A conflict of interest in science occurs when a researcher has interests or associations that could interfere with their performance of ethical and legal duties as a scientist. These duties include carrying out their responsibilities in an unbiased and objective manner, like their expectation to report their findings accurately and transparently. (Friedman, P.J., 2002) This is expected of scientists, in order to defend the integrity of science and protect the public trust of scientists and their research. Conflicts of interests, often referred to as COIs, may encourage a scientist to intentionally violate their obligations, or unknowingly compromise the way they perform their research and the decisions they make. Interests can be tangible (financial) or intangible (personal, political or social). (Resnik, 2007) This becomes an issue when scientists use their authority in the situation for personal or financial gain, which threatens the integrity of science and the science community.

Not all COIs qualify as scientific misconduct; conflicts of interest exist whether or not actual decisions are compromised. (Friedman, P.J., 2007) When there is a conflict of interest, a professional scientist is expected to recognize the COI, avoid relationships that might provoke a COI, and then disclose the COI to affected parties. Even when a scientist follows these steps and protocols, being sure not to violate any of their obligations, it is still considered a conflict of interest. Friedman says “Their potential is to damage research objectivity by causing bias, which induces deliberate or inadvertent error.” (2002) Therefore, there is no “potential” conflict of interest, because the researcher might not realize that the COI is damaging their research; any kind of interest or association that could possibly lead to bias and damaging research is considered a conflict of interest.

Conflicts of Interest have always occurred in science research. However, they didn’t start to receive recognition until the 1980’s, when relationships between private companies and institutions became more prevalent, due to legislative changes encouraging technology transfer from the public to the private sector. (Resnik, 2007) Since then, regulations and rules have been implemented, like disclosure requirements of industry and other funding. (Ruff, 2015) These statements are becoming more prevalent and are called disclosure of interests, or DOI. DOI statements require the researcher to disclose all (financial, political, personal, and professional) interests, activities, and relationships that could affect their research, their thinking, and their outcomes. (Ruff, 2015) DOIs require the researcher to report these interests to affected parties of their research article; for example, reviewers and readers of a journal article, supervisors, and research participants. 

Though precautions like DOIs are in place, it does not wholly solve the COI issue. Conflicts of interest will not only always exist, but become more and more complex. Constructing new and improved solutions to this issue will be an ongoing challenge, but it is the duty of the scientific community to take action and combat the issue of COIs to protect the integrity of science research. 

How are hypothetical conflicts of interest discovered?

The reasons for why a Conflict of Interest occurs can often be very hard to define as mentioned in the previous section, however the tensions that may become apparent from one is very noticeable, thus many may feel subject to reason that they may be experiencing a conflict of interest. The best way for scientists to develop the skills to understand how these conflicts are discovered, and hopefully prevent their own, is by looking into some scenarios. A lot of these scenarios are based on real events and research was done on those events.

One major industry that relies on the work of science in sports. Sports science has been advancing drastically in the past couple of decades, and there are a lot of educational papers on the topics of sports medicine. And in more expensive sports leagues such as the NFL, millions of dollars are spent each year to take care of their players and make the sport safer. When an injury occurs, the physician on call has a moral obligation to treat the player and make sure that they are okay. However, the team and player may have an issue with removing the player from the game as they may be an important asset. When this occurs, the physician’s recommendations for the well-being of the player may be overridden by the team. Moreover, in a league as prestigious as this, everything is written and documented. This allows for other doctors to use those recommendations for consultations and could potentially even be new areas for research. Most importantly, that written document that says the player should or should not play could be used against the physician if anything goes wrong. And at that moment, a potential conflict of interest was just discovered. The physician could choose to not pursue any further action but if the situation was very serious to a point that morally the doctor couldn’t allow the player back on the field there could be a much bigger conflict brewing especially in leagues such as the NFL (Cohen, Lynch, Deubert, 2016). On top of that, the written reports that explain the physicians’ findings could be used as evidence against them if any legal action does take place.

