. All researchers have political, intellectual, and sometimes religious interests, as well as life experiences, that are often what draw people to do research. Labeling certain personal beliefs as “nonfinancial conflicts” suggests that others—who may hold different beliefs but nonetheless have beliefs and values—are objective. Following this line of thinking can result in the recusal of experts and stakeholders who, as Galea notes, have been explicit about their beliefs.⁵ This suggests that transparency disadvantages participation; that an objective view is one that entails an attitude of “don’t know and don’t care.”

SUMMARY

In summary, we agree that career, network-based, and ideological interests can be important influences on science and that merely articulating these interests may not improve research. Empirical research to identify the ethical, political, and social issues that underlie these influences is needed to address the root of the problem. Treating these interests in the same way as conflicts of interest obfuscates more important influences on science such as institutional structures for academic recognition, the lack of diversity and representation, and discrimination.

The focus on nonfinancial interests serves as a means to detract from financial conflicts of interest and the urgent need to develop rigorous management strategies. Despite being one of the many possible options for managing conflicts of interest, disclosure is the most commonly proposed and implemented strategy.⁶ No evidence indicates that disclosure eliminates conflicts or reduces bias and may, in some cases, achieve the opposite.⁷ Very little has been done to manage financial conflicts of interest, such as limiting or prohibiting financial ties between investigators and industry or removing individuals with financial ties from decision-making roles. The science that supports population health will be best served by more rigorous management of conflicts of interest and addressing the institutional structures, social systems, and politics that influence research.