Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
Reaffirmed with minor revision by the 201st WMA Council Session, Moscow, Russia, October 2015,
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025
PREAMBLE
This policy is intended to identify areas where a conflict of interest might occur during the day-to-day practice of medicine, and to assist physicians in resolving such conflicts in the best interests of their patients. A conflict of interest arises when professional judgement concerning direct patient care might be unduly influenced by secondary interests. Factors such as mandatory institutional requirements or career advancement pressures could represent conflicts of interest.
As stated in the WMA’s International Code of Medical Ethics, the physician must recognize and avoid real or potential conflicts of interest.
In some cases, it may be enough for a physician to acknowledge that a potential or perceived conflict exists. In others, specific steps to resolve the conflict may be required. Some conflicts of interest are inevitable and there is nothing inherently unethical in the occurrence of conflicts of interest in medicine, but it is the manner in which they are addressed that is crucial.
In addition to practicing medicine and providing direct patient care, physicians serve in additional roles and pursue various other interests, such as participating in research, contributing to seminars and conferences, training and educating future physicians and occupying administrative or managerial positions. As private interests within medicine have expanded in many locales, physicians have occasionally provided their expertise to these endeavors as well, acting as consultants (and sometimes employees) for private enterprises, including those involved in the development of new technologies and digital solutions.
The growing interaction between physicians and private sector stakeholders reflects the broader systemic influence of these private interests on healthcare markets, clinical practice, research priorities, and medical education. These factors are also referred to as commercial determinants of health.
Although the participation of physicians in such activities can ultimately serve the greater public good, it can also give rise to conflicts with their primary obligation to the health and well-being of their individual patients, as well as broader public health needs. Other interests must not be allowed to influence clinical decision-making or even have the potential to do so.
Physicians have a moral duty to scrutinize their own individual behavior for any potential conflicts of interest. If unacknowledged, conflicts of interest can seriously undermine patient trust in the medical profession as well as in the individual practitioner and therefore negatively impact the patient-physician relationship. Any conflict of interest, be it real or potential, financial or personal, including relational conflicts of interest, should be disclosed. Depending on the circumstances, additional remediation may be necessary.
Physicians may also wish to consult additional resources such as specialty societies, medical associations or regulatory authorities on issues relating to conflicts of interest, and they should be aware of applicable national regulations and laws.
The WMA unambiguously addresses the issue of conflicts of interest in its fundamental ethical policies, including the Declaration of Geneva: The Physician’s Pledge, the International Code of Medical Ethics, and the Declaration of Helsinki. These core documents make it clear that the health and well-being of the patient or research participant must always be the physician’s first consideration.
RECOMMENDATIONS
Research
1. The interests of the clinician and the researcher may not be the same. If the same individual is assuming both roles, as is often the case, the potential conflict should be addressed by ensuring that appropriate steps are put in place to protect the patient, including disclosure of the potential conflict to the patient.
2. Medical research must be conducted ultimately for the advancement of individual and public health. A physician-researcher may never place financial interests above the welfare of patients. Patient health and well-being and scientific integrity must be paramount.
3. All relevant and material physician-researcher relationships, sources of funding, institutional affiliations, and conflicts of interests must be disclosed to potential research participants, research ethics committees, appropriate regulatory oversight bodies, medical journals, conference participants and the medical centre where the research is conducted.
4. Prior to commencement of any research, all parties involved in the research including trial sponsors, the physician-researcher and research participants, should agree to key terms and conditions relating to, at a minimum:
• financial compensation for the physician-researcher,
• control of and access to research results,
• the right and obligation of the physician-researcher to publish negative results,
• the right of the physician-researcher to release relevant information to trial participants at any point during the study,
• funding for participants’ medical care in the event of complications associated with the research,
• data protection and incidental findings.
5. Physician-researchers should retain control of and should have full access to all trial data and should decline non-disclosure clauses.
6. Physician-researchers should ensure that, regardless of the trial results, the presentation or publication of the results will not be unduly delayed or otherwise obstructed.
7. Physicians should not accept payment or other benefits solely for referring patients to research studies or for sharing patient data. Patient information should only be shared with due regard for patient confidentiality and data safety.
