Intended for healthcare professionals

Head To Head

Should we try to manage non-financial interests?

BMJ 2018; 361 doi: (Published 12 April 2018) Cite this as: BMJ 2018;361:k1240
  1. Miriam Wiersma, master of philosophy candidate1,
  2. Ian Kerridge, professor of bioethics and medicine1 2,
  3. Wendy Lipworth, associate professor1,
  4. Marc Rodwin, professor of health law34
  1. 1Sydney Health Ethics, University of Sydney, Sydney, NSW 2006, Australia
  2. 2Royal North Shore Hospital, St Leonards, NSW, Australia
  3. 3Suffolk University Law School, Boston, MA, USA
  4. 4Fondation IMéRA, Aix Marseille Université, Marseille, France
  1. Correspondence to: M Wiersma miriam.wiersma{at}, M Rodwin mrodwin{at}

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

Yes—Miriam Wiersma, Ian Kerridge, Wendy Lipworth

Non-financial conflicts of interest in medical research and practice, which include those of a political, ideological, individual, or religious nature,12 are often overlooked, denied, and even defined out of existence.34 The focus is directed instead towards financial interests, such as those stemming from drug industry sponsorship of research, or payments to doctors.

But dismissing non-financial conflicts of interest is naive, empirically unfounded, and dangerous. It is also unnecessary because non-financial conflicts can be managed with nuance and sensitivity.

Strong drivers

Research shows, and common sense dictates, that people are driven at least as much by non-financial motives as they are by financial gain. These motives, which include the desire to protect ourselves or our family from harm, to reinforce our deeply held beliefs and values, to reciprocate gifts or favours, to attain status, and to avoid social disapproval, unquestionably exert a powerful influence on human behaviour.56 As argued by Cappola and Fitzgerald in relation to academia, “the prospect of fame may be even more seductive than fortune.”7

For example, the decisions of well remunerated doctors to participate in drug industry advisory boards or accept the role of “key opinion leader” are far more likely to be driven by other motives than by financial gain.8 Indeed, the financial incentives associated with advisory board membership—for example, $1000 (£700; €800) or a free flight—seem to pale in comparison with the social and psychological importance of being invited …

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