coi bingo

CHRISTMAS 2015: PROFESSIONAL CONSIDERATIONS COI bingo Daniel S Goldberg assistant professor, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University; 2015-16 Honors College Faculty fellow, 600 Moye Blvd, Mailstop 641, Greenville, NC 27834, USA I’ve spent years studying, teaching, and writing about conflict of interest (COI). In that time I’ve seen hundreds of justifications offered for deep entanglements between physicians or scientists and commercial industry. Plausible arguments support such relationships, but the actors in question rarely invoke them. Instead, the standard reasons given often suggest no familiarity whatsoever with the substantial evidence base regarding motivated bias and its impact on human behavior, including physicians’ and scientists’ behavior. Any reasonable attempt to justify deep relationships with commercial industries must begin by acknowledging the evidence rather than trotting out tired justifications that have mostly been contradicted by the evidence. The claim that various barriers to such influence are sufficient to prevent it—for example, individual virtue, institutional management, or disclosure—is simply not an evidence based view. After reading yet another news story containing the usual sorts of flaccid justifications, I decided to construct a COI Bingo chart as a way of both satirizing the rationales offered and suggesting their typicality: a typicality which, again, contravenes a healthy and robust evidence base. Physicians and scientists often profess a commitment to follow the evidence wherever it leads. Those seeking to justify deep relationships with commercial industry ought to follow that dictum and acquaint themselves with the evidence on motivated bias and COIs. 1-4 Hence, the COI Bingo chart (fig 1⇓). An earlier version of this chart appears at: https://twitter.com/prof_ goldberg/status/630822492416950272/photo/1. Follow DSG on Twitter, @prof_goldberg 1 Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252-5. 2 Cain DM, Loewenstein G, Moore DA. The dirt on coming clean: perverse effects of disclosing conflicts of interest. J Legal Stud 2005;34:1-25. 3 Sah S. Conflicts of interest and your physician: psychological processes that cause unexpected changes in behavior. J Law Med Ethics 2012;40:482-7. 4 Sharek Z, Schoen RE, Loewenstein G. Bias in the evaluation of conflict of interest policies. J Law Med Ethics 2012;40:368-82. Cite this as: BMJ 2015;351:h6577 © BMJ Publishing Group Ltd 2015 [email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2015;351:h6577 doi: 10.1136/bmj.h6577 (Published 16 December 2015) Page 1 of 2 Feature FEATURE

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CHRISTMAS 2015: PROFESSIONAL CONSIDERATIONS

COI bingoDaniel S Goldberg assistant professor, Department of Bioethics and Interdisciplinary Studies, BrodySchool of Medicine, East Carolina University; 2015-16 Honors College Faculty fellow, 600 MoyeBlvd, Mailstop 641, Greenville, NC 27834, USA

I’ve spent years studying, teaching, and writing about conflictof interest (COI). In that time I’ve seen hundreds of justificationsoffered for deep entanglements between physicians or scientistsand commercial industry.Plausible arguments support such relationships, but the actorsin question rarely invoke them. Instead, the standard reasonsgiven often suggest no familiarity whatsoever with thesubstantial evidence base regardingmotivated bias and its impacton human behavior, including physicians’ and scientists’behavior.Any reasonable attempt to justify deep relationships withcommercial industries must begin by acknowledging theevidence rather than trotting out tired justifications that havemostly been contradicted by the evidence. The claim that variousbarriers to such influence are sufficient to prevent it—forexample, individual virtue, institutional management, ordisclosure—is simply not an evidence based view.After reading yet another news story containing the usual sortsof flaccid justifications, I decided to construct a COI Bingochart as a way of both satirizing the rationales offered and

suggesting their typicality: a typicality which, again, contravenesa healthy and robust evidence base.Physicians and scientists often profess a commitment to followthe evidence wherever it leads. Those seeking to justify deeprelationships with commercial industry ought to follow thatdictum and acquaint themselves with the evidence onmotivatedbias and COIs.1-4 Hence, the COI Bingo chart (fig 1⇓).

An earlier version of this chart appears at: https://twitter.com/prof_goldberg/status/630822492416950272/photo/1.Follow DSG on Twitter, @prof_goldberg

1 Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry.JAMA 2003;290:252-5.

2 Cain DM, Loewenstein G, Moore DA. The dirt on coming clean: perverse effects ofdisclosing conflicts of interest. J Legal Stud 2005;34:1-25.

3 Sah S. Conflicts of interest and your physician: psychological processes that causeunexpected changes in behavior. J Law Med Ethics 2012;40:482-7.

4 Sharek Z, Schoen RE, Loewenstein G. Bias in the evaluation of conflict of interest policies.J Law Med Ethics 2012;40:368-82.

Cite this as: BMJ 2015;351:h6577© BMJ Publishing Group Ltd 2015

[email protected]

For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe

BMJ 2015;351:h6577 doi: 10.1136/bmj.h6577 (Published 16 December 2015) Page 1 of 2

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