What Do Clinical Professors of Hamadan University of Medical Sciences Know About Conflict of Interest in the Fields of Research, Education, and Treatment? A Qualitative Study

Mixed methods research (the combined use of quantitative and qualitative methods within a single study) has developed rapidly in the last few years. This methodological approach is becoming increasingly articulated, attached to research practice and recognized, along with qualitative research and quantitative research, as the third major research approach (Johnson, Onwuegbuzie, & Turner, 2007).The scientific fields with more tradition in using and developing mixed methods research are Education, Sociology, Psychology and Health Sciences. This methodological approach is championed by methodologists from these fields such as John Creswell, Abbas Tashakkori, Burke Johnson, Anthony Onwuegbuzie, Jennifer Greene, Charles Teddlie and David Morgan (Denscombe, 2008). Books specifically focused on mixed methods research are being published in these fields (Andrew & Halcomb, 2009; Bergman, 2008; Brewer & Hunter, 2006; Creswell & Plano Clark, 2007, 2011; Greene, 2007; Morse & Niehaus, 2009; Niglas, 2004; Ridenour & Newman, 2008; Tashakkori & Teddlie, 2003, 2010; Teddlie & Tashakkori, 2009).In January 2007 the first issue of a journal solely devoted to mixed methods research (Journal of Mixed Methods Research, Sage Publications) was published. The two founding co-editors, John Creswell and Abbas Tashakkori, are researchers in the field of Education. Other methodological journals that publish mixed methods studies include this journal (International Journal of Multiple Research Approaches, also launched in 2007), along with Quality and Quantity, Field Methods and the International Journal of Social Research Methodology. Empirical articles that employ a mixed methods approach using this distinct name in the title are also published in Education, Sociology, Psychology and Health Sciences, and literature reviews that analyze the prevalence and application of mixed methods are carried out. An annual conference devoted to mixed methods is organized by schools and researchers from these fields (in 2011 the 7th International Mixed Methods Conference was hosted by the School of Healthcare in the University of Leeds, UK). Moreover, a Special Interest Group on Mixed Methods Research was formed in the American Educational Research Association in 2005. In summary, as noted by Creswell and Plano Clark (2007), mixed methods research has only been carefully used and examined in a handful of disciplines.In the case of Business and Management, our fields of inquiry have not embraced this methodological approach as enthusiastically as the fields described. Although there are calls for using mixed methods research in Business and Management fields (Cameron, 2011, Currall & Towler, 2003; Jick, 1979; Molina-Azorin, 2007), the acceptance and attention devoted to mixed methods research is very low in relation to other fields. There is not any specific book on mixed methods research in Business and Management. To date and to the best knowledge of the two special issue editors, a special issue on mixed methods has not yet been published in any Business and Management journal. Moreover, Creswell and Tashakkori (2007) make the pertinent point that the literature base about mixed methods research may not be well known to individuals in specific fields. Cameron and Molina-Azorin (2011) and Molina-Azorin (2011) confirm this issue in the case of Business and Management studies.In addition, in contrast to studies in the fields of Education, Sociology, Psychology and Health Sciences, the term 'mixed methods' is not usually used in the title of mixed methods studies in Business and Management. Furthermore, in the journal Organizational Research Methods, the main methodological journal in our field, the term 'mixed methods' is not a listed keyword. This issue also occurs in other business and management discipline journals.On the basis of such broad scanning evidence it seems likely that the advantages, possibilities, purposes, designs and potential of mixed methods research may be yet still unknown to many researchers in Business and Management. …

