RSNA: Removing conflicts from interests, how to thwart the risk

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CHICAGO—Physicians must be careful when creating relationships with industry and ensure that professional judgments do not harbor conflicts of interests, and professional organizations must create policies against these relationships that are effective in hindering them, according to a presentation Nov. 30 at the 96th annual Radiological Society of North America (RSNA) scientific meeting.

“We have known from the start the definition of our lives as physicians is that we should not have a conflict of interest,” said Phillip M. Devlin, MD, a radiation oncologist at Brigham and Women’s Hospital in Boston. But how can you recognize one? he asked.

Devlin defined conflicts of interests as “circumstances that create a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”

To reach a conflict, there must be three components: a primary interest, a secondary interest and a conflict. Secondary interests can include financial gain, professional advancement or the recognition for personal achievement.

“We know that most policies focus on financial gain because it’s quantifiable, whereas some of the other considerations really aren’t,” he offered.

While the aforementioned secondary interests are common, a conflict of interest only arises when the first interest is outweighed by the secondary interest and disturbs professional decision making.

“There is a lot of evidence that even the silly things in life—a pen or a sticky pad—will be the sort of thing, even subconsciously, that takes away from focusing on the primary interest,” said Devlin.

“There are threats to the integrity of professional judgment, but the conflict of interest starts when there is a risk to the primary interest … and exists even when there is no actual influence or person or institution.”

To prevent conflicts of interests, physicians must maintain a high standing in society.

“We must be vigilant, because once the confidence gets out of line its incredibly difficult to restore,” he said. Conflict of interest policies created by professional societies are meant to minimize situations that could put individuals at risk for stepping over professional boundaries.

“The concept of professionalism makes [conflicts of interest] preventive, makes them corrective, but does not make them punitive.”

Devlin said rather than focus on consulting fees, conflict of interest policies should center around situations, not individuals.

These policies must be not about a doctor's consulting fees, but instead regard conditions that made the influence happen. “What we need to do is to ask what needs to be declared … what matters?” said Devlin.

Questions to be addressed include what are the relationships that make conflicts of interest exist and what is the seriousness of possible harm.

Accountability and fairness are two issues that should be addressed when creating such policies.

Devlin concluded that physicians must constantly ask:

  • What would the public or patients think about this arrangement?
  • What is the purpose of the industrial arrangement? and
  • What would my colleagues think about this?