The editorial process: Conflicts of interest

Since the 1970s, there has been growing concern about the potentially corrupting influence of industry and commerce on academia, including on research publication and clinical practice development. Although far too many examples exist whereby undeclared conflicts of interest (COI) have led to misinterpretation of evidence, and even changed policy direction, contemporary arguments have been made that refute the claim that having a COI is inconsistent with transparency and balance.

It is common practice for authors to indicate any potential COI relevant to their submitted articles. However, this begs the question: what is deemed relevant? What about “in kind” conflicts (conflicts not directly related to financial compensation)?

Conflicts of interest are part of a wide spectrum. They include “financial relationships (e.g., any financial relationships or obligation to the research sponsor or other companies, including contractual relations or consultancy fees for scientific, government, or legal services, or equity in the company) and non-financial relationships (e.g., personal relationships, including those of immediate family members, and participation in litigation) that could inappropriately influence or seem to influence professional judgment.”¹

It is the journal’s responsibility to be clear and specific about what authors need to declare. Clear, closed questions (based on yes/no responses) tend to be answered, while open-ended, general questions remain unanswered and conflicts undeclared.² The International Committee of Medical Journal Editors (ICMJE) has developed a standard form.³ CUAJ’s modified form uses the yes/no template, but expands its reach to include all financial and in-kind relationships beyond the scope of the submitted article.⁴ With CUAJ’s more inclusive and specific COI Statement, authors, upon submission, must disclose whether they have a relationship with a commercial entity, such as a pharmaceutical organization, medical device or communications firm (not only those relevant to the subject being discussed) encompassing the previous 2 years.

The onus is on the reader to determine whether or not a conflict exists. It is the responsibility of the author to disclose all potential and perceived conflicts. This inclusive declaration elevates the level of transparency and increases the journal’s credibility. If authors have a stake in a particular research, their findings may be biased, even though they may have taken the necessary precautions in their research protocols. To read and understand research findings, readers should be informed of the context within which the article was written.

Having a perceived or clear conflict of interest does not necessarily imply an outright rejection of the paper. We believe this type of categorical ruling may make it punitive for authors to disclose. Our role at the journal is not to play judge; editors need to put themselves in the role of the reader and be aware of any potential perceptions of bias. If in doubt, authors are requested to disclosure more rather than less.⁵

Editors at the British Journal of Dermatology consider the sole responsibility of declaration on the authors’ shoulders. One author in the journal did not declare his patents in an anti-aging skin compound — an apparent financial interest. In their defense, the editors at BJD stated that the “authors are responsible for disclosing all financial and personal relationships between themselves and others.”⁶ Is this naïve? We think so. Yes, it is the responsibility of the author, but it is the ethical burden of the journal editor to ensure all steps were taken to gather conflicts from authors. In a 2011 study by Columbia University in New York, David Rothman found that out of 95 articles written by orthopedic surgeons who had been paid at least $1 million by device makers, less than half of the articles listed COIs.⁶ This is a sobering statistic indeed.

The editorial team at the CUAJ will continue to be vigilant in our requests and reporting of COIs and strive to enhance processes to ensure compliance to facilitate public scrutiny of the information within its covers.