Some Reflections on Conflict of Interest
Adam Burgess
Conflict of interest (COI) has its own distinct dynamics and history but it is useful for it to be considered as part of the wider insistence upon openness. The notion is not new, but it now operates in an environment of a universal imperative for transparency. Explaining the expansion of its COI requirements, for example, the British Medical Journal stated that: “Transparency is the key” (1). It is partly for this reason it has acquired such momentum and sense of inevitability. This adds to the sense that transparency is an obvious good, beyond the question of all but the self-interested who wish their activities to remain hidden from public scrutiny. “What have you got to hide?” is the only question that need now be asked of objection to transparency, as if there could be no principle standing above it. This is problematic in the same way as the assumption of guilt without trial.
We have become (over)accustomed to the demands for transparency and statement of conflict of interest, losing sight of their distinctive, even peculiar character. Conflicted interest is readily resolved into corruption in a headline, yet there is no indication of the means by which such a process might occur, or how one might substantiate such a claim. Contemporary policy discussion is required to be “evidence-based,” yet such a requirement is lacking when it comes to the presumption that COI will result in corruption.
The routine assumption of COI is only one problematic aspect of this discussion. Its inconsistent and selective character has struck me in the course of conducting research. In one project, I interviewed campaigners against mobile/cell phone towers (2). Campaigners commonly expressed twin complaints about mobile phone corporations. On the one hand, they cared so little about public health that they refused to fund the research needed into whether their products were harming us. Yet any research that was associated with the mobile companies was likely to be dismissed because of its association with them. Corporate interests were necessarily conflicted in their view. Campaigners displayed credulity rather than cynicism when faced with commercial products implausibly claiming to offer protection from radiation, however. One of the principal voices of concern about mobile radiation was, at the same time, an entrepreneur selling home-made devices promising protection. Here a separate set of assumptions prevailed whereby financial benefit didn’t figure, and protective devices were made available as some kind of public service.
Contemporary culture is widely recognized as being, by historical standards, unprecedented in its mistrust of authority and institutions. It is a defining characteristic of the “risk society,” particularly mistrust towards the claims of science and expertise (3). As Beck’s description affirms, however, this mistrust is not consistently or uniformly applied, falling particularly upon scientific authority. One of the most useful perspectives from which to understand this process is that elaborated by Douglas and Wildavsky (4). One of the most enduring dichotomies they refer to - that has arguably acquired even greater force today - is that between the ”natural” and “unnatural.” Scientifically, this is evidently a false a counter position, as if there are, for example, “natural” and “unnatural” chemicals, let alone that the former is necessarily more beneficial to humans than the latter. But the dominant cultural script is not science-based, and it is in this context that the natural/unnatural motif can flourish and selectively elevate or extinguish apparent interests.
What is deemed “natural” tends to be embraced while its “unnatural” counterpart becomes absolutely rejected, and this contradiction also tends to inform whose and what interests are considered suspect. The global popularity of organic food and corresponding suspicion of genetically modified food is an example of both the contradictions of modern culture and the patterns along which it divides. There is little evidence that increased consumption of organics is informed by knowledge of the (very different) standards that apply to different organic produce. Rather, popularity is based simply upon a sense that it is more “natural” and will therefore be better for you. Organic is defined negatively by what it is not - "unnatural.” On this basis it goes without question that it must be better than the cheaper, manufactured alternative. Ironically, its extraordinary growth from the 1990s turned it into a global industry worth billions of dollars. While absorbed into mainstream supermarket shopping, its natural quality rendered it immune from suspicions normally falling upon other food.
“Frankenfoods,” as they were successfully dubbed by the media, enjoyed a quite different fate. Despite being, in scientific terms, only a refinement of agricultural technique, “genetic” suggested “playing God,” the embodiment of “unnatural” practice. While no conflicting interests are assumed to be at play in the case of organics, there appears to be nothing but commercial interests involved in GMOs - as if no practical benefit possibly could accrue to society from this innovation. For the anti GM campaigners, multinationals were simply foisting their unwanted – and unnatural – products on a vulnerable world. By contrast, the organic farmer or radiation protection device entrepreneur are not recognized as having even a potential conflict between a desire to sell products and being honest about their proven benefits. Culturally, they occupy the hallowed position of apparently not having any interests in the first place, and there is therefore no potential for conflict.
