Interest in Conflicts

Abstract

Orthopaedics in general, and highly-compensated orthopaedists in particular, have come into the spotlight related to potential conflicts of interest. Studies have indicated that there has been inconsistent reporting of many potential conflicts, both by speakers at annual society meetings and by authors in orthopaedic journals. An article in the Archives of Internal Medicine in September 2010 reported a 46% nondisclosure rate of potential conflicts of interest among thirty-two orthopaedic surgeons whose work had been published in twenty-six orthopaedic-related journals and who were known to have been paid over $1 million in the year prior to the article’s publication1. A 2009 report that noted a 29% rate of nondisclosure among presenters and board and committee members at the 2008 Annual Meeting of the AAOS2 led to a mandatory disclosure policy for presenters and board and committee members before AAOS participation is allowed3. One part of the recent health-care reform bill requires industry, beginning in 2013, to publicly report all payments to physicians over $10 or over $100 in a year. Receiving disclosure information from authors has been hampered by the multitude of forms currently used to collect this information. Commonly, an author is required to fill out a different form for each journal, each presentation, and each society’s program participation. In 2009, the International Committee of Medical Journal Editors (ICMJE) prepared and piloted a Form for Disclosure of Potential Conflicts of Interest in an attempt to inject some uniformity into these disclosures. After an initial review, feedback from the medical journal community was used to modify this form to become the final ICMJE form for disclosure (www.icmje.org). This form covers three primary areas: (1) potential conflicts of interest with the research work and manuscript under consideration for publication, (2) relevant financial activities outside the submitted research and manuscript for the prior thirty-six months, and (3) other relationships that may have had an influence on the manuscript. Filled out and updated online, the ICMJE form is designed to be a standardized form that precludes the need to fill out a separate form for each journal. Recently, issues related to the adequacy of the current disclosure of potential conflict of interest policy at JBJS were addressed by our Board of Trustees and editorial team. The Board, the Deputy Editors, and I support the adoption of the ICMJE disclosure form for use by the authors of manuscripts submitted to JBJS. As of January 1, 2011, all authors must include a completed ICMJE form at the time of initial manuscript submission. As of July 1, 2011, all manuscripts published in JBJS will require an up-to-date completed ICMJE form prior to actual article publication. We plan to publish disclosure forms online for each author. The JBJS editorial office will manage these completed ICMJE disclosure forms. As is currently the case, disclosure of potential conflicts of interest will not affect the decision to accept or reject a submitted manuscript. Any request for additional levels of financial disclosure, other than that currently required, will not be implemented at this time. There is no doubt that orthopaedics and our patients have benefited greatly from the interaction that we have had with industry in developing new technology for improving patient care and outcomes. With the publication of research studies, whether sponsored by industry funding or other sources, our readers are entitled to know what relationships our authors have. As orthopaedic surgeons rely on orthopaedic journals more than any other source of orthopaedic information, our journals must insist on full disclosure of potential conflicts of interest. Improving our ability to obtain relevant disclosure of potential conflicts of interest will ensure that our readers understand the potential conflicts involved with every manuscript that we publish as JBJS continues our tradition of providing trusted orthopaedic information.