Abstract
The phrase “Conflict of Interest” (COI) is something most of us would have heard. Our first reaction, at least mine was that it is not related to me. That is not until I became the editor of our National Journal. Now I am hearing this phrase a minimum of five times a day and sometime last week there was this (all controlling) Whatsapp which had a forward on this topic. So here goes, this editorial is my two bits and a half on this.
This phrase affects us in all fields of Life – Politics, Journalism, Science etc. Wikipedia refers to it as a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another. Simply put, the decision taken on any issue may or may not be based on merit, mostly the latter. In all fairness , it could be because of ignorance of conflict of interest too. Imagine, a simple scenario: You are the chairman of the committee to select the National cricket team. For the last slot, there are two players and one is from your state. Who will you select? If there is clear meritorious demarcation, then the choice is easy. The situation becomes more complicated when both the players are of similar calibre.
In my humble view, even your simple I***lign certification hanging fashionably on your clinic wall is COI. You have paid to be certified to tell your patients that this brand is ….ahem…… “superior” . The point is it may be, more importantly it may not be. There is no evidence for or against. No Cardiologist will have a certificate stating that they have been certified by Littman. I guess, no other profession in healthcare. Okay we are deviating.
COI can extend in all aspects of Orthodontics. A few examples—The Head of the Department is a brand ambassador for Company D. The entire training is going to be based on that technique/material which may lack clinching (or even meagre) evidence of scientific superiority. The Editor is a Key Opinion Leader (KOL)for a particular brand and therefore data favourable to a particular brand only gets published. (We in the Journal of the Indian Orthodontic Society try our best that even reviewers’ get articles to review so that there is no COI). Another example would be the speakers at Scientific Conventions. Most conferences exhort the speakers to disclose their COI. The Cochin conference of IOS (like most IOS conferences - at least to my memory) followed this policy, rightfully to the fullest.
We are probably the only speciality which is proud of the fact that no two orthodontists think alike. While this may be appreciated, hope we are thinking in a particular direction without COI. While being a KOL may not be wrong, aspiring for posts in the Indian Orthodontic Society should be viewed with caution. Like the government has for certain posts, a cooling off period maybe considered.
Like any Editorial, both viewpoints must be presented. KOLs have the huge advantage of mostly a multinational backing and therefore social media control. Altmetrics is the new standard of assessment and stands for “alternative metrics.” Instead of impact factor or H-index, Altmetrics assesses mentions on Facebook, Twitter, etc. Though Altmetrics are meant to complement, not totally replace, one never knows.
The list where COI can be observed is endless. Parochialism can be all pervasive. It’s very important that we take it seriously and not be like the quote in Hamlet -More honoured in the breach than the observance. We owe it to ourselves and more importantly to our children. Quo Vadis?
As always your thoughts are welcome. Please pen them to