Conflicts of interest occur when researchers or their institutions have financial or personal ties with other persons or organizations that influence their work or the way it is presented. Financial relationships, such as an employment or consultancy relationship, or stock ownership, are among the most obvious reasons for a conflict of interest. In addition, intellectual passion, dependence on external funding, academic competition, and the interests that funding bodies may have in scientific research can jeopardize a researcher’s independence. Lack of independence can result in substandard science, damage the reputation of the researcher and the research group or institution, and ultimately even negatively affect patient care.

Because some conflicts of interest (particularly those of a non-financial nature) are intrinsic to research, they can never be completely avoided. That is all the more reason to report conflicts of interest as fully and transparently as possible. That will allow peer reviewers, editors, readers or the general public to judge the credibility and plausibility of researchers’ statements against the background of reported conflicts of interest.

Causes

Conflicts of interest can have numerous causes. Two situations that may lead to conflicts of interest are 'external professional activities' and 'collaboration with commercial parties'. Both are described briefly below along with several other examples, originally provided by the Association of American Medical Colleges.

External professional activities
Amsterdam UMC is generally supportive of its researchers having additional professional responsibilities elsewhere (nevenfuncties), as these external activities often support their scientific work and strengthen the institutions engagement with society. External professional activities, whether remunerated or not, are only permitted when they are compatible with the employee’s responsibilities at Amsterdam UMC and do not interfere with the interest or reputation of Amsterdam UMC. Article 9.3 of the Collective Labor Agreement for university medical centers (CAO UMC) contains clear guidelines for employees who are considering external professional activities (‘outside activities’). These guidelines state that external activities must be reported to the employer if they could potentially give rise to conflicts of interest, and that it may be necessary to obtain explicit approval from the executive board for external activities. The guidelines also cover payment for such activities.
Collaboration with funding parties
Amsterdam UMC values collaboration with third parties, provided this is conducted in accordance with institutional policies (see Chapter 'Research collaboration agreements'). Moreover, Amsterdam UMC advocates that, whenever feasible, research results should be rapidly converted into new diagnostic and therapeutic tools in order to allow patients or society to benefit from innovations. This usually requires collaboration with (commercial or non-commercial) funding parties (see Chapter 'Valorization'). However, a relationship with an external funding party may make researchers vulnerable to conflicts of interest. Therefore, funding bodies may demand disclosure of potential conflicts of interest from researchers applying for grants. Collaboration with funding parties must not cast doubt on the independence of the researchers or research performed at Amsterdam UMC. The arrangements that can be made to safeguard researchers’ independence and publish the results of research collaborations with external funding bodies or commercial partners are described in Chapter 'Research collaboration agreements'.
Other causes of conflicts of interest
  • Undertaking research when the researcher or the researcher’s immediate family has a financial, managerial or ownership interest in the sponsoring company or in the company producing the drug/device under evaluation.
  • Accepting gratuities or special favors from research sponsors (See NFU Guideline Richtlijn Gunstbetoon door bedrijven, 2010. Regarding relationships with pharmaceutical and medical device companies, the Code of Conduct for Pharmaceutical Advertising (Code geneesmiddelenreclame) and the Code of Conduct regarding Medical Devices (Gedragscode Medische Hulpmiddelen) also need to be taken into account).
  • Unreimbursed or unauthorized use of institutional resources (e.g. equipment, supplies or facilities) for personal purposes or to support the activities of an independent entity in which a researcher holds a financial or other interest..
  • Accepting support for research under terms and conditions that require results to be kept confidential, unpublished or significantly delayed in publication.
  • Requiring or recommending a product, such as a medicinal product, diagnostic test or a textbook, in which one has interest. In such cases an independent advice should be asked for.

Procedures for reporting potential conflicts of interest

Amsterdam UMC endorses the VSNU regulation for external professional activities (Sectorale regeling nevenwerkzaamheden); the Code for the prevention of improper influence due to conflicts of interest, drawn up by the Royal Netherlands Academy of Arts and Sciences (KNAW) and other parties in 2012 and updated in 2016; as well as the Valorization guideline Naar een goede waarde (in Dutch), issued by the Netherlands Federation of University Medical Centres. The following procedures to handle potential conflicts of interest have been established:

Established procedures to handle potential conflicts of interest

  • Transparency of activities:

    Employees should report any external professional activities that might lead to conflicts of interest to their departmental or division head, as well as to HR. Guidelines and policies on external professional activities are published here (in Dutch). Relevant external professional activities are disclosed on the website of location AMC and location VUmc. Furthermore, the financial relationships between UMC health care providers and commercial parties can be consulted in the Healthcare Transparency Register. Potential conflicts of interest must also be discussed during the annual performance appraisal interview between the employee and their head of department or division. Although disclosure itself does not eliminate bias or conflicts of interest, it can make financial relationships widely known and be used as a starting point for asking questions.

  • Report of potential cases:

    Researchers are required to report immediately to the business manager of their division (directeur bedrijfsvoering) if they believe they might be caught up in a conflict of interest or are exposed to potentially conflicting interests outside the institution. The business manager will inform the head of the department of all such notifications. The notification may be discussed with the legal advisor to the executive board, if appropriate. The executive board may decide to publish notifications. Both the notification and any approval granted by the executive board are recorded in the employee’s personnel file.