‘Confluence of Interest’ policies?

In JAMA, Anne R. Cappola and Garret A. FitzGerald argue that we need to change the term “conflict of interest” to “confluence of interest.”

the term conflict of interest is pejorative. It is confrontational and presumptive of inappropriate behavior. Rather, the focus should be on the objective, which is to align secondary interests with the primary objective of the endeavor—to benefit patients and society—in a way that minimizes the risk of bias. A better term—indicative of the objective—would be confluence of interest, implying an alignment of primary and secondary interests.

This is not an improvement. Conflict of interest policies presume that pursuit of private interest over professional duty is possible. We know inappropriate behaviour is possible because there is a history of it. If ‘conflict’ is pejorative because it treats divergence of interests as the default, ‘confluence’ makes the same error by taking the alignment of interests as a default. We’re better off keeping conflict as the default, for two reasons.

First, conflict of interest is the term used in the law and, to my knowledge, by every other profession. I am baffled why clinical researchers imagine they are being singled out for scrutiny. Being scrutinized for possible conflicts of interest is the everyday experience of public officials, attorneys, people who work in the financial industry, and, I expect, every other service industry.

Second, sometimes my private interest does not align with my professional duty and, moreover, cannot be aligned with it. Conflict of interest is a universal experience. Every empiricist knows that moment of fear before you look at the results of a study that, if it worked, may win you a grant / let you get or retain a job / keep your startup alive / or whatever. If the news is good, your private interest and your public interest align. If the news is bad, your duty is to make that known and that duty unavoidably conflicts with your personal interest. Sorry, but that’s the job.

The purpose of conflict of interest policies is to put people on notice. Why would anyone ever need a “confluence of interest policy”? If interests are confluent, what’s the point?


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