Many conflicts of interest may also be a matter of money and finances. When we think about funding for research, oftentimes institutions fund research that they are more interested in. In an article that had to do with the do with robotic-assisted unicompartmental knee arthroplasty (UKA) vs the standard approach UKA, it can be almost obviously be presumed that more funding will be granted towards robotic-assisted UKA versus the standard approach leaving those who pursue the standard approach with less funding. This may cause certain Conflicts of Interest between the funders and the researchers writing about the less popular approach because they are purposely being ignored for their research, and the priority is given to the robotic-assisted research. (Bronson, Chen, 2019)

Let’s take a look at another example. Consider a researcher that is writing a new protocol, that could potentially change the course on how a drug is to be studied. Let’s say a board member of the institution that the researcher works at had different plans on how the protocol should be written and persuaded them with gifts or other bribes(Nichols-Casebolt, Macrina, 2015). That researcher now may feel as though they are in an uncomfortable situation, they have no choice but to agree with the board member. This would be a perfect example of a COI in research and something that would have to be looked into.

After examining these scenarios, it is easy to assume that conflicts of interest can be discovered in a wide variety of ways, such as the examples with the physicians in the NFL or the researchers, and there isn’t a set measure that leads to the discovery of a conflict. Another important takeaway is that usually when people think of a conflict of interest in a professional setting, it was most likely due to an issue that arose from money, however that is not always the case and it could very well be due to a question of morals and ethics within the people in the situation as described in the NFL situation. There are many deeper meanings to how one can discover a conflict of interest but these are some of the common ones. 

What drives a conflict of interest?  

Conflict of interest, at its core, is a human-related issue. If we are looking at its factors, it isn’t hard to see that it is usually caused by personal matters. Scientists and researchers of different fields have to follow a variety of strict codes of conduct in their respective institutions to avoid conflicts of interest, and violating them can bring different degrees of punishment. However, even with these rules and regulations, people and organizations will be driven to violate said rules and cause conflicts, because there is still a possibility that individuals have a strong desire to maximize and/or protect their profit at the risk of creating conflicts of interest. In short, “A researcher has a conflict of interest if and only if he or she has personal, financial, professional, or political interests that have a significant chance of compromising the judgment of the average scientist in the conduct of research.”  (Almassi, 2014) A conflict of interest can be caused by varying types of factors. In this case, we will divide the factors into two categories: non-financial and financial. 

Non-Financial Conflicts of Interest

Non-financial conflicts of interest factors include a wide range of subjects, including but not limited to: 

• Ideological or religious beliefs (conflicts of conscience)
• Personal friendships or enmity
• Academic favoritism or jealousy

Ideological or religious beliefs (Conflicts of conscience)

For example, a scenario where a reviewer whose religious affiliation makes her “morally opposed to fetal cell research being asked to referee a study of a project using cell lines derived from an aborted fetus” (Marcovitch, 2010) is an example of conflict of interest involving religious beliefs. Science and religion have been having conflicts of interest for a very long time in history due to their differing views on subjects ranging from biology and physics to astronomy. Another example of conflict of interest involving religious or ideological beliefs is the famous case of Giordano Bruno defending Nicolaus Copernicus’ model of heliocentrism, which received severe opposition from the church and ended up costing Bruno’s life. In this case, heliocentrism directly conflicted with the church’s teachings of geocentrism and could cause people to doubt the accuracy and credibility of religious scriptures, resulting in a decrease of people supporting the church. 

Personal friendships or enmity

In the process of publishing scientific works, a researcher might choose reviewers, editors, and authors that are familiar or share interests with them and them only. That’s because it means the researcher will have a higher likelihood of having their work approved based on personal relationships instead of the research publication itself, and the reviewers are likely to approve the publication in order to keep that personal relationship for future personal profits. For example, an editor can send to “known sympathetic reviewers a paper from an author who had supervised his postdoctoral fellowship and who remained a personal friend.” (Marcovitch, 2010) This is an example of personal friendships affecting the validity of research findings, creating conflicts of interest via personal bias and friendships. If personal friendships can cause conflicts of interest, so can personal enmity. For example, if the reviewers in the example above did not approve of the editor’s works, then it is possible for that editor to think of the reviewers as enemies and vice versa. This scenario can end up creating personal enmity, which creates conflicts of interest again by looking at a publication based on negative personal relationships instead of the objective validity of the publication.