So far the implementation of Tri Dharma Human Resources Management of Universities, a lecturer carries three main tasks, namely: (1) education and teaching; (2) Research; and (3) devotion to the community. The general objective of this study, namely to find out and analyze the influence of the Human Resource Management of Tri Dharma Higher Education on improving the quality of PTS lecturers in the high school cluster in the DKI Jakarta and West Java areas. Interpretation and analysis of the results of the study, obtained general conclusions as follows: (1). There is an Effect of Human Resource Management in the field of education and teaching of improving the quality of lecturers at STKIP Kusumanegara; (2). There is an Effect of Human Resource Management in the field of research on improving the quality of lecturers at STKIP Kusumanegara; (3). There is an Effect of Human Resource Management in the field of service to the public on improving the quality of lecturers at STKIP Kusumanegara; (4). There is an Effect of Human Resource Management in the field of education and teaching, Human Resource Management in the field of research and Human Resource Management in the field of service to the community jointly to improve the quality of lecturers at STKIP Kusumanegara; (5). There is an Effect of Human Resource Management in the field of education and teaching of improving the quality of lecturers at STIE MBI; (6). There is an Effect of Human Resource Management in the field of research on improving the quality of lecturers at STIE MBI; (7). There is an Effect of Human Resource Management in the field of service to the public on improving the quality of lecturers at STIE MBI; (8). There is an Effect of Human Resource Management in the field of education and teaching, Human Resource Management in the field of research and Human Resource Management in the field of service to the community jointly to improve the quality of lecturers at STIE MBI; (9). There is an Effect of Human Resource Management in the field of education and teaching on improving the quality of lecturers at STMIK MIC (10). There is an Effect of Human Resource Management in the field of research on improving the quality of lecturers at STMIK MIC; (11). There is an Effect of Human Resource Management in the field of service to the public on improving the quality of lecturers at STMIK MIC; (12). There is an Effect of Human Resource Management in the field of education and teaching, Human Resource Management in the field of research and Human Resource Management in the field of service to the community jointly to improve the quality of lecturers at STMIK MIC; (13) There are supporting factors and inhibiting the quality of lecturers at STKIP Kusumanegara, STIE MBI, STMIK MIC through the implementation of the Human Resource Management Tri Dharma Higher Education. The findings of the study, namely from the three Tri Dharma components of college, research and publications including difficulties carried out by lecturers, while there are demands to publish the results of their research on reputable international journals that have a significant effect on improving the quality of lecturers.

Trials embedded in cohorts, registries, and health care databases are gaining ground

The current study aimed to identify the obstacles that prevent conducting qualitative research in the English Language field at university, as well as the theoretical and philosophical premises of qualitative research. The researcher used the explanatory approach, and used the interview as one of the qualitative research methods. The study found that we need to conduct qualitative research in the English language because of the predominance of quantitative research tools and methods in an explicit omission of qualitative research, despite its importance and suitability for the study of many phenomena and problems in the field of the English language. Philosophical study of the phenomenon is more in depth in the cognitive construction, in addition to its use of a number of means to collect the data of the phenomenon such as observation, interview, document analysis, and knowledge of the social, personal and material circumstances and scenes related to the phenomenon being studied. The study also found that there are many obstacles that prevent conducting qualitative research in the field of education in general and the field of English language in particular. The researcher has developed a set of proposals to overcome the obstacles of qualitative research in the English language field.

Conflicts of interest: an invisible force shaping health systems and policies

ObjectivesThe objective of this study was to assess the frequency and types of conflict of interest (COI) disclosed by authors of primary studies of health policy and systems research (HPSR).DesignWe...

This study aims to analyze the development of lecturers in the fields of education, research, service, and support at IAIN Madura, Madura State Polytechnic, and Trunojoyo University Madura. This study uses a qualitative approach with a multi-site design. The results of the study show that in the field of education, PTK already has facilities that are planned but not optimal; in the context of learning assignments, PTK There is still no planning and nomination list for lecturers who will further study for the development of lecturers through training. In contrast, PTU has structured planning in providing lecture facilities, further study of lecturers and development of lecturers through training. The field of research at PTK still needs a RIP and guidelines because they are still in the final stage, while at PTU, there are RIPs and procedures, and training on research has also been carried out. In the field of service in PTK and PTU, there are guidelines, but in PTK, it has yet to be integrated with study programs; in PTK, it has been facilitated but not comprehensive, while in PTU, it has been carried out by all lecturers. In the supporting aspect, PTK and PTU have a development policy for all lecturers to carry out outside activities and a Tridharma-supporting development facility policy.

