Conflicts of interest are rampant in medical journals and COVID-19 research

Conflicts of interest, authorship, and disclosures in industry-related scientific publications: the tort bar and editorial oversight of medical journals.

Conflicts of interest in medical journals

Conflict of Interest and the Journal Revisited

Conflict of interest in medical publishing exists when a participant’s private interests compete with his or her responsibilities to the scientific community, readers, and society. While conflict of interest is common, it reaches the level of concern when “a reasonable observer might wonder if the individual’s behavior or judgment was motivated by his or her competing interests”1. Having a competing interest does not, in itself, imply wrongdoing. But it can undermine the credibility of research results and damage public trust in medical journals. 
 In recent years, the extent of conflict of interest in medical journal articles has been increasingly recognized. Medical journals and the popular media have published numerous examples of competing interests that seemed to have biased published reports 2,3,4. Organizations have expressed concern for the effects of conflicts of interest on research 5, publication 1,6,7 teaching8 and continuing medical and nursing education9.
 The World Association of Medical Editors (WAME) is one of the institutions engaged in this discussion. WAME was established in 1995 10, 11 to facilitate worldwide cooperation and communication among editors of peer-reviewed journals, improve editorial standards, and promote professionalism in medical editing 12. Membership in WAME is open to all editors of peer-reviewed biomedical journals worldwide; small journals in resource-poor countries are well represented. As of December 2009, WAME had 1595 individual members representing 965 journals in 92 countries. WAME has broad participation as there are no dues and WAME activities are largely carried out through the member list serve and the member password-protected website.
 In March 2009, WAME released an updated policy statement, “Conflict of Interest in Peer-Reviewed Medical Journals” 1. It details the issues WAME believes journals should address when establishing their own policies for conflict of interest. The editors of this journal thought that the issues were important enough to share with its readers. A summary of the statement is presented in the Table and the full statement 1 can be found on WAME’s website 12.
 How Does This Statement Differ From Earlier Conflict–of-Interest Statements?
 First, WAME expands the scope of competing interests. Other statements have been concerned almost exclusively with conflicts of interest related to financial ties to industry – companies that sell healthcare products. The assumption is that financial incentives are especially powerful and are not readily recognized without special efforts to make them apparent. WAME has extended the concept of financial conflict of interest to include the effects of clinical income. For example, physicians who earn their livelihood by reading mammograms or performing colonoscopies may be biased in favor of these technologies. WAME has also included non-financial conflicts of interest (or the appearance of one) related to scholarly commitment: “intellectual passion,” (the tendency to favor positions that one has already espoused or perhaps even established); personal relationships (the tendency to judge the works of friends/colleagues or competitors/foes differently because of the relationship); political or religious beliefs (the tendency to favor or reject positions because it affirms or challenges one’s political or religious beliefs); and institutional affiliations (the tendency to favor or reject results of research because of one’s institutional affiliations).
 Second, WAME did not prescribe a universal standard for when meaningful conflict of interest exists. Rather, it defined and recommended elements of conflict of interest policies and encouraged journals to establish their own standards. WAME left operational definitions and standards on the basic issues to member journals, recognizing that journals exist in very different contexts across the globe, standards for conflict of interest are evolving, and some journals already have well-established policies and standards. WAME does not presume to judge which conflicts require action and what the appropriate action may be, although its policy does offer factors to consider 1. Obviously, excessive concern for these and more comprehensive lists of possible competing interests could paralyze the peer review and publication process and is not feasible. Editors must make judgments as to the strength of the conflict, but to do so must have uncensored information. Similarly, readers need transparency about conflicts, and therefore editors should publish with every article all relevant author disclosures 1. 
 Third, WAME confirms the seriousness of failure to disclose conflict of interest by indicating that editors have a responsibility for investigating, and if relevant acting, if competing interests surface after a manuscript is submitted or published. The intent is that allegations of failure to declare conflicts of interest must be taken seriously by journals.
 Finally, WAME has addressed in a single statement the conflicts of interests threatening all participants in the research and publication continuum, including authors, peer reviewers, and editors. Conflicts between editors and journal owners, which might affect both the accuracy of articles and the credibility of journals, have been addressed in another WAME policy statement 13.
 What Can Be Done About Conflict of Interest in Medical Journals?
 Conflicts of interest cannot be eliminated altogether but it can be managed so that it has the smallest possible effects on journal content and credibility. The backbone of managing conflicts of interest is full written disclosure; without it, nothing else is possible. Currently, authors may not reveal all of their competing interests and even if they do, journals too often do not publish them 14, so there is plenty of room for improvement. Even so, disclosure alone is an imperfect remedy; editors still must determine whether a conflict has sufficient potential to impair an individual’s objectivity such that the article should not be published. Even more work may be needed on reviewers’ and editors competing interests, given their critical role as gatekeepers for the medical literature.
 No statement will solve the conflict of interest problem, nor will it ever be solved altogether. As understanding of the problem and its management evolves, journals should be given latitude to establish their own standards, matching their policies to the best standards of their discipline and culture. WAME believes journals should make these policies readily accessible to everyone. All of us—editors, authors, reviewers, and readers--should be paying more attention to conflict of interest than we have been. We hope this statement serves that purpose.
 
