Conflict of Interest
Practice Scenarios & Quizzes

August 2019

1. Promoting a Product

You work as a dietitian in industry. Your company produces frozen meals and part of your job is to promote the sale of this product to purchasing agents for various retail outlets. The purchasing agents know that you are a dietitian. Are you in a conflict of interest?

The company hiring you wishes to make a profit from selling the products that you are asked to promote and knows that consumers respect your professional opinion about nutrition. They are buying that trust. A perceived conflict lies between the interests of the company paying you to represent their product, and that of consumers and other dietetic professionals.

A reasonable person could question whether your interest lies with the company or the consumer. In most circumstances, transparent, honest and evidenced-based promoting of a product would be perceived as managing the conflict appropriately.

The situation would be quite different if you were not employed by the company but were retained as an independent expert to endorse the product only to purchasing agents. Purchasing agents are not clients except in the most commercial sense of the term. They can still reasonably expect, however, that you would be transparent and clearly identify your role as a sales agent for your employer. They can also reasonably expect that any nutritional claims you make would be fair and accurate, based on evidence and not misleading by omission. In that context, you would have a competing duty in your role as dietitian and your minimal professional duty to the purchasing agent. You must ensure that representation of the product is always based on evidence.

The situation would also be quite different if, as a dietitian, you were to participate in advertisements to the general public endorsing a product with words like, "I am a dietitian and I recommend X to all of my lactose intolerant clients because it is the best product on the market".

Dietitians may wish to avoid a personal endorsement of this type entirely because they are so open to misunderstanding. In that context, their duty to the general public would be a competing interest. When working for a commercial entity that deals directly with the public, dietitians should always identify themselves as representatives of their company and should avoid any perception that they are making a clinical recommendation to anyone. This situation must be carefully managed through honest, transparent, and evidence-based practice.

2. Speaking Engagement

Normally, you work on salary from 8:30 to 4:30. Your job provides you with a lot of independence and off-site work. A community partner asks you to provide a presentation at a community group during a weekday afternoon. This presentation is not in your job description. You will be paid a modest honorarium. No one will miss you at work, and you believe that this speaking engagement will enhance your relationship with the community partner. Is there a problem?

In the scenario, “Speaking Engagement”, the fact that you are keeping your attendance a secret from your workplace is a good indication that something is wrong. Your primary client in this context is your employer. You are supposed to be working from 8:30 to 4:30 for your employer and are being paid for that time. Your competing personal interest would certainly include the honorarium and using work time for other activities.

Even if you were not paid the honorarium, you would have to be confident that your employer would approve the presentation time.  In many jobs, it would be natural for you to discuss the invitation with your supervisor before accepting it.

Depending on the circumstances, the concerns can probably be successfully managed by appropriate communication. Some safeguards could include notifying your employer of the speaking engagement offer and obtain approval for your participation. Your employer may ask you to justify the presentation as it is not within your job description.

You have developed expertise in hyperlipidemia. You have been asked to speak at a conference and present a paper on a nutrition treatment of hyperlipidemia. After agreeing to speak, you receive the conference materials and learn that each session has a corporate sponsor. A yogurt company sponsors your session. Is there a problem?

One dilemma in this situation is whether you are using your professional status to implicitly endorse the yogurt company. You want to avoid a situation where you felt pressured to slant a presentation in a way in order to avoid upsetting the sponsor. There might be an inference of influence over the content of the paper if, for example, the yogurt company's logo was on your paper or handouts. To a large extent, the perception of conflict would depend on:

  • how the sponsorship was portrayed before, during and after the conference;
  • how much influence the sponsor had or appeared to have over the content of the presentation; and
  • what other safeguards were in place?

Additional information would clarify the situation. A possible safeguard might be a disclaimer in the written materials indicating that you had no connection with the sponsor. The organizers of the conference could also be approached to ensure that there was no actual or perceived influence of the sponsor over the content of the presentation.

Depending on the circumstances, the concerns can probably be successfully managed through the DORM Principle:

  • Disclosure: at the earliest opportunity, dietitians should disclose the nature of the conflict to the client;
  • Options: inform the client of his/her alternatives and assist in arranging for alternatives where requested;
  • Reassurance: reassure clients that choosing another product or service will not affect the quality of the professional services to them;
  • Modification: making small modifications can remove or greatly reduce the potential for conflict of interest.

Conflict of Interest - Quiz

Select the best answer to each of the following questions. Consider the reason for your choice. Review the correct responses. 

1. In the scenario, "Promoting a Product, what safeguard would you include to ensure honest and transparent communication?

a. Ensure that you clearly identify yourself as a representative of your company
b.  Ensure that your communications improve the company’s reputation
c.  Provide a clinical recommendation
d.  All the above

 The best answer is (a). Dietitians should be transparent and clearly identify their role with the company. Answer (b) is not a safeguard for honest and transparent communication.  Answer (c), dietitians should avoid any perception that they are making a clinical recommendation in this scenario. Answer (d) is incorrect.

2. In the scenario, "Promoting a Product", a reasonable person could question if your interest lies with the client, or with the company. From the list provided below, what should a dietitian do to avoid a conflict of interest?

a. Focus on self-interest ahead of client interest
b. Provide honest and transparent communication
c. Provide evidence-based information
d. Focus on client-interest ahead of self-interest
e. B, C, and D 

 
The best answer is (e). Honest, transparent, and evidence-based practice is necessary to  avoid conflict of interest.  Answer (a), is a concern – client interest should always be ahead of self-interest.

3. In the scenario, "Speaking Engagement", what should a dietitian do to avoid a conflict of interest?

a. Communicate openly and honestly with the employer about the request
b. Decline the community agency’s request  
c. Provide the session without telling anyone

 
The best answer is (a). Notifying your employer of the speaking engagement allows you to   discuss and obtain approval for your participation. Answer (b) is not client centered without first exploring the options with your employer. Answer (c) is a concern since the competing personal interest would include an honorarium and using work time for the activities.

4. In the scenario, "Sponsored Conference", what should a dietitian do to avoid a conflict of interest?

a. Use professional status to endorse the company and their products
b. Slant the presentation in a way to avoid upsetting the sponsor
c. Put the yogurt company’s logo on your handouts and in your slides
d. Provide a disclaimer that the opinions are your own and you have no connection to the sponsor

 
The best answer is (d). Disclosing that you have no connection to the sponsor provides a safeguard of transparency to ensure the nature of the relationship has been provided to the audience.  Answer (b) is not client centered or honest. Answer (c) is a concern since it can   create a perception that you are representing the company.

5. According to the Standards and Guidelines for Professional Practice: Conflict of Interest,  dietitians are responsible for identifying situations that are, or may lead to, conflict of interest.  RDs can identify a conflict of interest, using a “Am I in a Conflict of Interest” Framework (p.4), which includes:

a. The proper influence and professional judgment test
b. The professional judgment and irrational person test
c. The personal interest and professional judgment test

 
The best answer is (c). According to the Standards and Guidelines for Professional Practice Conflict of Interest, the Framework includes: The Personal Interest Test, The Professional Judgment   Test, The Improper Influence Test, and the Reasonable Person Test.