According to Wikipedia, ‘Çonflict of interest’ is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest' 1. It may be broadly described as conditions which may influence one’s judgement in a situation (primary interest) for some other gain (secondary interest), this may be financial or non-financial . It is of importance to understand that having a secondary gain is not wrong but these gains should not be illegal. This pertains to delivery of patient care, teaching and research in the medical profession.

We must understand the minor difference between a gain being the secondary outcome of our actions rather than the outcome unduly influencing the primary actions. It is important for the trainees/students and younger post graduates to understand this minor difference.

It is important to know the difference between an ethical issue and conflict of interest. Ethical issues usually involve two choices and one has to choose the correct one, depending on the moral stands of the concerned group in that situation. A glaring example of ethical issue in recent times is of the COVID vaccine, there were reports warning against the vaccine as it had not passed through requisite trials before being used for the public 2. However, the major health and economic implications in waiting for herd immunity provided the ‘ethical justification’ for fast tracking of the vaccine all over the world3. This is not conflict of interest.

For most practical situations conflict of interest implied with financial conflict of interest, however other conflicts of interest like desire for professional progress, to get more research funding are examples 4, 5. Not only individuals, even organizations or institutions are faced with these situations for being able to balance their needs and requirements.

We need to understand the difference between interest and conflicting interest. The natural interest we have towards better care of patients included in our research protocol is very much acceptable. However, if the decisions of the researcher are based purely to achieve the research or financial goals while compromising patient care it would amount to conflict. People who are more independent or less accountable are more probable to perform conflicting behaviour. Hence bodies like research boards, peer reviews and other committees which comprise of non-biased persons may be capable of keeling such practices in check.

Addressing all potential conflicts of interest has made research a very tedious and lengthy process worldwide. Regulatory bodies, panels, committees all are geared up to make things ‘CONFLICT’ free but is it effective ?This needs to be explored. Principles underlying conflicts and their possible solutions need to be addressed and taken up.

Many scenarios have been described recently 6. i)Financial Conflicts: The fact that a person maybe a financial stake holder in company would definitely make them biased towards a particular product, may end up recommending that product if on board of an advisory team . Thus, transparency concerning the funding agency must be declared. No research is possible without funding, so it must be considered as the facilitating force rather than the conflict causing force. It is upto the researchers and their integrity to keep work conflict free even if stakes are high. ii.) Regulators: Unbiased bodies regulating the research process must be involved however they must understand that despite all efforts some conflict is unavoidable and an approach of trust rather than distrust must be adopted. iii.) Unbiased approach : Though randomised controlled trials (RCTs) are considered as the only valuable methodologies, other research strategies may also be approached with objectivity for unique situations or research questions. Methodologies like prospective studies , cohort studies and follow-up studies in well-characterized cohorts which have considered specific end points have been shown to produce scientifically relevant results 7, 8. iv.) Conflicting research : A comprehensive information portal like clinical trials.gov.in is a very good way to avoid conflicts arising out of similar research and also provides transparency of research outcomes. There may be factors inhibiting or causing failure to publish negative or a neutral result on a new product in comparison to standard products available, related to a product with which a person may be associated. Or overall non-inclination towards publishing a negative report. Journals not accepting negative results or even neutral results –publication bias. ‘Enthusiasm’ of Journals with high impact factors for publishing negative or neutral reports is a possible solution to this problem. A special section of ‘neutral’ reports can be allotted to each Journal. These could include thesis of students which usually report these subtle findings before the guides or investigators take on a blown up form of a positive study.

Transparent peer review. Acceptance and rejection of papers must not depend totally on peer review where conflicts may arise. Also peers of the authors choice may be selected discreetly.

Recognizing and addressing various aspects of conflict of interest may be dependant on the setting. However, it is important to recognize and address these rather than allowing it to become a roadblock in the way of good research. In the setting of a vast Indian subcontinent this is of more significance as we are advancing in research and will soon be emerging as leaders on the world map.

Gupta Indrani Baru Rama Economics & ethics of the COVID-19 vaccine: How prepared are we? Indian Journal of Medical Research 2020 152 1 153 153 0971-5916 10.4103/ijmr.ijmr_3581_20 Medknow https://dx.doi.org/10.4103/ijmr.ijmr_3581_20 Fauser B.C.J.M. RBM online: challenges ahead in scientific publishing Reproductive BioMedicine Online 2017 34 3 221 224 1472-6483 10.1016/j.rbmo.2017.01.006 Elsevier BV https://dx.doi.org/10.1016/j.rbmo.2017.01.006 https://en.wikipedia.org/wiki/Conflict_of_interest Thompson D Understanding financial conflicts of interest N Engl J Med 1993 329 573 576 Fauser Bcjm Macklon N S May the colleague who truly has no conflict of interest now please stand up! Reprod Biomed Online 2019 39 31540846 31540846 Levinsky Norman G. Nonfinancial Conflicts of Interest in Research New England Journal of Medicine 2002 347 10 759 761 0028-4793, 1533-4406 10.1056/nejmsb020853 Massachusetts Medical Society https://dx.doi.org/10.1056/nejmsb020853 Fauser B C J Patient-tailored ovarian stimulation for in vitro fertilization Fertil. Steril 2017 108 585 591 Bird E Scientist warns against fast tracking of COVID-19 vaccine trials 2020 https://www.medicalnewstoday.com/articles/scientist-warns-against-fast-tracking-covid-19-vaccine-trials#1