 Acknowledgment
 The authors wish to warmly thank the World Association of Medical Editors (WAME) Officers for their helpful comments on an earlier version of this editorial. Many thanks to President Margaret Winker (USA); Past President Michael Callaham (USA); Vice-President John Overbeke (Netherlands); Treasurer Tom Lang (USA); and Secretary Farrokh Habibzadeh (Iran). 
 The WAME Statement on Conflict of Interest in Peer-Reviewed Medical Journals was approved by the WAME Board in March 2009. Many thanks to the members of the WAME Ethics Committee and to the WAME Editorial Policy Committee for their insightful and helpful comments on an earlier version of the statement. Warm thanks to the WAME Board for their input and comments: Margaret Winker; Michael Callaham; John Overbeke; Tom Lang; Farrokh Habibzadeh; Adamson Muula (Malawi) and Rob Siebers (New Zealand).
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Are most journals published in Africa too weak to be useful to local practitioners, researchers, and policy makers?Might a new method for scholarly communication on the African continent improve the utility of these journals?According to a provocative article published in Learned Publishing (Smart 2007), the answer to both questions is yes.Smart argued that the African research and education communities need to rethink their tendency to "slavishly . . .follow the Western model of academic promotion based on publishing in journals."In an earlier article, Horton (2000a) voiced concerns that researchers, policy makers, and philanthropic organizations in developed countries believe simply providing access to Western information will solve many of the problems of developing nations.On the contrary, he wrote, in Africa "there is already a well-developed local information culture that needs support, not swamping," noting, moreover, the lack of African journals in MEDLINE (Horton 2000a).According to a survey conducted in 2005, about 158 medical journals were published in 33 African countries, but most had circulations <1,000, were published ≤ 4 times per year, and were excluded from major bibliographic indexes (Siegfried et al. 2006).African Journals Online, an online repository of African scholarly abstracts hosted by the International Network for the Availability of Scientific Publications (INASP), lists 111 health and medical journals from 18 African countries in 2008 (African Journals Online 2008).However, compared with those of other continents, African medical and health journals continue to be poorly represented in international indexing services: among 5,000 journals indexed in MEDLINE, 38 are from Africa (13 countries), and among 6,700 journals in the Institute for Scientific Information's Science Citation Index, only 20 are from Africa (4 countries), including just 1 medical journal.Even within Africa, there is a disparity in research publication, with South Africa, Egypt, and Nigeria producing 60% of the total number of articles indexed by PubMed between 1996 and 2005 (Uthman and Uthman 2007).Moreover, there are gaps in research information published in leading Western and Northern journals on conditions and diseases that are most relevant to low-income countries in Africa (Horton 2000b).Thus, despite the recognized benefits of medical journals to health practitioners (Gross 2000; Lamas 1992), Africa's medical journal and research production and distribution are low, and as a result, research from Africa is not readily available to colleagues on the continent or in the international scientific community.Quality journals are needed throughout Africa to help raise the visibility of African science to researchers, practitioners, and policy makers in countries within Africa, especially sub-Saharan Africa, and to the wider international community (Ofori-Adjei 2006).Both Smart (2007) and Horton (2000a, 2000b) provide insights into the troubling issue of scientific and medical communications within Africa.Although there is no doubt that many of the medical and health journals published in Africa are weak, it would not be appropriate to declare them moribund and give up on the traditional peer-reviewed journal model for these medical, health care, and research communities (Ofori-Adjei 2006).In fact, substituting another communication vehicle for this specific subset of journals would need to be undertaken with extreme caution, if at all.Scientific

