Understanding "interests": historical insights for managing conflicts of interest in healthcare and biomedical science.

Conflicts of interest are widely regarded as being morally, socially, and scientifically problematic in the many sectors, including in the health sector. There has been considerable attention paid to managing conflicts of interest in clinical practice, medical research and health policy through strategies such as recusal, disinvestment, and disclosure. While these efforts have been important, they are often based on a superficial account of "interests", as few in healthcare and biomedical science have sought to unpack the concept. In this paper, we argue that adopting an historically and philosophically informed account of interests can enrich our thinking about COI in healthcare and biomedical science, and lead to the improvement of COI management strategies. To support this claim, we first provide an overview of contemporary debates about COI in these domains. We then summarise the historical trajectory of the concept of "interest" and show how these insights can be used to inform the management of COI in healthcare and biomedical science using the example of physicians' relationships with the pharmaceutical industry. In particular, we challenge assumed hierarchies of interests and call for increased attention to the multiplicities of interests, both financial and non-financial, that may at times converge and conflict.