Conflict of interest as ethical shorthand: understanding the range and nature of “non-financial conflict of interest” in biomedicine

© 2019 Elsevier Inc. Objectives: The aim of the study was to identify the range of issues labeled as “non-financial conflicts of interest” in biomedicine, articulate the associated concerns, and analyze the implications of defining these issues as conflicts of interest. Study Design and Setting: This was a qualitative study, triangulating data from three purposively sampled sources: (1) literature, (2) policies, and (3) interviews. Participants were corresponding authors of sampled literature (December 2017 to January 2019). A critical, interpretive approach served as the analytic strategy. Results: A total of 99 articles provided the sampling frame; we recruited 16 participants and sampled 20 policies. Participants labeled a wide range of personal attributes, social relationships, professional experiences, intellectual endeavors, and financial interests as “non-financial conflicts of interest.” Despite a lack of consensus regarding the nature of the problem, many “non-financial” interests are currently subject to policy action. The term serves as ethical shorthand to describe the ways that (1) “strong beliefs,” (2) “predetermined views,” (3) experiences, and (4) relationships shape evidence-led processes. Conclusion: Expansion of the definition of conflict of interest to include non-financial interests may have unintended consequences, including exclusion of diverse perspectives. Problems labeled “non-financial conflicts of interest” should be defined in terms of what they are rather than what they are not (i.e., “non”-financial). We suggest instead, preventing financial conflicts of interest and ensuring inclusive and equitable representation within evidence-based processes.