Conflicts of interest in medicine: a never-ending story
Conflicts of interest in medicine: a never-ending story
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DOI：
10.1007/s11739-020-02293-4
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发表时间：
2020-03-02
影响因子：
4.6
通讯作者：
Mannucci, Pier Mannuccio
中科院分区：
文献类型：
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作者：
Garattini, Livio;Padula, Anna;Mannucci, Pier Mannuccio
当个人在工作职责和个人利益之间做出选择时，可能会有利益冲突(COI)。在医学领域，COI可能无处不在，它们的披露现在已经成为职业生活中解决这些问题的最频繁的策略。在医学文献中，COI被分为两种不同的类型-金融型和非金融型。财务COI很容易识别，可以对研究中的任何结果产生偏差；因此，财务COI的披露非常重要。无法解决的两难境地是在哪里设置从行业获得的金额的最低限额。非金融COI是一个与相关个人内在相关的非常大的类别，范围从家庭关系到宗教信仰，仅披露其中许多就会引发隐私和道德问题。制药业引发的财务COI之争呈现出两种截然相反的叙事特征。批评者认为，由于制药业的首要目标不可避免地是推广其产品，最好的战略是远离财务COI。另一方面，辩方声称，金融COI受到意识形态的推动，但在实际实践中没有意义，因为任何一种利益都可能引发潜在的冲突。在关于金融COI的辩论中，一个缺失的问题是，医疗保健是经济学理论中的一个典型的“市场失灵”例子。由于健康不能被认为是一种“消费品”，“自由市场”的经济模式不适合医疗保健产品。总而言之，尽管财务COI的透明度本身无法阻止偏见的风险，但拒绝它将是一个更大的错误。在不同的情况下，强制性披露非金融COI风险在许多情况下是令人困惑和有问题的，矛盾的是分散了人们对金融COI造成的潜在偏见的注意力。
Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types-financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of 'market failure' in the economic theory. Since health cannot be considered a 'consumer good', the economic paradigm of 'free market' does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.