Ethical challenges to the integrity of physicians: financial conflicts of interest in clinical research

Financial conflicts of interest arise when physician's judgment and decision making become compromised by financial gains or interests, and thus create risk of undo harm to research participants, to the integrity of research projects, and, ultimately to society at large. Such conflicts also violate the moral maxims of medicine, and thus damage the integrity of physicians and the medical profession. I submit that key remedies for this problem are the integrity (self-respect) of physicians and the respectful engagement of research participants (whether patients or nonpatient volunteers) as partners in research projects. Accordingly, I consider physicians the primary moral agents, research participants the secondary moral agents, and society the tertiary moral agent with responsibilities for protection against whatever undue harm in clinical research. The latter needs to address the powerful, cultural, commercial, political, and social factors that contribute to physicians' financial conflicts of interest.