Editors and peer reviewers of research articles may have conflicts of interest that impact their evaluations. We aimed to characterize medical journals' conflict of interest policies for editors and peer reviewers. In this cross-sectional study, we randomly sampled 277 medical journals from Clarivate Journal Citation Reports. Two authors independently retrieved public conflict of interest policies and disclosures for editors and peer reviewers from journal websites and retrieved publishers' policies when journals also referred to them (January to June 2024). We used content analysis to analyze policies and multivariable mixed-effects logistic regressions to estimate the associations between journal characteristics and having a policy. After excluding 27 journals, we included 250 medical journals in English, of which 177 (71%) had a conflict of interest policy for editors and 174 (70%) for peer reviewers. Of journals with a policy, 137 (77%) and 129 (74%) described disclosure requirements, 160 (90%) and 163 (94%) described management strategies, 124 (70%) and 106 (61%) described policy enforcement strategies, and 17 (10%) and 15 (9%) described processes for appealing decisions. All 4 concepts were addressed in 16 (9%) policies for editors and in 11 (6%) for peer reviewers. Having a policy for editors was associated with higher journal impact factor (adjusted odds ratio (OR): 1.28; 95% confidence interval (CI): 1.05-1.56) and Committee on Publication Ethics membership (OR: 3.50; 95% CI: 1.42-8.65). Having a policy for peer reviewers was associated with higher journal impact factor (OR: 1.16; 95% CI: 0.97-1.37) and open access journal (OR: 4.59; 95% CI: 1.11-18.93). For a subgroup of journals referring to their publishers' policy, the content was concordant for 5 (11%) of 45 journals for editors and 4 (9%) of 47 journals for peer reviewers. Of 250 journals, 14 (6%) had public declarations of interest from editors, and 3 (1%) from peer reviewers. More than two-thirds of medical journals have conflict of interest policies for editors and reviewers; however, policies vary in comprehensiveness. There is potential to improve the content of conflict of interest policies and the transparency of interests in medical journals. Before a scientific study is published as a research paper in a medical journal, it is evaluated by the journal editors and other researchers, known as peer reviewers. This process is used to assess and ensure the quality and trustworthiness of the research and to assist editors in deciding whether to publish the paper. Editors and peer reviewers, however, are not necessarily neutral and may have personal interests that can influence their opinions. For example, they may have personal relationships with the study authors or have financial relationships with a company whose product is investigated in the study, which could result in conflicts of interest. Although most journals have policies addressing study authors' conflicts of interest, little is known about the practices and policies of medical journals concerning editors' and peer reviewers' conflicts of interest. In our study, we randomly selected 250 medical journals and examined their public conflict of interest policies for editors and peer reviewers, as well as whether these policies aligned with their publishers' policies. In addition, we assessed whether the interests of editors and peer reviewers were publicly disclosed. We estimated the proportion of journals with available policies, assessed which journal characteristics were associated with having a policy, and analyzed the content of policies. Of the 250 medical journals, we found that 177 (71%) journals had a conflict of interest policy for editors and 174 (70%) for peer reviewers, but their interests were very rarely publicly disclosed. The policies often contained limited information and were often only described in detail in the publishers' policies, and sometimes information in the journal's and the publisher's policies was in disagreement. Finally, policies rarely describe how journal staff assess interests, how these assessments may influence the journal's editorial process, and how journals enforce the consequences of policy violations. There is substantial potential for medical journals to improve their conflict of interest policies for editors and peer reviewers, as well as the transparency of their interests in medical journals.

