Declare all or be damned

Abstract

All the evidence on general and multispecialty medical journals points to the rather unsurprising finding that most readers only read one or two articles of interest to them – providing that the journal is having a good week or month. Like most editors I probably delude myself that JRSM readers read much more of the journal than that. But if you were to only read two articles in this month's issue, I have my recommendations ready for you. A scandal in the House of Lords about peers accepting payment to influence legislation has exposed the fallacy of impartiality that is often associated with government and politicians. A few weeks before that scandal broke, I agreed to publish an editorial by Richard Smith and colleagues about the fallacy of impartiality in academic publications (JRSM 2009;102:44–45 ). The authors argue that competing interests in academic publications have become focused on the view that authors linked to for‐profit companies are heavily conflicted whereas those associated with the public sector and academic institutions are not. Indeed, why are representatives of government, royal colleges, medical societies and trade unions any less motivated by personal success or the success of their organizations than employees of companies and businesses? Moreover, the lack of transparency about the competing interests of public sector and academic institutions leaves them hostage to the hidden influences of powerful lobbying groups and organizations, as well as individual whims and fancies. ‘Our message is simple,’ say Smith and colleagues. ‘A view of the world that sees employees of private for‐profit companies as conflicted and doctors, or employees of public or academic bodies as not, is naive, potentially deceptive, and likely to distort reader response to new information.’ New information in surgery is sometimes revolutionary but often hard to substantiate with a robust study that would satisfy epidemiologists and methodologists. Peter McCulloch readily recognizes the difficulty of moving from proof of concept to trial development in surgery (JRSM 2009;102:51–55 ). Yet he argues that the real‐life development of surgical techniques shows a clear series of phases, which differ importantly from those in classical drug development. McCulloch goes further by proposing new reporting guidelines, modifications to randomized controlled trials, and novel study designs to address current difficulties in allowing evaluation to reach the stage of a randomized controlled trial. Finally – and yes I know this is a third article – if you would rather listen rather than read, you might consider the review on general medical podcasts (JRSM 2009;102:69–74 ). Many readers will be blissfully unaware of the upsurge in podcasts, an online audio recording, from medical publications. Will podcasts revolutionize medical communication? My own view is that the quality of medical journal podcasts has been amateurish and they have failed to add sufficient value. Is this a failure of the promise of the Internet? Possibly. But the Internet has been successful in exposing hidden competing interests, whether associated with private for‐profit, public sector, or academic organizations. The challenge is for journals to respond appropriately, and the JRSM requires authors to declare all competing interests, be they financial, political, religious or even related to being a public servant or academic.