8. Any compensation received by physician-researchers from trial sponsors should approximately replace lost clinical income and should be commensurate with the efforts and responsibilities of the physician performing the research. When enrolment is particularly challenging and time-consuming, reasonable additional payments may be made to compensate physician-researcher or institution specifically for time and effort spent on extra recruiting efforts to enroll appropriate research participants. Escalating bonuses designed to increase trial enrolment should not be accepted.
9. Payments or compensation of any sort may never be tied to the outcome of clinical trials. Physician-researchers should not have a financial interest in a company sponsoring a trial or a product being studied in a clinical trial if this financial interest could be affected positively or negatively by the results of the trial; they should have no direct financial stake in the results of the trial. They should not purchase, buy or sell stock (shares) in the company while the trial is ongoing and until the results have been made public. This might not apply for those physicians who have developed a medication but are not part of the enrolment process.
10. Physician-researchers should decline requests to review grant applications or research paper submissions from colleagues or competitors if their relationship poses a risk to impartiality.
11. Physician-researchers should only participate in clinical trials when they relate to their area of medical expertise, and they should have the appropriate ethical and scientific education, training and qualifications in the conduct of research and the principles of research ethics.
12. Authorship should be determined prior to the start of the trial and should be based on substantive scientific contribution.
13. Physician-researchers should be aware of broader commercial determinants of health that may influence research priorities, study design, and the interpretation or dissemination of results, and should actively seek to mitigate such influences to preserve scientific integrity and public trust.
Education and training
14. The educational needs of students and physicians in specialty training and the quality of their education and training experience must be balanced with the best interests of patients. Where these are in conflict, the interests of patients will take precedence.
15. Basic medical education, specialty training, and continuing professional development (CME/CPD) should include specific training on recognizing and managing conflicts of interest, as well as understanding commercial determinants of health, to support critical appraisal of information and uphold professional integrity in the best interests of patients.
Self-referrals , kickbacks, and fee-splitting
16. All referrals to other physicians or providers, and prescriptions for specific goods or services, should be based on the objective assessment of the referring or prescribing physician. Any form of collaboration among health professionals must prioritize the interests of the patient.
17. Physician self-referral occurs when a physician refers a patient to a service, practice, or health care facility (such as a laboratory) where they do not engage in professional activities but in which they have a financial interest. This practice has the potential to significantly influence clinical decision-making and is not generally considered acceptable unless there are appropriate safeguards in place and the referral is based on objective, medically relevant criteria. (For example, there is a need for the facility in a small rural community and other ownership is not a possibility. The physician in this situation should receive no more financial interest than would an ordinary investor.)
18. Kickbacks or fee-splitting occur when a physician receives financial consideration for referring a patient to a specific practitioner or for a specific service for which a fee is charged. These practices are not acceptable.
Product sales
19. Physician sale of medical products (health-related products), or of non-medical products (products not related to patient health or the practice of medicine), from their office or website may raises ethical concerns about financial conflict of interest and may risks placing undue pressure on the patient. Non-medical products and scientifically non-validated medical products should not be sold from physicians’ offices or websites. Sales of scientifically validated medical products are acceptable only in limited circumstances with appropriate safeguards, including appropriate disclosure to the patient.
Organizational/institutional conflicts
20. Health care institutions, in particular, are increasingly subject to a number of pressures that threaten several of their roles, and many medical centers have begun to identify alternate sources of revenue. Policies should be in place to ensure that these new sources are not in conflict with the values and mission of the institution and with medical ethical principles (for example, funding from the tobacco, food, or pharmaceutical industries in medical schools or clinics).
21. Individual medical organisations and institutions (including, but not limited to, medical schools, hospitals, medical associations, official/state regulators and research institutions) should develop and enforce conflict of interest guidelines which also apply to their employees and members, and which also address the broader commercial determinants of health. Such guidelines should be structured to assist physicians in making appropriate disclosures and identifying situations where a conflict of interest would preclude their participation in a given activity.
22. Health care institutions should have a clear demarcation between investment decision-making committees, technology transfer and the research arm of the institution.
23. Written policies should provide guidelines for disclosure requirements, or for discontinuing participation in the decision-making process, for those individuals who are conflicted due to sponsored research, consulting agreements, private holdings or licensing agreements.