Beyond Financial Disclosure: Rethinking Conflicts of Interest in Science and Policy
This article, in a slightly edited form, first appeared in Pain Medicine News on August 15, 2025.
In nearly every medical journal, academic conference or government advisory panel, experts are required to disclose any financial relationships that could influence their views. This is a good and necessary practice. Monetary incentives can bias outcomes, distort public discourse and erode trust in science. Yet, placing exclusive focus on financial ties risks overshadowing deeper, often more insidious, conflicts rooted in ideology, politics and institutional agendas.
A recent real-world example illustrates this clearly. Robert F. Kennedy Jr., as the 26th secretary of Health and Human Services, proposed creating a new HHS-backed medical journal. He publicly condemned established journals—The New England Journal of Medicine, JAMA, and the Lancet—as ideologically “captured,” suggesting that a government-owned outlet is necessary to correct scientific bias. While no industry dollars are involved, this represents a textbook case of ideological conflict, yet it would not register under standard conflict of interest (COI) disclosure rules.
Contrast that with a researcher who receives a $5,000 consulting fee from industry to advise on stem cell research. Despite rigorous methodology, transparency and peer review, that individual would face intense scrutiny and reputational damage if this financial relationship were not disclosed. Yet, the ideological bias of a cabinet-level official influencing the norms of scientific publishing remains unchallenged. Which scenario poses the greater threat to scientific integrity?
Our current COI paradigm is flawed. Leading frameworks accept that conflicts stem from situations, not personal moral failings. The Association of American Medical Colleges (AAMC) defines COIs as circumstances in which “financial or other personal considerations may compromise, or have the appearance of compromising, an investigator’s judgment.” The National Academy of Sciences, likewise, notes that a COI arises when a personal interest “may lead to a personal advantage.” Despite this, our systems almost exclusively address monetary influence.
This narrow approach ignores nonfinancial pressures. For example, Jeff Bezos’ reluctance to criticize the current administration, amid speculation about antitrust actions against Amazon or political attacks on The Washington Post, demonstrates ideological inertia without direct financial transaction. Shouldn’t that count as a conflict?
In healthcare, narratives around the opioid crisis show how ideology shapes research and policy. The dominant media storyline has focused overwhelmingly on overprescribing physicians and pharmaceutical companies, often casting them as the primary culprits. While these groups have certainly played a role, this framing tends to oversimplify the complex structural and social drivers of opioid use disorder such as poverty, trauma, unemployment and lack of mental health support. Patients with chronic pain or substance use disorder are often left out of the narrative entirely, or portrayed selectively depending on how closely their story fits popular tropes of innocence or deviance. Meanwhile, research exploring the unintended harms of restrictive opioid policies—such as worsened pain control, diminished quality of life or suicide risk—is frequently met with editorial resistance. This is bias through narrative conformity, not financial conflict, yet it remains outside the bounds of formal disclosure.
A systematic review in JAMA confirmed that industry funding affects study outcomes. But that analysis cannot detect more subtle distortions arising from ideological capture, such as editors’ or policymakers’ unexamined interpretive biases. This asymmetry undermines scientific integrity. Why is a financial honorarium treated as a conflict more rigorously than a political ideology equally capable of influencing outcomes? That imbalance distorts the public debate over what should be disclosed and ultimately understood.
Equally important is public education: COI disclosures should be tools for transparency, not moral judgment. As an AAMC publication emphasizes, “The conflict lies in the situation, not in any behavior or lack of behavior of the individual.” Without naming the full spectrum of conflicts, we cannot manage them effectively. Disclosure is the most transparent way to manage conflicts.
So how do we address this? First, redefine COIs to include positional, institutional and ideological influences, not just economic ones. Second, incorporate reflexivity protocols or structured practices, common in the social sciences, in which researchers and reviewers acknowledge how their own values, background or lived experience may shape their interpretation of evidence. Reflexivity does not imply disqualification; rather, it promotes transparency about the perspectives that inform scientific inquiry. Third, diversify editorial and peer-review panels to ensure ideological and experiential plurality, breaking up monocultural echo chambers.
If we are serious about preserving scientific integrity, we need a more honest and inclusive framework for understanding influence. Dollars matter, but they are not the only currency. Convictions, creeds, religious beliefs, political ambitions and institutional loyalty shape research and interpretation just as powerfully. If we continue to equate conflict with only financial interest, we’ll overlook deeper conflicts shaping policy and allow them to proceed unchecked.
Acknowledgements:
Lynn R. Webster serves as a consultant to Collegium Pharmaceutical, Elysium Health, Ensysce Biosciences and Trevi Therapeutics. He is not a member of any religious or political group.