The issue of conflict of interest has been an important concern in the field of medical research in recent years. With an increasing degree of partnership between industry and academic medicine, and a number of incentives (commercial, academic, political, and financial) being available for researchers, it cannot be denied that the possibility of conflict of interest exists. The International Committee of Medical Journal Editors (ICMJE), in their ‘‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication’’ states that ‘‘conflict of interest exists when an author (or the author’s institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions (such relationships are also known as dual commitments, competing interests, or competing loyalties).’’ Moreover, the ICMJE further elaborates that ‘‘the potential for conflict of interest can exist regardless of whether an individual believes that the relationship affects his or her scientific judgment’’ [1]. In 2011, a total of 36 original articles were published in the four issues of the 15th volume of Techniques in Coloproctology. A conflict of interest statement was published in only 12 (33.3 %) original articles (3/8 in March issue, 1/8 in June issue, 1/11 in September issue, and 7/9 in December issue). There may be two reasons for this. Either the authors did not declare the conflict of interest or the editorial board chose not to publish the declaration. We believe that there is a large gap in the awareness among clinical investigators regarding conflict of interest. Accepting the potential for conflict of interest does not label a study as a biased one, or reflect on an author’s integrity as a researcher. It merely means that the readers are given the opportunity to use their own judgment regarding the results/conclusions in light of the full disclosure of the facts. We agree that the ICMJE [1] gives the room for editorial board to decide whether to publish information disclosed by authors about potential conflicts. However, The IJCME [1] further elaborates ‘‘If doubt exists, it is best to err on the side of publication.’’ We believe that publishing conflict of interest statement in all articles will be the right step to increase the public trust and credibility of the journal. Moreover, conflict of interest disclosure should not be confined to the original articles. Disclosure of conflict of interest is also important in other categories of articles, such as editorials, letters, and review articles, because it can be more difficult to detect bias in these publication types than in original articles [2].

This paper is concerned with the definition of the field of educational research and the changing and developing role of the Australian Association for Research in Education (AARE) in representing and constituting this field. The evidence for the argument is derived from AARE Presidential Addresses across its 40-year history. The paper documents the enhanced complexity and diversity of the field over these 40 years, including the emergence of a global educational policy field, theoretical and methodological developments in the social sciences and new research accountabilities such as the Excellence in Research for Australia (ERA) measure. Specifically, the paper suggests that the evidence-based movement in public management and education policy, and the introduction of the ERA, potentially limit and redefine the field of educational research, reducing the usefulness and relevance of educational research to policy makers and practitioners. This arises from a failure to recognise thatEducation is both a field of research and a field of policy and practice. Located against both developments, the paper argues for a principled eclecticism framed by a reassessment of quality, which can be applied to the huge variety of methodologies, theories, epistemologies and topics legitimately utilised and addressed within the field of educational research. At the same time, the paper argues the need to globalise the educational research imagination and deparochialise educational research. This call is located within a broader argument suggesting the need for a new social imaginary (in a post-neoliberal context of the global financial crisis) to frame educational policy and practice and the contribution that educational theory and research might make to its constitution. In relation to this, the paper considers the difficulties that political representations of such a new imaginary might entail for the President and the Association, given the variety of its membership and huge diversity of its research interests.

