Conflicts of Interest
- Of all the causes which conspire to blind
- Man’s erring judgment, and misguide the mind,
- What the weak head with strongest bias rules,
- Is pride, the never-failing vice of fools.
- Alexander Pope1
A conflict of interest occurs when an individual’s objectivity is potentially, but not necessarily, compromised by a desire for prominence, professional advancement, financial gain, or a successful outcome. Conflicts of interest that arise from personal or financial relationships, academic competition, and intellectual passion are not uncommon in science. In biomedical publication, a conflict of interest may exist when an author (or the author’s institution, employer, or funder) has financial or other relationships that could influence (or bias) the author’s decisions, work, or manuscript.2-4 However, much concern has been directed toward the financial interests of researchers and authors, perhaps because such interests are the easiest to measure, and because of the complex relationships between them and the funders of their work.5-11 In addition, concerns have increased about author biases associated with financial ties to industry6 and pressures from commercial funders that result in delayed or suppressed publication.5,10
Journal editors strive to ensure that information published in their journals is as balanced, objective, and evidence-based as possible. Because of the difficulty in distinguishing the difference between an actual conflict of interest and a perceived conflict,12 many biomedical journals require authors to disclose all relevant, potential conflicts of interest.2-4 Financial interests may include but are not limited to employment, consultancies, stock ownership, honoraria, expert testimony, royalties, patents (filed, pending, or registered), grants, and material or financial support from industry, government, or private agencies. Nonfinancial interests include personal or professional relationships, affiliations, knowledge, or beliefs that might affect objectivity.
Many potential biases may be detected during the editorial assessment and peer review of a manuscript (eg, problems with a study’s methods and analysis, inappropriate interpretation of results, unbalanced selection or citation of the literature, unjustified emphasis or overly enthusiastic language, and conclusions that go beyond a study’s results) or are obvious from the author’s affiliation or area of expertise. However, financially motivated biases are less easily detected. Therefore, in the 1980s biomedical journals began to require authors to disclose any financial interests in the subject of their manuscript.13,14 During the next 20 years, authors typically included information about financial support from grant and funding agencies in their submitted manuscripts, primarily because the funding agencies require them to do so, but it was less common for authors to disclose other financial interests, unless such information had been specifically requested.
Until recently, many journals did not have conflict of interest policies. A 1997 study of 1396 high-impact biomedical and science journals identified only 181 journals (13%) with conflict of interest policies; those journals with policies were overrepresented by medical journals.15 A study conducted in 2005 of the 7 highest-impact, peer-reviewed journals in 12 different scientific disciplines showed a higher prevalence of journals that reported having conflict of interest policies (80%), although only 33% made these policies publicly available (eg, in their instructions for authors). All of the top-ranked general medical and multidisciplinary science journals had such policies, but journals in other scientific disciplines were less likely to have such policies and/or to publish them in their instructions for authors.16
Many biomedical journals, including JAMA and the Archives Journals, require disclosure of financial interest from everyone involved in the editorial process: authors, reviewers, editorial board members, and editors. The International Committee of Medical Journal Editors (ICMJE),2 the Council of Science Editors (CSE),17 and the World Association of Medical Editors (WAME)18 support this policy. Many journals also require individuals (such as editorial and publishing employees and full-time and part-time editors) who have access to material during the review and publication processes to comply with policies on conflicts of interest. The CSE has a framework (recommendations and a list of questions) to help journals develop and review current policies on conflicts of interest.19
Different journals and publishers have various conflict of interest policies and procedures (eg, some request disclosures, some require disclosures, and some exclude authors, reviewers, and editors with conflicts of interest from participation in the publication process).16 Journals also define relevant conflicts of interest in different terms; they may have a broad interpretation of conflicts of interest to include financial and nonfinancial conflicts or may focus only on financial interests, and for financial interests, they may define relevance in terms of monetary amounts or lengths of time. The following discussion addresses policies in general as recommended by the ICMJE,2 CSE,17 and WAME18 and provides specific examples of policies, procedures, and terms as used by JAMA and the Archives Journals.