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Ethics

Conflict of interests: an unavoidable challenge

In the exact measure in which the importance of scientific and technological research is growing within the context of economic life, situations in which the results of development of research projects advance or clash the objectives of economic interests, be they of the researchers involved in them, or of companies or institutions responsible for their financing, even partially, these situations have become more frequent. To what point does this situation interfere in the scientific trustworthiness of these results? How can we measure the degree of this trustworthiness in each case? What are the relevant parameters for measuring it? Throughout the world, there is today an intense and healthy debate about these questions, involving development agencies, scientific publications, universities, researchers, companies and governments. For example, the New England Journal of Medicine, one of the most important scientific periodicals of the world, has published various articles on this very point.

To better illustrate the complexity of the problem and the relevance of the debate, we would like to consider a typical and ordinary case. Before a new medicine is launched on the market by a pharmaceutical company, research has to be carried out in order to determine if it is really efficient and if it doesn’t have undesirable side effects. More often than not, this research is financed by the company which is objectively interested in demonstrating that its product is good and harmless, and in many cases it is carried out by the researchers employed or hired by the company, objectively interested in the financial success of the company on which depends for example, their jobs and future contracts and financing.

To these interests, one may add the ethical and professional interest of the researchers in carrying out their work according to good scientific methodology, as well as the interest of society of having an sound product able to address health problems, but with reasonable guarantees that the risks of possible side effects have been adequately evaluated. These multiple interests can, of course, converge, but just as well they may diverge. Anyhow, a situation is taking shape, well described by the term “potential conflict of interests” whose repercussions both ethical and appropriately scientific, cannot be underestimated.

Let us suppose that someone is entrusted with refereeing a football game in which his son is playing. We are speaking of a person who is absolutely righteous, the potential conflict of interests is extreme: the desire that his son is successful could conflict with the desire of refereeing in a completely impartial manner. If all of the decisions of a football referee could be taken through the mechanical application of explicit rules, the existence of this conflict, in the hypothesis of the righteousness of the referee, could innoway interfere with the final result of the game.

However, it so happens that many of these decisions depend on the evaluations which have a large dose of subjectivity and it is precisely there that the potential conflict makes its effects felt: involuntarily, a decision favorable to his son may occur, which wouldn’t be made in other circumstances; or, on the contrary, compelled to act with impartiality, the referee could make a decision detrimental to his son that would not be made in other circumstances. Summing up, the potential conflict of interests can interfere in the exercising of the capacity of judging by the referee, in a manner which cannot, in principle, be precisely detected, controlled or avoided by him. Even if, in fact, there is no interference, the perception of the degree of impartiality of his decisions will inevitably be affected by the potential conflict of interests.

In lots of aspects, the consequences of a potential conflict of interest in scientific and technological research are of the same type. And furthermore, in various moments of their work, the researchers are obliged to take decisions whose correction cannot be measured beforehand by a set of precise and explicit rules – for example, decisions relative to alternative strategies of carrying out the research or of the determination of the value of certain chunks of data, certainly relevant, though not entirely conclusive, or even conflicting. In these moments, the quality of the decisions taken depends essentially on the capacity of the researchers to judge which might be called “good sense methodology”, derived principally of the coming together of experience and talent. It is the exercising of this ability that can be involuntarily affected by the potential conflict of interests – in a manner which cannot, in principal, be precisely identified, controlled or avoided by them. As well, at this point, the perception of the degree of impartiality of the decisions taken can be effected by the existence of potential conflicts of interests.

The simplest way of excluding the risks of a situation of conflict of interests is to impede its appearance: the father would not referee a game in which his son is playing, the researcher would not develop a project whose results could go against his personal interests, a company or institution would not finance a project whose results could be in conflict with its economic or institutional interests. However, this solution may be just too simple, being in the majority of cases impractical, and even undesirable.

In fact, refusing to referee the game could imply its cancellation, in a way that the players might prefer running the risk of playing with an unintentionally biased referee. Analogously, the clinical testing of a medicine might not be materially possible without the support of the company interested in its commercialization, which could signify the deprivation of the access to a valuable therapeutic instrument. Furthermore, it seems to be reasonable that a large part of the costs of the process of the elaboration of a commercial product should be picked up by the company which will benefit from its commercialization and not, for example, by the organs or agencies supported by public funding.

For this reason, it only remains for us to deal with potential conflicts of interests through more complicated strategies, that very often can only be completely defined case by case. But nonetheless, two principles should be considered, in all cases, in the formulation of these strategies: the principle of full information and the principle of full verification. Not only the research community but all of society should be informed aboutall of the circumstances of the realization of a projectthat might possibly contain the existence of potential conflicts of interest.

Only in this manner can the degree of trustworthiness be determined prior to the results obtained, which would then determine to what length those results should be submitted to a critical treatment before being incorporated as valid scientific results. The magazine Nature, for example, will demand that the articles which it publishes relate all of the sources of research financing relevant to the results obtained.

For this critical treatment to be possible, all of the data and procedures used by the researchers in the realization of their project would have to be available for verification by independent auditors, whether it be by the initiative of other researchers, of organizations or government agencies, or non-governmental associations. The application of these principles in private cases might not be a simple situation, but it is a challenge which the profile and the motivation of a large part of contemporary scientific and technological research is destining us to confront.

Dr. Luiz Henrique Lopes dos Santos is the Scientific Assessor of FAPESP and Dr. José Fernando Perez is the Scientific Director of FAPESP

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