The purpose of this focused issue is to advance understanding of qualitative research methods in the international business context. Debates on qualitative research methods in the key international business (IB) journals have been rare. There has been no focused issue on this topic previously, either in mir or in other journals in the field, making this a 'special' issue. During the process of editing a recent handbook on qualitative research methods (Marschan-Piekkari/Welch 2004), we realized that while this collection covered many topics, often for the first time in the IB field, there were many others still outstanding. There was thus scope for continuing a dialogue about qualitative methods in the IB research community. The challenge of making qualitative research count in the quantitative world of IB remains. Qualitative research is difficult to define, since the term encompasses many different research traditions, research strategies and methods for data collection and analysis (Prasad 2005). A typical definition is that everything non-numerical is qualitative research (Marschan-Piekkari/Welch 2004, p. 19). However, even this very simplistic definition soon breaks down, since research strategies which are typically considered to be qualitative, such as case studies, can combine numerical with non-numerical data (Hurmerinta-Peltomaki/Nummela 2004). There is also no clear divide between qualitative and quantitative research in terms of research traditions, with much qualitative research in management and IB sharing the positivist assumptions of quantitative research (Prasad/Prasad 2002). This focused issue is not about reporting the empirical findings of IB studies applying qualitative methods; rather it is about the process of undertaking qualitative research in the IB field. Of course, there is a large volume of literature on qualitative research methods already. However, we would argue that the IB context warrants special treatment. As the authors of this focused issue discuss, the distinctiveness of the field stems from its multiple linguistic and cultural settings; organizational complexity; and its intellectual roots in post-War academic institutions in the USA. These issues receive little treatment in general texts on qualitative methodology. There has been some methodological debate in previous issues of mir. Earlier articles in mircan be grouped into three categories: first, reviews of existing methodological practices in IB publications (e.g., Cavusgil/Das 1997, Nasif et al. 1991); second, proposals for new quantitative techniques (e.g., the use of key informants in cross-cultural studies, as proposed by Lenartowicz and Roth 2004 and a linguistic-based measure of cultural distance as developed by West and Graham 2004); and third, calls for new methodological approaches (Boddewyn/Iyer 1999). The absence of qualitative research methods in this debate perhaps reflects the limited amount of empirical qualitative research published in this journal. A recent analysis of mir issues between 1990 and 1999 revealed that only 5 percent of articles published in this period used qualitative methods (Welch/Welch 2004). This focused issue is therefore a response to those, such as Boddewyn and Iyer (1999) in this journal, who have called for alternatives to surveys and secondary data analysis. This focused issue attracted 39 submissions from more than 15 countries. Given that there have been limited outlets for methodological articles in IB, this is a considerable number. It perhaps suggests a level of interest to which IB journals have not responded to date. Of the total number of submissions, 11 were selected for review. On the basis of reviewers' comments, six of these papers were ultimately rejected. The final five papers underwent two and, in some cases, up to four rounds of revisions. In selecting the articles, we used the following criteria: appropriateness of the topic for the focused issue; demonstrated knowledge of IB and methodological literature; quality of argument; originality and innovativeness of the contribution to IB methodology; organization and clarity of the paper; and potential application to research practice in IB. …

This paper compares the research method of phenomenological psychology to other qualitative research methods such as ethnography, participant observation, grounded theory, dramaturgical interviewing and content analysis. An attempt is made to identify similarities and differences. As a prelude, the major metatheories with which they are associated (phenomenology and symbolic interactionism) and the related differences between natural science and human science are discussed.Interest in qualitative research methodology appears to have gathered momentum over the last decade (e.g., Rist, 1980). One of the recurrent themes in the discussion of qualitative methods has been the question of whether quantitative and qualitative methods are compatible. Opinion has been divided. Gibbs (1979) made a plea for complementarity of subjectivist and objectivist methods in psychology. Mahrer (1988) has advocated discovery oriented research in the field of psychotherapy, while Sperry (1988) has suggested an integration of positivistic and phenomenological thought to form a more naturalistic approach to the study of brain and consciousness.The split between those who support and those who do not support complementarity of quantitative and qualitative methodology has also occurred in the field of educational research. For example, Howe (1985, 1988) and Firestone (1987) have argued for compatibility, while Smith (1983) and Smith and Heshusius (1986) have argued for incompatibility.The early eighties marked the growth of an interest in qualitative methodology which has paralleled the growing disenchantment with traditional logical - empirical research methods. The hegemony of natural science type research methods has been increasingly challenged by descriptive and hermeneutically oriented methods (e.g., Giorgi, 1986; Packer, 1985; Palmer, 1969; Polkinghorne, 1983; Rommetveit, 1987). Contextualism (Rosnow & Georgoudi, 1986), social constructionism (Gergen, 1985) and deconstructionism (Derrida, 1977) have also challenged the objectivity of traditional natural science methodology by emphasizing the socially derived foundationalisms upon which methods are based.There seems little doubt that qualitative methodology has come out of the closet in the field of the human sciences. Although quantitative methodological hegemony continues, the degree of coexistence and complementaritybetween quantitative and qualitative research methods seems to be increasing. Nonetheless, there are those who, while seeing symptoms of the inadequacy of standard quantitative methodological practice, see possible cures and solutions in the same metatheoretical terms (e.g., Aiken, West, Sechrest & Reno, 1990). Sarbin (1976) has noted the difficulty that psychologists trained in logical - empirical traditions have in breaking their reliance on habitual methods.The Transition from Quantitative to Qualitative MethodologyThose researchers who are willing to explore qualitative methods face several difficulties. Usually they have been trained in the quantitative tradition and find the transition to qualitative research methods requires a major shift in world - view. The metatheories underlying such methods often differ from the logical - empirical base of natural science (Jacob, 1987). As will be seen later, some aspects of the qualitative methods associated with symbolic interactionism follow normative natural science practice (e.g., the Iowa school of ethnography) while other qualitative methods use a mixture of natural and human science approaches to research (e.g., the Chicago School of ethnography). Qualitative research methods such as phenomenology and the phenomenological aspects of ethnography, participant observation and grounded theory are based on metatheories that are associated with a human science approach to psychology (see Giorgi, 1970). The emphasis is upon discovery, description and meaning rather than the traditional natural science criteria of prediction, control and measurement. …

