Conflict of interest: A tenacious ethical dilemma in public health policy, not only in clinical practice/research

Abstract

In addition to the ethical practice of individual health professionals, bioethical debate about conflict of interest (CoI) must include the institutional ethics of public policy-making, as failure to establish independence from powerful stakeholder influence may pervert public health goals. All involved in public policy processes are accountable for CoI, and our examples involve experts, scientists, professionals, industry and government officials, including the liquor industry in South Africa, which is presented as a case study. Generic principles of how to identify, manage and address CoI are discussed. We propose that health professionals and policy makers should avoid partnering with industries that are harmful to health. Regarding institutional CoI, we recommend that there should be effective policies, procedures and processes for governing public-private joint ventures with such industries. These include arms-length funding, maintaining the balance between contesting vested interests, and full disclosure of the identity and affiliations of all participants in structures and reports pertaining to public policy-making.