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BMJ 2015;351:h6577 doi: 10.1136/bmj.

h6577 (Published 16 December 2015)

Page 1 of 2



COI bingo
Daniel S Goldberg assistant professor, Department of Bioethics and Interdisciplinary Studies, Brody
School of Medicine, East Carolina University; 2015-16 Honors College Faculty fellow, 600 Moye
Blvd, Mailstop 641, Greenville, NC 27834, USA
I’ve spent years studying, teaching, and writing about conflict
of interest (COI). In that time I’ve seen hundreds of justifications
offered for deep entanglements between physicians or scientists
and commercial industry.
Plausible arguments support such relationships, but the actors
in question rarely invoke them. Instead, the standard reasons
given often suggest no familiarity whatsoever with the
substantial evidence base regarding motivated bias and its impact
on human behavior, including physicians’ and scientists’

Any reasonable attempt to justify deep relationships with
commercial industries must begin by acknowledging the
evidence rather than trotting out tired justifications that have
mostly been contradicted by the evidence. The claim that various
barriers to such influence are sufficient to prevent it—for
example, individual virtue, institutional management, or
disclosure—is simply not an evidence based view.
After reading yet another news story containing the usual sorts
of flaccid justifications, I decided to construct a COI Bingo
chart as a way of both satirizing the rationales offered and

suggesting their typicality: a typicality which, again, contravenes
a healthy and robust evidence base.
Physicians and scientists often profess a commitment to follow
the evidence wherever it leads. Those seeking to justify deep
relationships with commercial industry ought to follow that
dictum and acquaint themselves with the evidence on motivated
bias and COIs.1-4 Hence, the COI Bingo chart (fig 1⇓).
An earlier version of this chart appears at:
Follow DSG on Twitter, @prof_goldberg

Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry.
JAMA 2003;290:252-5.
Cain DM, Loewenstein G, Moore DA. The dirt on coming clean: perverse effects of
disclosing conflicts of interest. J Legal Stud 2005;34:1-25.
Sah S. Conflicts of interest and your physician: psychological processes that cause
unexpected changes in behavior. J Law Med Ethics 2012;40:482-7.
Sharek Z, Schoen RE, Loewenstein G. Bias in the evaluation of conflict of interest policies.
J Law Med Ethics 2012;40:368-82.

Cite this as: BMJ 2015;351:h6577
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For personal use only: See rights and reprints


BMJ 2015;351:h6577 doi: 10.1136/bmj.h6577 (Published 16 December 2015)

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For personal use only: See rights and reprints