The Institute of Medicine Calls for Voluntary and Regulatory Measures to Reduce Conflicts of Interest

Welcome to the 40 th anniversary year of Australian Prescriber. While there have been many advances since 1975, the clinical challenges are similar. Mary Stewart and Kirsten Black advise on how to choose a combined contraceptive pill, while Barry McGrath discusses the diagnosis of hypertension. Vitamin D testing is more frequent nowadays, but Paul Glendenning explains the problems in measuring vitamin D concentrations. Measuring the QT interval on the ECG can also be problematic and Geo rey Isbister reviews the risks related to QT prolongation. 1975 also saw the first publication of the bulletin of the Adverse Drug Reactions Advisory Committee in Australian Prescriber. The successor to that publication, Medicines Safety Update, has appeared in Australian Prescriber since 2010, but

Addressing Conflict of Interest and Bias in Research, Education and Clinical Practice.

The purpose of the study was to assess medical journals' conflicts of interest in the publication of book reviews. We examined book reviews published in 1999, 2000, and 2001 (N = 1,876) in five leading medical journals: Annals of Internal Medicine, British Medical Journal (BMJ), Journal of the American Medical Association (JAMA), Lancet, and New England Journal of Medicine. The main outcome measure was journal publication of reviews of books that had been published by the journal's own publisher, that had been edited or authored by a lead editor of the journal, or that posed another conflict of interest. We also surveyed the editors-in-chief of the five journals about their policies on these conflicts of interests. During the study period, four of the five journals published 30 book reviews presenting a conflict of interest: nineteen by the BMJ, five by the Annals, four by JAMA, and two by the Lancet. These reviews represent 5.8%, 2.7%, 0.7%, and 0.7%, respectively, of all book reviews published by the journals. These four journals, respectively, published reviews of 11.9%, 25.0%, 0.9%, and 1.0% of all medical books published by the journals' publishers. Only one of the 30 book reviews included a disclosure statement addressing the conflict of interest. None of the journals had a written policy pertaining to the conflicts of interest assessed in this study, although four reported having unwritten policies. We recommend that scientific journals and associations representing journal editors develop policies on conflicts of interest pertaining to book reviews.

