COIs can arise in research as a result of the fact that investigators are paid for their services or have an interest in the outcome. Special issues arise in relation to investigator-initiated research, epidemiological research, and research undertaken by academics or industry employees, and clinicians, including private practitioners. Questions that may need to be considered relate to the design of studies, the consent process, controls and analyses of the data, and decisions about publication. There may be direct and indirect conflicts arising from payments for services rendered, both for clinicians and as researchers involved in clinical research; what is ‘fair payment for services rendered’ may not be unambiguous. There may be many non-financial motivations involved, including the possibility of increasing status, achieving fame, advancing a career. In many cases, these may be more important than financial considerations.
The arguments about whether investigators with a direct interest in the outcomes of research should be permitted to participate in such research are complex, as indeed are the organization and structure of individual research projects. It is important that this complexity and the full range of dualities and conflicts arising in relation to research are appreciated and that a flexible, case-specific approach is maintained. In individual instances, it is often possible to identify specific pressure points at which dualities may erupt into conflicts and to devise specific strategies to protect the integrity of the research process.