Academic favoritism or jealousy

Research papers and writings have to go through peer reviews, and the review process is vulnerable to conflicts of interest as well. Reviewers can have “professional differences that can be viewed as affecting the review’s objectivity” (Boruch, 2018). For example, reviewers of a publication are often researchers and/or scientists in the same field as the author, which means the publication they are reviewing might disapprove of their own. There is also a possibility that the reviewers are in favor of the publication they are reviewing, disregarding the validity of the publication’s findings. Both examples can both be considered conflicts of interest. In either case, the reviewers are highly susceptible to lowering their review’s objectivity. 

From the 3 factors above, it is not hard to see that non-financial conflicts of interest will always exist, since human emotions cannot be fully removed from the equation in scientific research, and human emotions can frequently clash with the more logical and scrutinized spectrum of scientific research.

 

Financial Conflicts of Interest

Financial conflicts of interest factors arise from financial relationships that can cause a conflict of interest. According to Institute of Medicine, these factors’ forms include: 

• Equity interests
• Profit-sharing arrangements

Equity interests

Equity interests include cases where capital like stocks are “held directly by the investigator or indirectly through various financial systems or holdings by relatives” (Institute of Medicine, 1991). Stockholders and researchers can have drastically different understandings and preferences on the same research publication. While researchers prioritize following their code of conduct and producing accurate results, stockholders would prioritize on profit. This would end up causing financial conflicts of interest. Adding to that, stockholders, in the end, are not scientists. This means that they are highly susceptible to giving researchers demands that are absurd or focus solely on profit or the image of companies without considering the actual work or obstacles the researchers are facing. In any field, not only science, having someone with little to no understanding of your research subject to hold power to redirect, edit or completely deny it can be detrimental. That’s because it can lead to unprecedented consequences like health or safety hazards if the research is focused on a product that is sold to the mass public.

Profit-sharing arrangements 

When researchers “acquire financial interests in the new drugs or clinical devices they are studying, or when they receive support for their laboratories from the manufacturer of those products, they face possible conflicts of interest” (Institute of Medicine, 1991). The truth to most scientific research is that money is an important driving force to it. Equipment, manpower, and research environment are just a few of everything that requires capital in science. For some scientific research, companies are behind the funding and sponsorship, so they have a say in the researcher’s results, hence creating conflicts of interest if the research findings have the risk of lowering the company’s profits. An example of profit-sharing arrangements creating conflicts of interest is an assessment of researches with sponsorship from or conflicts with food companies and their findings’ likelihood of associating sugary beverages with health hazards or not. According to the assessment, “SRs[scientific research] with stated sponsorship or conflicts of interest with food or beverage companies were five times more likely to report a conclusion of no positive association between SSB[sugar-sweetened beverages] consumption and weight gain or obesity than those reporting having no industry sponsorship or conflicts of interest.” (Bes-Rastrollo, 2013) 

 

Can a Conflict of Interest bias a researcher?

Conflicts of interest are important to consider because they have the potential to jeopardize the objectivity of a scientist by creating bias within their work. Whether this bias is intentional or unintentional, it can play a significant role in the motivation, decisions and integrity of a person. Someone’s bias can be hard to identify and can even go unrecognized often in research that is affected through a personal interest. This can be a major problem especially within research by skewing the findings of a paper to portray a conclusion that is not totally factual. Even though there are regulations and disclosure forms put in place to avoid these situations from occurring, they do not always solve this issue. In this section we will analyze: 

• Bias caused through a financial COI
• Bias caused through a non-financial COI
• Steps the scientific community is taking to prevent bias

Bias From a Financial Conflict of Interest

In order to show bias caused from a conflict of interest, we will focus on the sugar-sweetened beverage companies and the tobacco industry. We chose these two cases because they are clear examples showing how and why research can be biased.

