As an author of scientific publications, as a speaker in meetings, as a reviewer, as an opinion leader, you are expected to be as objective as you can when interpreting your own data and other people’s data. To make a declaration of your conflicts of interest does not free you from the responsibility to be as objective as you can. It just gives the reader or listener some information of obvious and possible conflicts.

There are very detailed forms to fill in when publishing in some journals. Most emphasis is given to possible financial interests such as employment or ownership in commercial companies with connection to the topic at stake; similarly if you are involved with patents related to the topic. Sometimes you may be remunerated to write a summary or review, which also makes you a financial beneficiary.

There are also multiple financial relations between commercial companies and experts in terms of advisory boards, invited lectures etc., where the effort is remunerated and compensation for the time spent for preparation as well as the time spent to travel somewhere to present.

Most speakers at meetings today show a second slide after the title displaying disclosures of this type. Still, the most important issue is whether you are as objective as you can be.

In addition, there are academic conflicts of interest, which are easily defined but not so easy to evaluate. Not for the reader or listener, but also not so easy for yourself to be sincere on this point. You act as an expert, and that is why you are invited. You hold an opinion which may be controversial, from which you evaluate your own results as well as the results of others. When filling in forms you are sometimes asked for possible academic conflicts of interest, but it is rare to encounter somebody who discloses such an academic conflict of interest.

My position of uncertainty regarding my conflicts of interest relates to two different situations: (1) do I fulfill the demand to be as objective as I can when I am invited as a remunerated expert lecturer by a commercial company, and (2) what about being as objective as I can on issues where I have an expertise when other people disagree?

Being involved with commercial companies

To be invited as an expert is flattering and strengthens your self-image. To be asked for advice is also a way to impact future products, which may be for the good of your patients. Many commercial companies organize educational seminars that are beneficial for the professional community, although a specific company will always profile the educational activity according to their marketing purposes.

Economic compensation for this type of involvement is sound and should be on a level that recognizes your expertise and the time spent. It should, however, not be above that level, as it may then become an extra personal income that makes you prone to adjust your expert presentations in line with what you feel is expected by the sponsor. Then you venture onto shaky ground. It may become even more problematic when your expert role in relation to a company is accompanied by a collaboration involving research projects and grants for such projects. Even when such grants are unrestricted, you may adjust your performance to stay on friendly terms with the sponsor. There is an old saying about “no free lunches”.

I am not aware of any survey among colleagues on this issue, but please consider the survey among North American GPs concerning marketing activities, where 90% were convinced that these activities influenced medical decision-making among their colleagues, whereas only 50% thought themselves influenced. When I scrutinize my own practice, I cannot recall myself adjusting my advice or presentations to please the sponsor, but on several occasions I have been addressed by colleagues (reviewers, friends), who were thinking differently.

In summary, this is an area where delusions are quite common, and I think more transparency would be a good thing. To disclose the size of remunerations and grants (asked for in some conflict of interest forms), will perhaps be useful in the process of maintaining professionalism, which we all need to constantly consider.

The academic conflict of interest

When you stand as a reviewer, you are sometimes asked to specify if there are conflicts of interest involved. This is usually denied, and at the end of the day it becomes a matter of conscience. My personal experience is that this is the most difficult area in which to be as objective as you can. There are two sides: the over-interpretation of your own results, and the over-criticism of other people’s results. It is so easy to end up in a position where you defend your results and your conclusions, just because you unwisely jumped to conclusions based on an over-interpretation.

As a large part of my academic activities related to intensive care medicine has been in the field of nutrition, it comes easily to me to put forward examples from that field. Overall, everybody agrees that the level of evidence is low, nevertheless many opinion leaders have designated views over what should be recommended. This results in a large number of guidelines, to a large degree in agreement, but also with conflicting recommendations even though evidence might be weak or very weak. Conclusions are drawn from retrospective to observational data, good for hypothesis generation but not for recommendations. My interpretation of this heterogeneity is that academic conflicts of interest are not properly disclosed, one's own data are over-interpreted and others’ data are under-interpreted.

Some journals practice open reviews, in which reviewers sign their statements. This is probably helpful in better respecting other people’s results. Still many reviewers do not approve of this system, claiming that important criticism may be held back out of cowardice or politeness.

In summary

When I am not sure if I have a conflict of interest, being more transparent is probably the best way to make the possible conflict of interest visible to the listener or reader. When money is involved, disclosures of exact sums of compensation may enhance transparency. For academic conflicts of interest, unblinding of reviewers and declaration of publications may help others to judge the possible academic conflict of interest.