Investigator's and institutions' financial conflicts of interest (CoI) in medical research raise serious questions about the objectivity of such research, the safety of human Ss, and the threat to public trust in the integrity of clinical research. CoI are quite common in complex settings such as those of academic medicine, and usually pose no problem, both because of the safeguards already in place and the integrity of most researchers. But it is clear that both non-financial CoI (e.g., career advancement, peer recognition, etc) and financial ones are double-edged: they can motivate individuals to do their best work but also can compromise judgment and undermine objectivity. Whether or not CoI have actually created significant problems, academic medicine risks great peril if its leaders fail to respond to the growing perception that such problems exist. To foster public trust, the public needs to be better educated about how, with proper safeguards, limited financial incentives in the conduct of clinical research can benefit everyone. In addition, safeguards against the downsides of such financial incentives must be visibly strengthened. The author offers 8 suggestions for what academic medicine's leaders might do in this regard.