This article will explore conflicts of interest in the context of clinical research, focusing on the incentives and practices that foster such conflicts. Part I will briefly define and categorize the revenue streams at play in clinical research—both contemporaneous with the clinical trial, and the downstream, long-term gains available to the researcher and research university. Part II will discuss how these entangled revenue streams result in financial and non-financial conflicts of interest that affect the nature and balance of the research enterprise and potentially endanger patients and human subjects. Part III will summarize current conflicts of interest regulations and policies, including methods for addressing and preventing conflicts of interest. Finally, Part IV will suggest some reforms to the current conflict of interest management strategies, with the concession that, absent a major culture shift in research institutions and existing law, conflicts of interest will continue to undermine confidence in the integrity of the research enterprise
