funds are juxtaposed with agency support needs serious consideration in each case and careful management to safeguard the conclusions of the PORTs from the conflicts of interest inherent in accepting such funding.

Second, regarding nonfinancial sources of bias, such as those arising from professional training and loyalties and other academic pursuits, PORTs must be diligent in ensuring multidisciplinary representation. They should also actively encourage internal and external examination to recognize and counterbalance any nonfinancial sources of bias.

ASSUMPTION

One product of scientific research—including the particular form of health services research conducted by PORTs—is inference. Beyond using the best and most powerful scientific means available in their studies, researchers seek to maximize the validity of their inferences by identifying sources of bias and by minimizing the effects of those biases on their findings. The committee recognizes that biases from conflicting interests, whether financial or nonfinancial, are but some of the many sources of bias that should concern researchers. The central purpose of this report is to help PORTs identify the risks posed by conflicts of interest and to suggest measures that will enable them to reduce those risks.

The committee believes that PORTs—from a self-interested desire to enhance and maintain their own credibility—will be responsive to suggestions for reducing bias. As a result, the committee has concluded that PORTs should not be constrained by a full set of prescriptions about how they should behave, and the committee advises restraint in the promulgation of rules. Yet investigators need guidance in recognizing a conflict of interest and knowing when to disclose it. The committee also recognizes, that complete reliance on informal mechanisms does not address the fact that the scientific community has not always been adequately self-regulating, especially when the expectation of replicability does not apply. Moreover, on the clinical side, physicians have, until lately, been reticent in bringing forward and examining marked differences in medical practices.

PORTs, which combine research with involvement in clinical medicine, need to pay special attention to the appearance as well as the reality of conflict of interest, given the relevance of PORT findings to physician-patient interactions and policymaking and the consequent public scrutiny to which PORT research methods and findings will be exposed. Real or apparent conflicts of interest involving sources of support, other activities of PORT members, and the adequacy of representation of differing viewpoints will be primary targets for critics. Earlier chapters have shown that PORT research is similar to biomedical research or



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