Controversies such as those concerning GMOs and organic food suggest it is not so much that there are good and bad interests, but that interests (from which those bringing risks to our attention are exempt) themselves are negatively regarded. COI can become a pejorative rather than merely descriptive expression partly because the very notion of “interests” themselves have, to an extent, become a “dirty word.”
The imperative towards revealing COI and the wider drive for greater transparency is not simply a response to actual incidents proven to have had a negative impact upon society.
However COI and transparency are regarded, it is important to recognize that it is a reactive response to mistrust. The assumption that it will do more than defensively respond and go on to resolve the crisis of mistrust is unsubstantiated. As late as 1979, for example, only 4% of British respondents in a survey on public perceptions toward regulators felt that a close collaboration between industry and the regulator was improper (5). In the European context it was, above all, the BSE crisis that has shaped contemporary regulatory responses (6). The BSE crisis was perceived in terms of conflict between a government and regulatory authorities that were claiming to be ensuring public safety through intense and uncompromising scrutiny but, at the same time, were beholden to the agricultural lobby. In the U.K. the crisis led directly to the creation of the Food Standards Agency, for example, an organization exemplifying the new ethos of transparency, which has all of its board meetings filmed and placed on the Internet. There is some evidence that the FSA has been able to increase trust in itself through being so transparent (7). But generally there is remarkably little scrutiny of the widespread implicit claim that greater transparency will restore lost trust and credibility.
The transparency imperative is a self-reinforcing perspective that tends to reinterpret everything in its own procedural terms. The assumption is that the BSE crisis might have been avoided had transparency already been in place, an unwarranted conclusion. The focus on procedure and communication style distracts from the fundamental problem, which was scientific. There was no scientific basis upon which to believe it would be possible for the disease to affect human beings, as it proved to do some 10 years after being identified in 1997. The issue with the BSE crisis was principally one of managing a disease and, secondly, how to communicate uncertainty. To reduce the problem to a lack of transparency and masking of conflicted interests is simplistic and misleading. Now, what the FSA actually does seems to have become less important than how it does it.
COI is about procedure and that the “right thing” is seen to be done. This may be necessary under certain circumstances, but we should recognize that it tends to limit discussion and only affirm rather than challenge public misconception around important issues. The prejudice that research outcomes are necessarily merely the product of their sponsors’ requirements (and that criticism can only be self-serving defence of interests) is reinforced by further attention and measures to limit COI. There remains limited public understanding of peer review and the scientific method, and in this context criticism of COI measures usefully raise issues that could benefit understanding of the scientific process. It would be useful to develop public understanding of how different aspects of the scientific method from case control to peer review limits (though, of course, doesn’t exclude) the potential for bias. It would even be useful to encourage greater public understanding of how the bias addressed through random selection of participants is more an unconscious one than related simply to sponsorship. This could temper blind cynicism and turn it into a more active scepticism.
The exclusive focus on COI tends to restrict discussion to the narrow question of the source of research funding. Particularly when important substantive issues are at stake, this becomes problematic. COI is a very limiting and simplistic perspective through which to understand research, and it would be better to encourage an examination and debate around actual evidence. Discussion should be mindful of the broader public understanding, what assumptions will be reinforced and how any negative effects might be tempered. Drawing all this out into the open would be a useful exercise in itself, encouraging more discussion of an issue that has largely escaped critical scrutiny. Besides anything else, we need to make clear that there is nothing wrong with interests and they can no more be abolished than can risk. Further, we need to ask why it is that the demand for COI is so inconsistently applied and assumed. This would be a step towards a more grown-up dialogue that can see beyond the exclusive focus upon the source of research funding to the exclusion of the methods and content of research itself.
References:
1. Smith, R. (1998). Beyond conflict of interest. Transparency is the key. BMJ,317, 291-292.
2. Burgess, A. (2004). Cellular phones, public fears and a culture of precaution. New York: Cambridge University Press.
3. Beck, U. (1992). Risk society: Towards a new modernity. London: Sage.
4. Douglas, M., & Wildavsky, A. (1994). Risk and culture. Berkeley, CA: University of California Press.
5. Hayward, J., & Berki, R. (1979). State and society in contemporary Europe. Oxford: Robertson.
6. European Commission. (2001). European governance: A white paper. Brussels.
7. FSA. (2003). Comparison of putative health effects of organically and conventionally produced foodstuffs: A systematic review. London.