’s policy is disclosure of conflict of interest rather than prohibition.5
We simply don’t think prohibition is feasible, although we try to avoid having an editorial written by somebody with a major conflict of interest. We send authors of all original papers, editorials, and review articles and of selected letters a form in which we define what we mean by conflict of interest and ask them to sign to say whether they have one. We have gone for a broad definition that extends beyond financial interests to personal, political, academic, and religious ones. With original papers we give the source of funding and disclose what authors have told us about whether or not they have other interests. With the other articles we add a note only if authors tell us they do have a conflict of interest.
Our impression, supported by the two recent papers, is that many authors are willing to sign that they don’t have a conflict of interest when by our definition they do. We have two hypotheses to explain this. Firstly, authors think that an admission of a conflict of interest implies wickedness. We don’t think so. Secondly, authors are confident that they have not been influenced by a conflict of interest and so don’t tell us they have one. Our response is that bias works in subtle ways and that none of us is blessed with knowledge of our own motivations and mental mechanisms. We are thus proposing some changes to see if we can do better. They will be phased in from now.
• We will replace the term “conflict of interest” with “competing interests.” This will, we hope, reduce the sense of wrongdoing and encourage people to disclose competing interests.
• We will restrict ourselves to financial interests and modify our form accordingly. The authors of the New England Journal of Medicine
article suggest that authors should be sent a questionnaire similar to the one they used in their study, and we have adopted this idea (see the form on our website (www.bmj. com/guides/advice.shtml)). Restricting ourselves to financial interests is a tactical move: narrowing the range may make it more likely that authors will declare competing interests. If authors want to disclose other competing interests then we will disclose them to readers.
• Authors of all original papers, editorials, and review articles will be asked to complete our questionnaires. Competing interests will be disclosed, and if authors tell us they have none (the usual case) we will write “none declared” rather than “none.” With letters we will continue to encourage authors to disclose competing interests but will send them a questionnaire to complete only if we suspect that authors might have competing interests. Authors of letters about drugs will usually be sent a questionnaire.
• If we learn after publication that authors had competing interests that they did not disclose then we will tell readers.
Some readers will regret such moves and remember a golden age when conflict of interest was not an issue. Times have changed however, and trans- parency and accountability are increasingly expected in all aspects of society. I doubt that the changes we are proposing will solve the problem, but they seem to us to be a step in the right direction. Authors and readers who disagree will no doubt tell us—and we will listen.