In recent years, to maintain the trust that the public has in the medical profession and scientific research, public accountability and clarity of relationships have become more important.1 In this regard, addressing the problem of conflict of interest is one of the important issues.
As of this issue, the Journal of Vascular Surgery will join many other major medical journals in requiring authors to disclose financial and other potential competitive interests.2 In justifying the introduction of routine disclosure of “competitive interests” in the British Medical Journal in 1998, Richard Smith3, 4 reviewed the mounting studies that suggest that authors may develop an unconscious professional bias that is influenced by secondary factors, often financial gain.5, 6, 7 As suggested by Smith, we will use the terms “competition of interest” or “competitive interests” rather than conflict of interest to emphasize our belief that it is not intentionally deceitful conduct but rather inherent in human interaction.
In the Instructions to Authors, the Journal of Vascular Surgery asks its authors to declare any conflicts of interest that might impact their work. However, over the past 2 years, few have made such a disclosure. Although the source of non-governmental or non-foundation funding has been declared, authors have rarely disclosed personal financial interests (ie, equity holdings, honoraria, patents, consultancies, or scientific advisory board memberships). We believe that this low level of disclosure in the JVS needs to be addressed.8
In changing our policy and requesting requiring authors, editors, and editorial board members to declare any competition of interest, the following explain our views on this complex issue.
Competition of interest is defined as a circumstance or situation that is present if the author's views or conclusions might unintentionally be influenced by secondary factors, such as the potential for financial profit, personal conflict, academic gain, or beliefs.
Although there are several potential sources of competition of interest, for pragmatic reasons, we will ask authors to disclose potential financial competition of interest, which is generally regarded as the most relevant.
We do not believe that competition of interest is inherently wrong. As expressed by Brody,9 it is common; there is nothing fundamentally wrong with having interests that compete or conflict. Brody states “The existence of conflicting loyalties has always been a part of the patient-physician relation. Physicians, have, in addition to their obligation to any individual patient, obligations to their other patients, to their families, to themselves, to society, their religion, etc. Like everyone else, physicians live in a tangled web of conflicting obligations.”9
Because some degree of competition of interest is inescapable in most papers, the most practical approach to reducing the risk that the overall quality of a paper is reduced by unconscious biased decisions in the design, implementation, analysis, or discussion of the research is to ask the authors to disclose potential competitive interests to the readers. Through disclosure, competitive interests are made transparent. Consequently, the readers can assess the magnitude of the competition and add this to their overall interpretation of the published work.
Even though disclosure of potential financial interests is emphasized (eg, equity holdings, payment for corporate consultations), it is important to recognize that grant support to individuals or institutions from either industry or the public sector may also be an important source of competition of interest. Grants provide funding for the research proposal but may also provide overhead to support the institution and “profit” to support other unrelated research projects and thereby potentially contribute to academic advancement.
With the goal of providing readers with information that may help them judge the application of the data in the paper to their practice, we will now ask the authors to make the following disclosures.
1.Acknowledge the authors' university, institutional, or corporate affiliations.
2.List all sources of funding for the research project from national or local agencies, the institution, companies, and other sources. Also, it may be appropriate for an author to declare the sources of funding that have supported previous or other work that might have influenced their views expressed in the paper.
3.Disclose any financial associations that might represent a competition of interest in respect to the manuscript, such as a consulting or employment arrangement or a royalty or stock agreement with the company. If a paper is accepted for publication, the authors will be asked to draft and attach a competition of interest statement that may be published as a footnote with the article. For example, it might read as follows: “KR has been paid a consulting fee by XYZ Company and is on their speakers bureau; PW has shares in the company; RC received funding for a research assistant from the XYZ Company.” Also, the authors have the opportunity to disclose personal, academic, or other possible conflicts.
The form that will be sent to the authors of accepted papers is printed on the next page. In summary, competition of interests is inevitable but may subconsciously influence an author's study design, interpretation of results, or opinions expressed in a published article. It is therefore reasonable to ask the authors to disclose them. There are several potential sources of competition, but for pragmatic reasons, we will ask authors to disclose potential financial competition, after the paper has been accepted for publication. We will start phasing in this policy with this issue. Also, on a yearly basis, the editors and members of the editorial board will be asked to disclose any competition of interest. We are requesting our readers to judge the impact of this policy and through feedback from them over time, we will determine whether this new policy provides added greater perspective and accountability.
FULL TEXT