Is it Really All about the Money? Reconsidering Non-Financial Interests in Medical Research

Abstract

Concern about financial conflicts crowds out sufficient consideration of other interests that may bias research conduct. Regulations, institutional policies, and guidance from professional bodies and medical journals all primarily focus on financial ties. But why? Economic gain is not the only powerful influence. This article argues that we under-prioritize non-financial interests in the regulation of medical research. It critiques the usual reasons given for regulating financial and non-financial interests differently - that the interests contrast in terms of tangibility, that financial interests are optional, and that financial interests can be efficiently carved out as a discrete area of focus. Moreover, disparate regulatory treatment seems inattentive to the very similar social and psychological forces that animate the bias effect of both financial and non-financial interests and fails to account for how financial and non-financial interests synergistically interact. Under-prioritization of non-financial interests threatens to erode public trust and creates negative spillover effects that weaken financial conflicts regulation. Optimal regulation requires a more integrated, balanced, and proportionate response to secondary interests in medical research.

Should we try to manage non-financial interests?

“…Indeed, the financial incentives associated with advisory board membership—for example, $1000 (£700; €800) or a free flight—seem to pale in comparison with the social and psychological importance of being invited to contribute to clinically relevant research, “improve” patient care, and gain status and respect in the medical community 89…”

“…The dismissal of non-financial conflicts of interest often stems from the notion that they are too complex and ubiquitous to be effectively managed 9. However, non-financial conflicts can be identified, assessed, and managed using similar strategies to those for financial interests—including, for example, disclosure and recusal.…”

“…Some propose trying to regulate the intellectual conflicts,9 while the solution for others would be to reduce or cease oversight of financial conflicts 14. However, consider that the law—which is where the notion of conflicts of interests first emerged—does not define conflicts of interest simply as anything that creates bias, nor does it regulate non-financial biases as conflicts of interest 15…”

Financial Conflicts in the New Era of Sunshine

“…Concern about financial conflicts has crowded out consideration of other secondary interests that can also bias health care decision-making. 199 Unfortunately, the evidence base is underdeveloped concerning the prevalence and influence of non-financial interests. There is no equivalent to the Sunshine Act in terms of comprehensive reporting of non-financial interests.…”

Don't fall in common science pitfall!

“…While the incidence of research misconducts is unknown precisely at global level (Fanelli, 2009), multiple symptoms and consequences of these drifts are tangible. Funding of research projects for example is entangled in complex competing financial and non-financial interests (Bird and Spier, 2005;Saver, 2012). Scientists are often assimilated to robots; they should be always available, highly productive and permanently at the top of the scale.…”