Ethics Forum: Is a Conflict-of-Interest Slide Enough?

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We have all been to numerous lectures, grand rounds and other continuing medical education activities where the speaker, prepared and poised at the podium, begins his lecture with a title slide. Soon after, we see the ubiquitous conflicts of interest slide, which lists the invited speaker’s research funding, his consulting activities and his board memberships—all of which may influence the information presented. This slide is quickly clicked through, and the presenter then proceeds to deliver a well-researched, well-delivered lecture that is (usually) well received by the audience.

How does the audience truly know the presenter’s data and information are free from conflict? Is the conflict of interest slide adequate to protect the integrity of the information being delivered in any particular lecture or talk?

Recently, there has been no shortage of media reports pertaining to conflicts of interest in both the political and medical spheres. Despite the recent publicity, however, the concern over physician and researcher conflicts of interest is not new.

Definitions

When we speak about conflicts of interest, what do we really mean? The International Committee of Medical Journal Editors defines conflicts of interest as a type of conflict between a physician’s primary interest (i.e., patient care) and his secondary interests (e.g., financial gain, promotion).¹ The concern is that one’s secondary interests may interfere or influence the primary interests.

Conflicts of interest can potentially erode the trust between the conflicted party and the audience. In a recent issue of the Journal of the American Medical Association, McCoy and Emanuel describe a three-part causal chain in which a physician has a secondary interest that has the potential to bias their judgment. If their judgment is influenced by their secondary interest, then the biased judgment could lead to some type of harm.²

This is why everyone, including professional medical societies, medical schools, medical journals and the lay public, should have a shared concern in recognizing, understanding and addressing the issue of conflict of interest.

Status Check

How are we doing at the ACR? A 2017 study examined the reporting of conflicts of interests during oral presentations at five different medical conferences, including the 2016 ACR/ARHP Annual Meeting.³ The ACR fared well when compared with the other academic meetings observed; 45 of the 45 presentations analyzed included some type of a conflict statement or a slide dedicated to conflicts of interest.

This study also looked at the duration of time the conflict of interest slides were left up for viewing. The median duration of time these slides were shown was approximately two seconds.

The ACR has well-defined policies regarding conflicts for speakers, volunteers, committee and board members. The ACR website includes the disclosures of all board members. Again, is disclosure enough to ensure that conflicts of interest can be adequately examined and assessed?