Threats to scientific advancement in clinical practice

STUDY DESIGN. Point/counterpoint. OBJECTIVE. To facilitate debate regarding conflicts of interest and ethical considerations in physician/industry relationships. SUMMARY OF BACKGROUND DATA. We find ourselves working in a health care system in which nearly $2 trillion are spent, only to rank 37th in world health. That much money at stake piques peoples' interest, and various parties, without loyalty to the Hippocratic principles, will find opportunities to gain financially. Clearly, current health expenditures do not always coincide with better outcomes. Yet some believe that over 20% of the gross national product will be necessary to maintain our health care system in the future. Medical liability causes a paradoxical situation: physicians are at times driven to use the newest technology and perform many diagnostic tests, for fear of litigation. This practice is often independent of the best evidence. METHODS. Literature search and experience. RESULTS. The nature or magnitude of conflict(s) of interest influences the risk of bias in research. It is important to acknowledge and disclose these potential conflicts while recognizing that the existence of such conflict does not necessarily adversely affect the quality of the research. CONCLUSIONS. Conflict of interest need not be a conflict of the mind and is not an evil. Physicians need to disclose all relationships to industry and/or other potential conflicts in order to maintain the trust of one's community, and in order to advance the best science.