1 Boring Old Man

ra·tion·al·ize  /raSHne,liz/
verb
attempt to explain or justify [one’s own or another’s behavior or attitude] with logical, plausible reasons, even if these are not true or appropriate

Confluence, Not Conflict of Interest
Name Change Necessary

JAMA

by Anne R. Cappola and Garret A.

September 24, 2015

The primary interest of the biomedical scientific endeavor is to benefit patients and society. Frequently, this primary interest coincides with secondary interests, most commonly financial in nature, at the interface of the investigator’s relationship with a private sponsor, typically a drug or device company or, increasingly, venture capital firms. Academia and the public have become sensitive to how such a secondary interest might be unduly influential, biasing the interpretation of results, exposing patients to harm, and damaging the reputation of an institution and investigator. This concern has prompted efforts to minimize or “manage” such “conflicts of interest” resulting in a plethora of policies at both the local and national level. Although these policies are often developed in reaction to a limited number of investigators, once introduced, they apply to all. Given the broad array of stakeholders, the diversity of approaches, and the concern that such policies might restrain innovation and delay translation of basic discoveries to clinical benefit, the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania recently convened an international meeting on conflict of interest. Several themes emerged…

Conflicts of Interest:

Dr Cappola
• reports receiving consulting fees from Biomarin, Mannkind Corporation, and Takeda.
Dr FitzGerald
• reports being the McNeil Professor of Translational Medicine and Therapeutics, a council member of the American Association for the Advancement of Science, and a member of the National Academy of Medicine biomarker committee;
• receiving a stipend for being co-chair of the advisory board for Science Translational Medicine;
• grants from the Harrington Family Foundation and Eli Lilly;
• consulting fees from Calico and Pfizer, Eli Lilly, Glenmark Pharmaceuticals, and New Haven Pharmaceuticals;
• serving as chair for the Burroughs Wellcome Foundation review group on regulatory science awards, the Helmholtz Foundation advisory board for the network of cardiovascular science centers, and the PhD program committee of the Wellcome Trust, a section committee of the Royal Society;
• and serving on the advisory boards of the Oklahoma Medical Research Foundation and King’s Health Partners in London. He also serves on the advisory boards of the Clinical and Translational Science Awards held by the University of Connecticut, Harvard, the Medical University of South Carolina, Duke University, and the University of California at San Francisco.

Funding/Support:

• This work is supported by a grant [UL1 TR000003] from the National Institutes of Health.

First, 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. In this regard, the individuals and entities liable to bias extend far beyond the investigator and the sponsor; they include departments, research institutes, and universities. The potential for bias also extends to nonprofit funders, such as the National Institutes of Health and foundations, as well as to journals that might, for example, generate advertising revenue from sponsors…

In 1934, Anna Freud wrote the Ego and the Mechanisms of Defense to flesh out her father’s ideas about how the mind gets around unsavory motives. She devoted a whole chapter to intellectualization and rationalization, a favorite of adolescents. Another way to look at it is that there is a cognitive leap in adolescence [Piaget] when the child can finally use formal logic and can think in the same way as his/her parents [stripping them of the power of a superior intellect]. A smart adolescent can justify [rationalize] anything and delights in endless mind games to the consternation of parents through the ages. For a time, it’s a new tool to get what you want, or enter into the power struggle phase of growing up rather than a tool for understanding. And some people never make that latter jump and rationalize their way through life.