title: Debates about Conflict of Interest in Medicine: Deconstructing a Divided Discourse.
abstract: The pharmaceutical industry plays an increasingly dominant role in healthcare, raising concerns about "conflicts of interest" (COI) on the part of the medical professionals who interact with the industry. However, there is considerable disagreement over the extent to which COI is a problem and how it should be managed. Participants in debates about COI have become entrenched in their views, which is both unproductive and deeply confusing for the majority of medical professionals trying to work in an increasingly commercialized environment. We used a modified meta-narrative review method to analyse debates about COI in the academic and grey literature. We found two Discourse Models: The Critical Discourse Model sees COI in health and biomedicine as a major problem that both can and should be addressed, while the Defensive Discourse Model argues that current efforts to control COIs are at best unnecessary and at worst harmful. Each model is underpinned by profoundly differing views about how society should be organized-in particular whether market forces should be encouraged or curtailed-and how the dangers associated with market forces should be managed. In order to make any headway, academics and policymakers must recognize that these debates are underpinned by profoundly differing worldviews.
authors.affiliation: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Serena
authors.initials: S
authors.lastname: Purdy
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Miles
authors.initials: M
authors.lastname: Little
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mayes
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia. wendy.lipworth@sydney.edu.au.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lipworth
mesh_terms: D016265:Conflict of Interest / Q000331:legislation & jurisprudence*; D030881:Disclosure / Q000941:ethics*; D004345:Drug Industry / Q000941:ethics*; D004995:Ethics, Professional; D006801:Humans; D011050:Policy Making; D012109:Research Support as Topic / Q000941:ethics*; D012955:Societies, Medical
keywords: Conflict of interest; Discourse analysis; Health policy; Meta-narrative review; Pharmaceutical industry