In the case of sugar sweetened beverages, as mentioned in the section What Drives a Conflict of Interest an examination was conducted on whether conflicts of interest affected systematic reviews on this type of beverage and their link to weight gain. The sugar-sweetened beverage companies had a major financial interest, as they would have taken a major hit if scientific nutritional evidence had come out against the sugary beverages. With this interest at stake, this shows why beverage companies would sponsor research about their products. The research found systematic reviews affiliated with the food or beverage companies “were five times more likely to report a conclusion of no positive association between SSB consumption and weight gain or obesity than those reporting having no industry sponsorship or conflicts of interest.”(Bes-Rastrollo, 2013) This suggested that research sponsored by these companies might be biased towards a certain conclusion. The reason why this research is being biased is because companies are sponsoring scientists’ research. Due to this implication, researchers can feel obliged to skew their results to favor the view of their funder. This discrepancy found within research of a financial interest involvement could have been caused by bias within the design, publication, or analysis of the results from the experiment.

In the tobacco industry a case occurred with companies sponsoring scientific research papers about the effects smoking has on the human body. This case study analyzed the differences in opinion on smoking and their connection to tobacco companies. The study found that “94 percent (29/31) of reviews by tobacco-industry affiliated authors concluded that passive smoking is not harmful compared with 13 percent (10/75) of reviews without tobacco industry affiliations.” (Krimsky 2013) The tobacco companies’ sponsoring research were 88.4 times more likely to conclude that passive smoking was not harmful compared to non-sponsored research. The tobacco companies sponsored a large number of papers that were filled with biased evidence and statements, due to the researchers financial interest. This conflict of interest very clearly diluted the scientific opinion for the financial benefits of the tobacco companies.

Bias From a Non-Financial Conflict of Interest

In the field of psychiatry, medical professionals diagnose and treat patients who are affected by mental disorders. It is their duty to evaluate their patients to the best of their knowledge to see if they have any conditions. Even if a psychiatrist uses their professional opinion on a patient, this could be influenced by personal beliefs that they may have. Certain medical practices nowadays directly go against individuals religious and political beliefs. An example of this is “if a psychiatrist holding such ideas denies pharmacological treatment and/or hospitalization to a severely depressed patient, who then commits suicide.”(Maj, 2010) If the doctor’s opinion toward a certain medication was biased based on their religious beliefs, that would be a major conflict of interest which jeopardizes the primary interest of the patients health. 

Even though we only analyzed one example of bias due to a non-financial interest, it is clear that scenarios similar to these can happen in any field of research or industry. Non-financial conflicts of interests are driven by a wide range of influences like a person’s personal, political, and religious beliefs that are intangible in nature. This makes them incredibly hard to identify. Since these attributes are not always common knowledge, they can be hidden away from the public. This can cause researchers driven by personal interests to hide bias within their data and research. This is a problem when unrecognized that can influence and sway the audience’s opinion in a way that is factually incorrect.

Preventing Bias

A method commonly used to avoid scenarios such as the ones stated above is the use of conflict of interest disclosure forms as mentioned in the section Defining a COI. The goal of these disclosure forms is not to avoid interests–whether financial or personal– but to be transparent to one’s audience, and allow them to formulate their own opinions, based on research. Although “if mere disclosure made it easy to prove who was intentionally giving self-interested advice, prodisclosure arguments would unsurprisingly win out. Unfortunately it is not that easy… COIs often lead to unintentional bias rather than intentional lies.” (Cain, 2020) Even with disclosure agreements in place, reducing bias is difficult where a situation is not just black and white, but where gray area is involved. Within the gray area, conflicts of interest can cloud someone’s judgement causing them to think that a decision with bad ramifications is the better outcome instead of the morally correct decision. There is no clear perfect way to tell if a person’s judgment or actions include bias, caused from a conflict of interest.

How are COI Resolved?  

When resolving conflicts of interests there are two major categories that are considered: individuals and pervasive industry conflicts. An individual conflict of interest involves a singular researcher or lab. In the case of conflicts of interest with industries, they involve more widespread conflicts that often impact an entire industry. Pervasive industry wide conflicts often occur in spaces where there are large companies that would benefit from certain discoveries or use of certain practices; some examples include medicine, climate change research, and economics or political studies. In the case of individuals, their place of work, whether it be a college or independent research facility, will have different policies on how to define, report, and address conflicts of interest. For industry-wide conflict of interests, the recommendations range from limiting or monitoring outside influence to completely separating outside influences on research or practice in a field. The main authorities on conflict of interest policies are the National Science Foundation(NSF), Public Health Service (PHS), and the federal government in some cases (research-ethics.org). 

