Core Faculty, Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Department of Family Medicine (CU School of Medicine), University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
J Bioeth Inq. 2020 Jun;17(2):217-227. doi: 10.1007/s11673-020-09989-4. Epub 2020 Jun 30.
The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.
本文的主要观点是，知识利益冲突（COI）确实存在，但相对于健康专业人员与商业行业之间因财务往来而产生的利益冲突，其伦理优先级较低。本文首先定义了知识 COI，并将其置于非财务 COI 学术研究的背景下进行阐述。然而，本文解释说，关键区别不在于财务和非财务 COI，而在于产生偏差的动机是源于关系还是其他因素。虽然对特定想法或观点的承诺可能会导致各种认知偏见，但这一事实并不能证明否认金钱关系对医疗行为、政策或两者都有巨大影响的合理性。有充分的理由认真对待知识 COI 和财务 COI，但本文表明，后者具有更高的伦理优先级。本文将提供多个理由，但主要理由是，知识 COI 可能提供怀疑认知偏见的理由，但它们通常不涉及对社会角色的信任丧失。而健康专业人员与商业行业之间因财务往来而产生的利益冲突则不然。本文随后假设主要理由是错误的，并进一步表明，为什么知识 COI 比基于关系的 COI 更重要的说法在其自身优点上是值得怀疑的。本文的最后一节对全文进行了总结和结论。