A conflict of interest is a set of circumstances or relationships that create the risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. Secondary interests may be internal, meaning limited to the personal sphere, or external, linked to the interests of third parties or institutions. Internal interests are related to individual identity and personality, and tend to be perfectly aligned with the primary professional interest. Therefore, we usually only speak of a conflict of interest when external secondary interests, usually of a financial nature, are opposed to the primary professional interest (preserving the health of the population in the case of public health). In addition, biases due to internal interests are bidirectional and difficult to quantify, while those deriving from financial conflicts of interest are predictable, unidirectional and large-scale. Although they are different phenomena, they are often mixed up with one another to create confusion and divert attention from financial conflicts of interest. In public health, conflicts of interest can arise in the field of research when studies are conducted on the health effects of pharmaceuticals, chemicals, tobacco, alcohol or food and in decision-making regarding policies related to these same products. In this chapter we present several examples of conflicts of interest in public health and a series of recommendations for their management, beyond their public declaration, which is necessary but insufficient. All public health organizations should adopt standards to avoid, detect, eliminate or minimize the impact of conflicts of interest and ensure that these are put into practice.

The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. We thank Dr Timek for his comments regarding the elegant approach to investigating the implications of incorporating (reefing) the anterior mitral leaflet to the anterior annulus.1Timek T.A. Commentary: reefing the sails and the direction of the wind.J Thorac Cardiovasc Surg Open. April 25, 2021; ([Epub ahead of print])Google Scholar,2Brunel L. Williams Z.A. Yata M. Robinson B.M. Wise I.K. Paterson H.S. et al.Incorporating the anterior mitral leaflet to the annulus impairs left ventricular function in an ovine model.J Thorac Cardiovasc Surg Open. 2021; 7: 111-120Scopus (4) Google Scholar Dr Timek noted that the reefing intervention abolished anterior leaflet movement, distorted left ventricular geometry by a reduction in anterior leaflet height, and removed the baffle effect that promotes laminar blood flow through the ventricle during diastole. The effects of these components on left ventricular function are difficult to assess independently but as a whole, there was impairment of left ventricular function. We wish to clarify the issues that Dr Timek has raised with regard to left ventricular outflow tract obstruction and aortic valve incompetence. The pressure components of the hemodynamic parameters altered by the reefing intervention were measured with a solid-state pressure catheter in the left ventricle. We have demonstrated in a separate sheep model that left ventricular outflow tract obstruction causes an increase in intraventricular pressure rather than a decrease.3Brunel L. Williams Z.A. Beijerink N.J. Robinson B.M. Wise I.K. Paterson H.S. et al.Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction.J Thorac Cardiovasc Surg Open. May 21, 2021; ([Epub ahead of print])Google Scholar A separate pressure catheter was positioned in the aortic arch and the pressure continuously observed and recorded throughout each study. Any “subclinical” outflow tract obstruction did not manifest as an outflow tract gradient. Both reefing the anterior leaflet and insertion of the mitral prosthesis can cause aortic valve incompetence. We performed a detailed echocardiographic assessment at the time of initial reefing and releasing of the anterior leaflet in each sheep. This included an assessment of the left ventricular outflow tract. We did not repeat this assessment for subsequent interventions in the absence of suspicion based on altered hemodynamic parameters. We hope that our findings do add to the basic understanding of mitral valve physiology and acknowledge that there are limitations to the clinical extrapolation. We remain grateful to Dr Timek for his leadership in this field of research. Commentary: Reefing the sails and the direction of the windJTCVS OpenVol. 7PreviewThe transcatheter valve technologies that have revolutionized our approach to aortic valve pathology1 are now beginning to be harnessed to address mitral regurgitation2 in prohibitive-risk patients. The mitral valve represents a greater technical challenge due to its complex structure, ill-defined annulus, and potential for left ventricular outflow tract (LVOT) obstruction due to the displacement of the anterior mitral leaflet (AML). Identifying patients with favorable anatomical features continues to be a challenge3 but is of critical importance, as LVOT obstruction during transcatheter mitral valve replacement (MVR) is associated with up to 34% procedural mortality. Full-Text PDF Open Access

Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the RetractionWatch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing "closed infusion systems" for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers' dependency on industry ties. Further research is needed on COIs and their management.