Dealing with Individual Conflict of Interests 

When resolving an individual researcher or lab’s conflict of interest the course of action can vary greatly depending on the place of employment. Most types of businesses or schools have similar policies within their classification but the policies may vary in defining conflict of interests and the specifics in the policies on how to report and resolve a conflict of interest. The main goals of these policies are “…attempts to ensure that professional decisions are made on the basis of primary interests and not secondary interests”. ( Field MJ 2009) As discussed in previous sections many policies use disclosure of conflict of interest as the best way to resolve a conflict of interest. Disclosure is a very poor way to mitigate a conflict of interest and this is mainly due to the inconsistencies in enforcing,  reporting,  and actually publishing conflicts of interest. (James, 2020) These areas:  enforcing policies, improved reporting, and increased publication of reported conflicts of interest,  are the main focuses currently in improving the impact of conflict of interest, but these focus all rely on the belief that disclosure is an effective way to mitigate conflicts of interest.  Disclosure of conflict of interest, when done, is seen as the best way to inform the reader of any bias so they are able to weigh the results against the reported conflict of interest. Even though this notion is widely believed,  there has been no evidence to show that readers are able to use the disclosure to discern what information in the reporting should be discounted and how much it should be discounted. (James, 2020) To further prove James’ point in some cases it has been proven that disclosures cause researchers to compromise their work more. A study reported that in some cases writers who have disclosed a conflict of interest will increase how much they manipulate the data or conclusion in order to compensate for the perceived deduction in confidence the reader will make due to the disclosed conflict of interest.  (G. Loewenstein) 

For example, if an ecologist or climate scientist researcher were to receive funding from an oil fracking company and then conduct research related to oil fracking’s impact on the environment,  this would be considered a conflict of interest. When the researcher publishes their findings if the discourse is done by the researcher and if the journal publishes the disclosure then it is up to the reader to find this information and assess it. Often the disclosure will clearly state that the researcher received funding from a specific company and they recognize that this is a conflict of interest. When the reader sees this they are now aware of the conflict but have no actionable steps to take to evaluate the conclusions made by this research unless they study the same topics. This example is just an example of how the research can be compromised but by putting the burden on the reader to discern what parts of the literature to discount, the scientific community is expecting too much of most of the readers outside of the academic space.

 

Some scholars (Field MJ 2009) propose three key factors in assessing a possible conflict of interest and the possible impact it could have. The factors used in assessing a possible conflict of interest are: 

•  how impactful the conflict of interest is to the person
• severity of harm 
• how well the severity of harm can be measured. 

The impact of the conflict of interest is usually tied to the financial sum the person would receive but in some cases can be linked to the strength of the personal or professional relationship. This factor helps to assess how much more likely it is that the conflict of interest will bias the writer or medical provider. The stronger the impact the more likely the conflict will have a greater effect. The factor of severity is used to bring the situation into perspective. In cases of conflict of interest that are likely to cause moderate to great harm to living beings or the environment the importance of sorting out the conflict of interest is vital. The last factor, availability to measure harm, is important in the case that the conflict of interest is not resolved beforehand but it may be used to help monitor the harm being done. The same scholars also use four different qualities to ensure that all conflicts are evaluated the same. These qualities are proportionality, transparency, accountability, and fairness. These key ideas are used to make sure when evaluating a conflict of interest that all cases are judged on the same grounds and the response if appropriate for the situation. These guidelines can be used to systematically address individuals’ conflict of interest in a fair and impartial manner.

For example, in the 2015 BlackRock case, the investment company ended up having to pay 12 million dollars back to its investors due to a conflict of interest oversight with one of their higher-up investment managers (SEC Emblem, 2015). In this case, the conflict of interest was personal and financial as this investment manager was responsible for the investment in the energy business but the company did not consider that he and his family had an existing business in this space. If this scenario were to have been analyzed the company would have been able to find the significant cause as to not give him this assignment in the first place. The impact on the customers is likely very high as this company regularly invests millions of dollars, the likelihood is very high due to the multiple types of conflicts involved and the severity is high due to the illegal nature of the financial transactions that could have taken place. This example is just one case where the analysis of a conflict of interest using the above criteria would have shown the unethical and likely change of this conflict of interest actively impacting this investment manager’s decisions.   

