Declaration of conflicts of interest may make bias worse, not better

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The way doctors categorise illness and manage it is usually highly influenced by panels of doctors. One problem here, though, is that these doctors can have financial ties to companies that can gain from those doctors’ recommendations. These ties can come in a variety of forms but include consultancy fees, speaking fees and stock/shareholdings in the company. These conflicts of interest can cause ‘bias’, and in an effort to do something about this, panel members are generally asked to declare their conflicts of interest.

It turns out, that in the US, psychiatrists on these panels more often than not have conflicts of interest. For example, 70 per cent of the members of panels responsible for drawing up the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM – the ‘psychiatry bible’) have declared conflicts of interest. The actual number may be worse as certain sources of funding (including some research funding) does not need to be declared.

Now, it’s generally accepted in the medical and scientific communities that declaration of conflicts of interest is a good thing. But does it actually help to stamp out bias? A recent piece in the on-line journal PLoS Medicine [1] suggests that declaration of conflicts of interests does not get to the root of the problem, and may make bias worse, not better.

The piece cites arguments from ‘decision scientist’ George Loewenstein and his colleagues which apparently show that “disclosure can actually lead doctors to give biased advice, either through strategic exaggeration (whereby more biased advice is provided to counteract anticipated discounting), or “moral licensing” such that advice is legitimized because advisees “have been warned” (that is, caveat emptor or “buyer beware”).”

According to their experiments, bias is considerably greater when conflicts of interest are disclosed. In addition, it turns out that patients think their doctors would never intentionally mislead them and tend not to discount advice in light of conflicts. In this way, it is claimed, “disclosure policies will never be the solution and are very likely exacerbating the problem of bias in medicine.”

Perhaps the real remedy here is to make it mandatory for panel members to be free of conflicts of interest. It is sometimes claimed that this would not work, as such people with appropriate experience would be difficult to find. If this is true, it speaks volumes as to how effective the pharmaceutical industry is at identifying potential ‘key opinion leaders’ and striking deals with them.


1. Clark J, et al. Does Conflict of Interest Disclosure Worsen Bias? PLoS Medicine 24 April 2012

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