What is a competing interest and what issues does it raise in the context of Clarity clinical knowledge production?
Competing interests (conflicts of interests) are circumstances in which a person’s judgement might be influenced by a secondary interest (such as financial gain). Competing interests are common, and can be virtually impossible to avoid from time to time.
What interests are involved?
There are a number of different types of competing interests. The following examples are taken from a Code of practice for declaring and dealing with conflicts of interest, published by the National Institute for Health and Clinical Excellence in October 2007.
Personal financial interests
- Any consultancy; directorship; and position in, or work for, a healthcare industry company that attracts regular or occasional payments in cash or in kind, that have been undertaken in the preceding 12 months or which are planned but have not taken place.
- Any fee-paid work commissioned by a healthcare industry company that has been undertaken in the preceding 12 months or which is planned but has not taken place.
- Any shareholdings, or other beneficial interests, of a healthcare industry that an individual is able to directly manage.
- Expenses and hospitality provided by a healthcare industry company beyond that reasonably required for accommodation, meals and travel to attend meetings and conferences, which have been undertaken in the preceding 12 months or which are planned but have not taken place.
- Funds which include investments in the healthcare industry that are held in a portfolio over which the individual has the ability to instruct the fund manager as to the composition of the fund.
- Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons.
Personal family interest
- Any consultancy; directorship; position in, or work for, a healthcare industry that attracts regular or occasional payments in cash or in kind undertaken by a family member.
- Any fee-paid work commissioned by a healthcare industry for which the family member is paid in cash or in kind.
- Any shareholdings, or other beneficial interests, in a healthcare industry which are either held by the family member, or for which an individual involved in the development or upkeep of the clinical topics has legal responsibility (for example, children, or adults whose full Power of Attorney is held by the individual).
- Expenses and hospitality provided to the family member by a healthcare industry company (except where they are provided to a general class of people such as attendees at an open conference).
- Funds which include investments in the healthcare industry that are held in a portfolio over which the family member has the ability to instruct the fund manager as to the composition of the fund.
Personal non-financial interest
- A clear opinion, reached as the conclusion of a research project, about the clinical and/or cost-effectiveness of an intervention under consideration.
- A public statement in which an individual has expressed a clear opinion about the matter under consideration, which could reasonably be interpreted as prejudicial to an objective interpretation of the evidence.
- Holding office in a professional organization or advocacy group with a direct interest in the matter under consideration.
- Other reputational risks in relation to an intervention under review.
Non-personal financial gain or benefit
- The holding of a fellowship endowed by the healthcare industry.
- Any payment or other support from an organization that does not convey any financial or material benefit to an individual personally but that might benefit him or her. Examples include:
- A grant from a company for the running of a unit or department for which a member is responsible.
- A grant or fellowship or other payment to sponsor a post or member of staff in the unit for which a member is responsible.
- The commissioning of research or other work by, or advice from, staff who work in a unit for which the member is responsible.
Note: an individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.
Who should declare competing interests?
Any individual (or organization) that is involved in developing, reviewing, or commenting on clinical content, particularly the recommendations. This includes authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members.
When should interests be declared?
External reviewers should formally declare any interests either before, or at the same time as, sending comments on draft topics. We are only able to consider comments from external reviewers if a declaration of interests is made.
How should interests be declared?
The presence or absence of competing interests (and their nature if present) should be declared on specific forms (declaration of interests form) and returned by email or post. It is not necessary to sign the forms if they are returned by email.
If individuals are reviewing draft topics on the website, they can declare their interests on-line.
What should be declared?
Where there are financial interests, only the name of the company/organization and the nature of the competing interest need be declared.
Non-personal interests involving less than £1000 from all sources in the previous year need not to be declared.
Where is the information kept?
All declarations of interests are securely held by Clarity Informatics Ltd.
What action will be taken if a competing interest is declared?
If a competing interest is declared, the authoring team will take account of any potential for bias when considering the comments. Declaration of interests of external reviewers are not routinely published.
Competing interests will not be made public without permission from the individual concerned.