Addressing Pervasive Conflict of Interests 

When a conflict of interest is pervasive in an entire field of study or practice, like medicine, the guidelines described above are not useful. This type of conflict of interest is prompted by the widespread financial gain that is provided by a specific company or industry. The extent of these wide conflicts can go as far as “…criminal activity, including illegal misrepresentations of research results, hiding data about harms, bribery, prohibited marketing of drugs for non-approved (‘off‐label’) use and health insurance fraud”(James, 2020). This can also go as far as to impact the general recommendation and beliefs of professionals in an entire field through industries campaigning for a change in evaluation or measurement that would positively impact their business. Since these conflicts are so pervasive disclosures, even though they do not work as stated above they would have no impact. So what are some courses of action that can be taken? 

Given the most used method for mitigating conflicts of interest has little to no impact then other more radical options have been proposed to help solve both personal and field-wide conflicts of interest. One solution is to lessen industry ties or as one author put it “towards a norm of separation”(Marks, 2020). This suggestion is preferred because it keeps in mind that in some fields a majority of research needs large financial backing to take place and these finances are not often in other places or are not a large enough sum. This more moderate approach suggests that industry-sponsored research should be allowed but should require stricter methods of monotoring (osf.io). This method would help to lessen widespread conflicts of interest when they occur, but would not do much to prevent personal conflicts of interest.  A more strict approach is to completely cut industry ties so that the main cause of conflicts of interest(ie financial conflicts of interest), both personal and widespread conflicts of interest,  will be prevented (James, 2020). While this approach is likely to be the most effective, many fields are unreceptive to the idea because it would greatly affect how funding is found and how much funding would be available. 

EXAMPLE: 

Click on the image to enlarge or click the link below to download the infographic file as a PDF.

Conflict of Intrest and its impact on the opoid epidemic (2)

 

Conclusion

• Conflicts of interest, in general, are a human-centered issue that is caused by financial and non-financial incentives. Different people are driven by different incentives but they all result in similar impacts on the research that is conducted.
• Bias from a conflict of interest is when a researcher changes their behavior or results in an experiment for their own personal gain. Whether this is for commercial profit or professional obligations, bias can be caused by both financial and non-financial conflicts of interest.
• Preventing bias can be challenging when tangible and intangible conflicts of interest go unrecognized in research. Disclosure forms are used not to avoid conflicts of interest, but to identify them and show that they do not cause bias.
• Preventing personal conflicts of interest will require places that conduct research to develop comprehensive conflict of interest policies that do not rely on disclosures. Instead, evaluation guidelines (impact, severity, and ability to be monitored) should be used to actively assess individuals’ situations and make the best-informed decision.
• Pervasive conflicts of interest are often industry-sponsored and involve multiple people or groups of professionals. In order to prevent these widespread conflicts of interest, experts (James, Marks) suggest a separation or complete break between research and industry.

