The Institute of Medicine defines a conflict of interest as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.” Lo, B. Field, M., eds., Conflict of Interest in Medical Research, Education, and Practice (Washington, D.C.: National Academies Press, 2009): At46. The primary interests of physician-investigators include advancing the scientific goals of their research and protecting the rights and well-being of research participants. Investigators may have a host of secondary interests as well, including career advancement, intellectual stimulation, and financial gain. Importantly, there is nothing inherently wrong with these secondary interests. As the IOM defines it, and as it is used here, the term “conflict of interest” does not equate to compromised judgment or action but to the risk of such compromisekk.Google Scholar

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See, e.g., Patient Protection and Affordable Care Act, Pub. L. No. 111–148, § 6002, 124 Stat. 119, 689 (codified as amended at 42 U.S.C. § 1320a-7h) (amending Part A of title XI of the Social Security Act by adding section 1128G) (2010) (requiring pharmaceutical and medical device manufacturers to disclose payments made to physicians and teaching hospitals for, among other things, conducting clinical research); California Health & Safety Code § 24173(c) (2006) (requiring disclosure to prospective research participants of “[t]he material financial stake or interest, if any, that the investigator or research institution has in the outcome of the medical experiment”).Google Scholar

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The centrality of internal motivations to comply has been noted in numerous areas of law. See, e.g., Kornhauser, M. E., “A Tax Morale Approach to Compliance: Recommendations for the IRS,” Florida Tax Review 8 (2007): 599–640, at 602 (discussing the importance of taxpayer attitudes and beliefs to tax law compliance). May, P., “Compliance Motivations: Affirmative and Negative Bases,” Law & Society Review 38 (2004): 41–67, at 48–49 (finding that homebuilders' attitudes and beliefs, including their belief that the building code is necessary heavily influenced their motivation to comply with building code requirements). Blair, M. M. Stout, L. M., “Trust, Trustworthiness, and the Behavioral Foundations of Corporate Law,” University of Pennsylvania Law Review 149 (2001): 1735–1810, at 1780 (arguing that “[l]egal sanctions and market forces often cannot bind corporate participants tightly enough to restrain all opportunistic behavior (at least if one assumes that participants are rational and self-interested players)” because “[t]he information requirements are just too high and the business environment is too complex, opaque, and uncertain.”).Google Scholar

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