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Conflicts of Interest in Nutrition: Categorical Thinking and the Stigma of Commercial Collaboration

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Abstract

There is a high level of concern about the possible influence of commercial organizations on food-related research and professional bodies, including regulatory and advisory panels. This has contributed to an increased emphasis on the declaration and management of conflicts of interest (CoI) in the reporting, evaluation, and application of research in nutrition science. However, common perceptions of CoI in nutrition, and procedures for declaring and managing these, often lack intellectual rigor and consistency. This commentary highlights 3 main issues related to CoI in nutrition, particularly the emphasis on industry-related CoI relative to other sources of conflict and bias. 1) Considerations of CoI in nutrition are largely limited to financial or collaborative links to the food industry, disregarding other important sources of influence such as intellectual allegiances or nonindustry financial and professional incentives. 2) Associations with industry incur ad hominem, often punitive stigmatization of individuals and their research, and inappropriate downgrading or exclusion of evidence. This disproportionately affects expertise in the food and agricultural sciences, in which commercial collaborations are widely encouraged. 3) These practices and related approaches to managing CoI are applied without due consideration of the nature of the conflicts and activities involved, the qualifications of individuals, or the availability of other, objective methods and guidance for assessing research quality and risks of bias. Overall, recognition of the nature and range of CoI in nutrition and approaches to their identification and management lack consistency and balance. A singular and strict focus specifically on industry-related CoI may paradoxically exacerbate rather than mitigate imbalance and bias in the field. This commentary outlines the underlying issues and the need for more comprehensive and nuanced approaches to the assessment, reporting, and management of CoI in nutrition.

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Early career researchers (ECRs) in nutrition and related fields often wish to approach commercial organisations for possible funding or collaboration in scientific projects and other activities. However, ECRs may experience challenges from their limited experience, lack of understanding of the food industry and concerns about working practices and research integrity. This commentary is oriented toward providing some basic, practical guidance for nutritionist scientists, to help in developing credible, principled and effective working relationships with the food industry. Based on the author's experience as an academic and industry researcher, and an advisor to academic‐industry collaborative projects, the text addresses a range of related aspects including: understanding and approaching the food industry; the industry environment and drivers; contracts, confidentiality and communication; potential challenges; and ensuring scientific integrity.
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Ideological biases influence medical research and practice and should be disclosed and managed, say Miriam Wiersma and colleagues. But Marc Rodwin argues that many of these interests are widespread and inherent to life and cannot be avoided or eliminated. © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.
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The traditional legal concept of conflict of interest is a practical tool to regulate conduct. In recent years several medical authors have defined “conflicts of interest” in ways that stray from its original legal meaning. The new definitions cause conceptual confusion and will result in policies that cannot be implemented effectively. We should not follow recent attempts to redefine “conflicts of interest” because doing so deviates from the legal concept and will lead to deregulation of financial conflicts and overregulation of so-called intellectual conflicts.
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Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest.
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During the Institute of Medicine’s 2013 workshop on conflict of interest (COI) and medical innovation, a presentation from PhRMA, the pharmaceutical industry association, delineated 5 types of potential conflict in medical research and the likelihood of each resulting in a true conflict.¹ Even though these sorts of distinctions between potential or perceived COI on one hand and true or actual COI on the other have become commonplace,²,3 they are misguided. Not only is the notion of a potential COI conceptually confused, labeling certain COI as merely “potential” or “perceived” diminishes their seriousness and obscures the ethical rationale for trying to limit COI in medical practice and research.