Work Cited

1. 1. Almassi, Ben. “Conflicts of Interest, Community-Based Research, and Trustworthy Science Communication.” Iowa State University Digital Repository, 2014, lib.dr.iastate.edu/sciencecommunication/2014/proceedings/3/. 
   2. Bes-Rastrollo, Maira, Matthias B Schulze, Miguel Ruiz-Canela, and Miguel A Martinez-Gonzalez. “Financial Conflicts of Interest and Reporting Bias Regarding the Association Between Sugar-Sweetened Beverages and Weight Gain: a Systematic Review of Systematic Reviews.” PLoS medicine 10, no. 12 (2013): e1001578; dicsussion e1001578–e1001578; dicsussion e1001578.
   3. Boruch, Robert. “Conflict of Interest.” Edited by Bruce B. Frey, The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation, 22 Feb. 2018, sk.sagepub.com.ezpxy-web-p-u01.wpi.edu/reference/sage-encyclopedia-of-educational-research-measurement-evaluation/i5754.xml.
   4. Cain, Daylian M., and Mohin Banker. “Do Conflict of Interest Disclosures Facilitate Public Trust?.” AMA journal of ethics 22, no. 3 (2020): 232-238.
   5. Cavinatto, L., Bronson, M.J., Chen, D.D. et al. “Robotic-assisted versus standard unicompartmental knee arthroplasty—evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics”. International Orthopaedics (SICOT) 43, 1865–1871 (2019). https://doi.org/10.1007/s00264-018-4175-5.
   6. “Conflicts of Interest.” Responsible Conduct Research: Conflicts of Interest. Columbia University, 2005. http://ccnmtl.columbia.edu/projects/rcr/rcr_conflicts/foundation/.
   7. Eger, nd. “Motivation, Bias, and Scientific Integrity.” Anesthesiology (Philadelphia) 81, no. 1 (1994): 270–271.
   8. Friedman, P.J. The impact of conflict of interest on trust in science. SCI ENG ETHICS 8, 413–420 (2002). https://doi.org/10.1007/s11948-002-0063-9.
   9. I. Glenn Cohen, Holly Fernandez Lynch, Chris Deubert, “NFL Player Health: The Role of Club Doctors”, SSRN Electronic Journal, 10.2139/ssrn.2879441, (2016).
   10. Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice; Lo B, Field MJ, editors. Conflict of Interest in Medical Research, Education, and Practice. Washington (DC): National Academies Press (US); 2009. 2, Principles for Identifying and Assessing Conflicts of Interest. Available from: https://www.ncbi.nlm.nih.gov/books/NBK22937/ 
   11. James, Jack E. “Disclosing Conflict of Interest Does Not Mitigate Healthcare Bias and Harm: It Is Time to Sever Industry Ties.” European Journal of Clinical Investigation 50, no. 12 (2020). https://doi.org/10.1111/eci.13344.
   12. Krimsky, Sheldon. “Do financial conflicts of interest bias research? An inquiry into the “funding effect” hypothesis.” Science, Technology, & Human Values 38, no. 4 (2013): 566-587.
   13. Loewenstein G, Sah S, Cain DM. The unintended consequences of conflict of interest disclosure. JAMA. 2012;307:669‐670. 
   14. Maj, Mario. “Financial and non-financial conflicts of interests in psychiatry.” European archives of psychiatry and clinical neuroscience 260, no. 2 (2010): 147-151.
   15. Marcovitch, Harvey. “Conflict of Interest in Science Communication: More than a Financial Issue: Report from Esteve Foundation Discussion Group, April 2009.” Gale Academic Onefile, Feb. 2010, go-gale-com.ezpxy-web-p-u01.wpi.edu/ps/i.do?p=AONE&u=mlin_c_worpoly&id=GALE%7CA221204290&v=2.1&it=r&password=NostimonHmar&ugroup=outside. 
   16. Marks, Jonathan H. “Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation.” Journal of Bioethical Inquiry 17 (2020): 173–89. https://doi.org/10.2139/ssrn.3655082. 
   17. Nichols-Casebolt, Ann, and Francis L. Macrina. “Current Perspectives Regarding Institutional Conflict of Interest.” Science and Engineering Ethics, Springer Netherlands, 7 Oct. 2015, link.springer.com/article/10.1007/s11948-015-9703-8. 
   18. On Being a Scientist. Washington, DC, MD: National Acad. Press, 1989. https://doi.org/10.17226/4917.
   19. “Patient Outcomes Research Teams (PORTS): Managing Conflict of Interest.” Edited by Molla S. Donaldson and Alexander M. Capron, National Academies Press: OpenBook, Institute of Medicine, 1991, www.nap.edu/read/1821/chapter/5. 
   20. “Press Release.” SEC Emblem, April 20, 2015. https://www.sec.gov/news/pressrelease/2015-71.html. 
   21. Resnik, David B. “Conflicts of Interest in Scientific Research Related to Regulation or Litigation.” The Journal of Philosophy, Science & Law 7, no. 2 (April 15, 2007): 1–16. https://doi.org/10.5840/jpsl2007722. 
   22. Ruff, Kathleen. “Scientific Journals and Conflict of Interest Disclosure: What Progress Has Been Made?” Environmental Health 14, no. 1 (2015). https://doi.org/10.1186/s12940-015-0035-6.