Complementary and Alternative Medicine (CAM) encompasses a wide variety of treatments, such as herbal remedies, not currently thought to be part of mainstream medicine. Our study focuses on herbal remedies, as their use is significant and increasing. (1) We ask whether media coverage of conflicts of interest in clinical trials of herbal remedies is of sufficient quality to provide the public with information to make decisions that are rational, well-informed, and low-risk. We know that the vast quantity of information available on CAM through popular media is of varying quality. (2) In recent years, the scientific community is increasingly interested in studying herbal remedies. (3) As conflict of interest has been an issue in synthetic drug trials, especially those receiving funding from industry, we have reason to believe that this will also be true of clinical trials of herbal remedies, many of which are industry funded. What is conflict of interest and why are we interested? In his thoughtful and widely accepted analysis, Thompson defined conflict of interest as "a set of conditions in which professional judgement concerning a primary interest (such as a patient's welfare or validity of research) tends to be unduly influenced by a secondary interest (such as financial gain)." (4) He also noted that, while a secondary interest is usually not illegitimate in itself, its relative weight in professional decision-making is problematic. The goal, therefore, is to prevent secondary interests "from dominating or appearing to dominate the relevant primary interest in the making of professional decisions", rather than to reduce or eliminate them completely. (5) Conflict of interest rules, those regulating the disclosure and avoidance of these conflicts, generally focus on financial gain because it is relatively objective and easier to regulate by impartial rules. This does not mean, however, that financial gain has a greater potential for harm than other secondary interests. (6) The subtle distinction between conflict of interest and bias must also be emphasized. A declared conflict should merely be seen as an association creating the potential for bias, rather than an indication of bias itself. (7) It has also been noted that if an association does compromise one's judgment, it is generally a result of unconscious bias rather than outright dishonesty. (8) Because the influence of secondary interests can be extremely subtle, the presence of bias is often difficult to determine with any degree of certainty. Why are these issues important in a media context? As the popular press is often cited as a prominent source of medical information for the general public, it has the ability to shape public views and interpretations of new medical research. (9) It follows that media reporting has the capacity to shape public perceptions of safety and efficacy of a particular herbal remedy, thereby influencing patterns of use. The goal of our analysis is to infer how reporting of herbal remedy clinical trials by the popular media may be influenced by the disclosure of funding information and competing interests (i.e., the perception of a conflict) in the scientific and medical literature. Approach We used a coding frame analysis to examine the media coverage of conflicts of interest in clinical trials of herbal remedies. (10) This technique allowed us to systematically compare newspaper articles to the reporting of the same trials in the medical literature. We compared 389 newspaper articles (from the U.S., U.K. and Canada) reporting on herbal remedy clinical trials with the reporting of the 58 clinical trials in the medical literature. Primarily, we assessed tone, claims of efficacy, reporting of risk, and the disclosure of funding information and competing interests. Our coding frame allowed us to compile information regarding the date and location of publication, authorship, the portrayed likelihood of benefits and risks, disclosure of conflicts of interest, disclosure of funding information and funding agency involvement, whether the article was framed as a controversy, and overall tone in both newspaper articles and medical journal reports of clinical trials. …

Medical research should be fully transparent. The aims of this study were to determine the prevalence of author-related conflict of interest (COI) policies and evaluate the actual state of COI disclosure in Korean medical journals. To determine the prevalence of author-related COI policies, we examined the 198 medical journals listed in the KoreaMed database. To investigate the actual state of COI disclosures in published papers, we analyzed the publications in a representative medical journal, the Journal of the Korean Medical Science, from the perspective of the relevance of the ethics of COI disclosure. A total of 164 (82.8%) journals required an author's statement of COI as a criterion for publication. Of these 164, most of them focused on financial COI, with 101 (61.6%) presenting the information related to COI disclosures as a separate paragraph with a clear title. We identified 114 articles published by the Journal of the Korean Medical Science over a seven-year period, from January, 2006 to December, 2012. Of these, 65 papers (57%) included an author's statement of COI. We found that the policies of Korean medical journals regarding the disclosure of author COIs are still behind the internationally suggested level.

Although medical ethics research is frequently published in medical journals, little is known about the prepublication review such articles receive. The authors sought to describe the prepublication review of medical ethics research at major medical journals and medical ethics journals. They also sought to compare the ethics backgrounds of editors at both journal types and editors' attitudes concerning the training necessary for reviewers of ethics research. In November 2006, the authors distributed a 19-item survey via the Internet and mail to editors of major medical journals, specialty medical journals, and medical ethics journals. The survey collected data on the use of peer review, importance of peer review, ethics training of editors, and editors' attitudes regarding the appropriate training for reviewers. Multiple-choice and open-response questions measured peer review use characteristics, and questions weighted with a five-point scale measured editor attitudes. Medical journals and medical ethics journals almost always peer reviewed articles examining topics in medical ethics and considered this review important to enhancing the quality of published ethics research. However, medical journals were less likely to have an editor with advanced training in ethics as compared with medical ethics journals (7% versus 100%, P < .001), and their editors viewed specialized training in ethics as less important for a reviewer than did medical ethics journal editors (2.56 versus 3.88, P = .035). Physicians should be aware that ethics articles in prominent medical journals may not have been appropriately reviewed by a reviewer with specialized training in ethics.

Conflicts of interest: call for new editorial policies in European national journals

Information for authors and editorial policies