Understanding financial conflicts of interest.

The problem of conflicts of interest began to receive serious attention in the medical literature in the 1980s1,2. Studies have described a wide range of conflicts involving physicians, medical researchers, and medical institutions (the most comprehensive is by Rodwin3). Among the areas of concern are self-referral by physicians,4–6 physicians' risk sharing in health maintenance organizations (HMOs) and hospitals,7 gifts from drug companies to physicians,8,9 hospital purchasing and bonding practices,3 industry-sponsored research,10,11 and research on patients12. Yet the concept of conflict of interest itself has been inadequately analyzed, and consequently its elements, the purposes . . .

[1]  K. Rothman.  The ethics of research sponsorship. , 1991, Journal of clinical epidemiology.

[2]  D. Shimm,et al.  Industry reimbursement for entering patients into clinical trials: legal and ethical issues. , 1991, Annals of internal medicine.

[3]  R. Conley,et al.  Conflicts of Interest: Physician Ownership of Medical Facilities , 1992 .

[4]  M. Rodwin.  Physicians' Conflicts of Interest: The Limitations of Disclosure , 1989, The New England journal of medicine.

[5]  K J Rothman,et al.  Conflict of interest. The new McCarthyism in science. , 1993, JAMA.

[6]  A. Relman,et al.  Dealing with conflicts of interest. , 1984, The New England journal of medicine.

[7]  Arnold S. Relman,et al.  The new medical-industrial complex. , 1980, The New England journal of medicine.

[8]  A. Hillman,et al.  How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? , 1989, The New England journal of medicine.

[9]  J. Kassirer.  Medicine at center stage. , 1993, The New England journal of medicine.

[10]  D Blumenthal,et al.  Industrial support of university research in biotechnology. , 1986, Science.

[11]  D Blumenthal,et al.  University-industry research relationships in biotechnology: implications for the university. , 1986, Science.

[12]  J P Kassirer,et al.  The journal's policy on cost-effectiveness analyses. , 1994, The New England journal of medicine.

[13]  B. Hillman,et al.  Frequency and Costs of Diagnostic Imaging in Office Practice‐A Comparison of Self‐Referring and Radiologist‐Referring Physicians , 1990, The New England journal of medicine.

[14]  J. M. Mitchell,et al.  New evidence of the prevalence and scope of physician joint ventures. , 1992, JAMA.

[15]  R. Green.  Physicians, entrepreneurism and the problem of conflict of interest , 1990, Theoretical medicine.

[16]  R Smith.  Conflict of interest and the BMJ , 1994, BMJ.

[17]  J. Siwek.  Buying Editorials. , 1995, The New England journal of medicine.