Medical journals are extremely important source of information for medical professionals, patients and policy makers. It is, therefore, crucial that any information, and publications, in these journals are reliable and trustworthy. It is now well understood that conflicts of interest (COI) can damage the credibility of a publication and/or a journal, and have far reaching consequences of undermining the trust of the readers in medical publications. In this editorial, I will aim to address some important issues related to the COI of medical journals. In particular, I will deal with the definition and types of COI, and the recommended practices of how these should be managed. In medical publishing, all the parties concerned with the publication of a particular article can have COI. These include researchers, authors, reviewers, members of editorial board, editorial staff and editors. In addition, the journal, the sources of funding for the journal, and the professional society or organization to which the journal belongs may all have COI. The Institute of Medicine has defined COI as “a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest”.1 For a typical medical journal, the primary interest would be “promoting and protecting the integrity of research, the welfare of patients, and the quality of medical education”. However, the secondary interests which could conflict with, and/or corrupt, the primary interest may be financial or non-financial. The financial COI have received attention in the recent years. These are relatively easy to trace and quantify. On the hand, the non-financial COI have received relatively lesser attention; compared with financial COI, the non-financial COI are more ambiguous, and difficult to pin point and quantify. Financial COI The authors may have financial arrangements or ties with commercial companies (drug manufacturers, equipment manufacturers). These companies may also be the funders of the research. The financial COI may present in many different forms at many different levels. The examples of such ties include the commercial company sponsoring and funding research, the authors holding shares or stocks in the patent rights and/or profits of the company, being paid for consultancies, or being employed, directly or indirectly, by the company. The authors may be employed by the institutions or organizations which rely heavily on the funding from the company. The other source of financial COI can be when the author is likely to be financially benefited from the effect which the publication may have on his/her professional practice. The source of funding of the journal is also important in this regard as it may have direct or indirect influence on the editorial strategy or the policies of the journal. Non-financial COI The non-financial COI could be equally corrupting as the financial COI. Some example of the sources of non-financial COI are given below. Academic bias/competition Academic bias or competition may affect the behaviour of the reviewers, members of editorial board and/or editors. The bias could be related to a particular technique (invasive vs non-invasive monitoring), research methodology (qualitative vs quantitative research) or research outcome (positive vs negative study). Also, there may exist competition among individuals for academic promotion or academic esteem. Personal relationships The examples for this kind of COI include an author's spouse or relative being employed by a commercial company likely to be benefited from the publication, and/or a member of family holding patent rights or shares in the company. Political or religious beliefs The authors, reviewers or editors could have their behaviour and attitude to a particular subject and/or outcome of research influenced by the beliefs that they hold. The examples where these conflicts can arise include research or publication in the subject area of abortion, immunization, end-of-life management, and public funding for treatment of smoking or obesity related disorders. Institutional affiliations The strategies of the organizations or institutions which award research grants can have a strong influence on the type of research which the authors may pursue. The employers of the authors may hold the patent rights of the product on which particular research is being considered or published. The employers of the authors, or journals themselves, may have strategies and preferences for a particular research type or topic (liaisons or negative attitude towards tobacco companies). Also, the drug manufacturers and/or the journals may stand to benefit from the revenue generated from publication of a particular article. As for example, a publication on effectiveness of a particular drug could financially benefit the pharmaceutical manufacturer, and may also lead to more reprint requests generating funds for the journal. Consequences of COI There have been a number of examples where the authors, who had financial association with a company, reported ‘no’ or fewer side effects of the product of that company.2 Research has also shown a strong association between the authors’ published position on the safety of a particular drug (calcium channel blockers) and their financial relationship with the drug manufacturers.3 It has been shown that the authors of review articles on the effects of passive smoking were likely to reach different conclusions depending upon whether or not they had financial ties with the tobacco companies.4 There is growing literature which shows that different types of COI, financial or non-financial, can introduce bias in collection, analysis or reporting of data. The COI may hide or