How Do We Know?
Determining whether a speaker’s judgment is biased is not necessarily straightforward. Although disclosures are an important part of identifying conflicts, some have argued that this measure is not sufficient.4,5 Critics argue that disclosing one’s relationships, financial or otherwise, does little in the way of alleviating concerns over conflicts of interest. In fact, they have argued that disclosures may, inevitably, complicate discussions pertaining to conflicts, as disclosures may be difficult to interpret by colleagues and patients. The difficulty in understanding disclosures could result in more skepticism and in loss of trust between the presenter and his or her audience.
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Explore This IssueDecember 2018
Proponents of strict conflict of interest standards understand that levels of severity in conflicts exist and that not all conflicts of interest are created equal. It has been argued that severity of the conflict can be judged by two factors: 1) the likelihood a secondary interest will bias judgment and 2) the level of harm caused by the biased judgment.4
What means do we have available to manage and evaluate a speaker’s conflicts of interest? Disclosures can be an important tool in assessing conflicts, but as mentioned earlier, their effectiveness may be limited. Rather than simply listing sponsored activities on a slide, we should perhaps do our best to assess the degree of potential bias these activities may cause.4
More specifically, it is important to fully understand the financial gains a speaker may receive from sponsored activities. The social science and medical literature is rich with examples of how gifts, however small, influence one’s decision-making process.6 That said, there is a relative lack of research showing how exact dollar amounts influence the decision-making process. It has been hypothesized that the greater the financial interests, the greater the potential for bias and, thus, the greater the conflict of interest.2
Here are some of the potential ways the disclosure slide can be improved upon so the audience is better able to assess the speaker’s conflicts:
- In addition to listing the sponsored activities, the speaker should list the dollar amount received or expected from the activity and the manner in which these funds will be allocated. This clarification would allow the audience to assess the potential severity of the conflict rather than simply the activity itself.4
- The speaker should include the duration of time they have been involved in the particular activity or the duration of time they will receive funding.4
- The disclosure slide should be kept on the screen for a time sufficient for the audience to read it. Perhaps, the slide should be shown again at the conclusion of the presentation, because that would allow those audience members who were not present at the beginning to review the information.3
Ideally, as healthcare professionals, researchers and teachers, our primary interests should always be our focus. We must remain cognizant of the effect that secondary interests may have on our judgment regarding patient care, research and teaching. At times, our ability to recognize these potential clashes between our primary and secondary interests is skewed. It is, therefore, imperative that we remain as open and transparent as possible to ensure we remain committed to our ideals and don’t allow conflicts of interest to interfere with our ultimate goal: the care of patients with rheumatic diseases.