distort truth. The corruption of the primary interest of medical publishing with the secondary interests (COI), therefore, can lead to public harm by manipulation of the truth. As for example, public harm may result if the authors chose not to publish the side effects of a particular drug, or if the positive effects of that particular drug are exaggerated in the publication. Managing COI In modern times, when the funding and resources for medical research are limited, partnership with industry is a reality. In some countries and organizations, this partnership is an active ingredient of their strategy to increase research output. Also, the journals require funding streams to sustain their quality and output; often these funding streams come from commercial companies in the form of revenues generated by advertising, reprint orders, sponsored issues, special themed issues, etc. With these realities which we face, one can choose to either ignore COI or manage them. Ignoring COI would be detrimental to public trust and damaging to the whole area of medical publishing. Hence, managing COI at all levels - funders, commercial companies, journals, editors and researchers - is the only sensible option. In managing COI, disclosure is the first step. Most journals now have policies on how the authors must disclose their COI. Disclosure of interests of all concerned parties allows openness, and helps policy makers, medical professional and general public to evaluate any research process or publication in the light of these interests of the parties involved. However, disclosure alone does not eliminate bias of COI. In addition, it may have some unintended consequences. It is known that the readers tend underestimate the research findings in a paper which is authored by individuals who have declared financial ties with commercial companies. Also, the authors themselves may not be strong enough in drawing conclusions of their research findings. Despite these limitations, it is widely agreed that a full and open disclosure of interests at all levels is fundamental to managing COI. Proactive management of COI is the next step. Before establishing a relationship where secondary interest may influence the primary objective of meaningful honest research or publishing, it is important that the organizations and individuals undergo a formal process of evaluating the risks related to the COI, and develop a strategy and/or a policy to mitigate these risks. The risks could be reputational or governance. As for example, for the journals it would be of paramount importance to have a clear policy of maintaining a firewall between the financial arrangements of the journal and the editorial process. The International Committee of Medical Journal Editors (ICMJE; www.icmje.org) has published recommended practices, based on ethical principles, to set standards and inform all concerned with medical science publications. According these recommendations, the authors must disclose their financial and non-financial COI. When the authors are unsure of whether or not a particular interest of theirs is in conflict with their intended publication, they should err on the side of caution. If the study has been funded or sponsored by industry, the authors should be explicit about the role of the industry in areas such as collection, ownership, access, handling and analysis of the data, and contribution to the paper. Like the authors, the reviewers must also declare all interests. In particular, they should be explicit about any competing interests with the authors or their institution. The reviewers should decline to review the papers from their own institution or from academic competitors. Editors and other members of editorial board and staff must declare their financial and non-financial interests which should be available publically. The role of the editors is to ensure that all submissions receive objective and unbiased evaluation. They must take all precautions to avoid sending papers to the reviewers who have obvious COI. All editorial decisions must be independent of any commercial or financial arrangements of the journal. To achieve this objective, a journal must have clear, transparent and published policies on manuscript handling, COI disclosure, editorial decision making, role of the editorial board and staff, sources of funding, management of funding streams and editorial independence. In the recent years, medical journals have progressed in having clearer guidelines on COI. The ICMJE recommendations are now central to most medical journals. However, some areas of ambiguity still remain. As for example, many trade associations, social advocacy groups and non-profit organizations are unclear about the sources of their funding. For the individuals, the threshold for declaring the level or the timing of their financial ties remains unclear. As for example, should one declare if they received honoraria of 100 USD from a drug company ten years ago for lecturing, or should the limit be 1000 USD and the time limit of 5 years? Also, there are no clear ways of extracting or declaring non-financial COI. Until clearer guideline emerge on these issues authors, reviewers, editors, and the organizations which fund and govern their activities, will be required to use their own sound judgement and ethical paradigms to ensure that all possible and existing conflict of interests are effectively managed at all levels, and the trust-worthiness of medical journals is retained all the time at its peak. Funding None. Conflicts of interests Editor-in-Chief of British Journal of Anaesthesia and Council Member of the Royal College of Anaesthetists, UK.