Almost all the journals that responded to our survey stated that they have written COI policies for authors, although the extent to which this applies universally to all submissions or is publicly disclosed is more variable. While the majority of journals (76.9%) require author COI for all submissions, almost a quarter of the journals do not require universal author disclosure. Absence of disclosure appears to be most common for narrative reviews, editorials, policy statements, and guidelines. This seems striking, given that all of these types of publications reflect the opinions of their authors, and that unlike research papers, most do not have any “Methods” sections that can be scrutinized by readers to determine the presence of bias. In addition, as these types of papers may in many cases be even more influential to the clinician reader than is original research, it would seem particularly critical for journals to mandate author disclosure, and public reporting, of authors' COIs for all such submissions.
To date, the study of editors and peer-reviewers in the production of biomedical research has been largely ignored. One prior survey of 37 general medical journals found that only 30% had a policy to deal with editor's financial COI despite most editors believing that the issue was important.16
Similarly, we found that less than half of the responding journals stated they have a written policy to manage peer-reviewer and editor COI, despite the fact that it is precisely people in these positions who have the power to decide what is or is not published.
Journals are dependent on the pharmaceutical industry for both advertising dollars and for the sponsored research studies that are their life-blood (and that provide further substantial revenues through the sale of reprints). Transparency in reporting, policies to handle potential COIs, and editorial independence are essential to the perception of the credibility of the information presented. As Richard Smith, the former editor-in-chief of the British Medical Journal
, stated “the quality of the journal will bless the quality of the drug,” and the economic well-being of a drug or product is tied to the “stamp of approval” provided by publication in prestigious journals.17
Recent increased public scrutiny of author COI should make journal publishers equally concerned about the public's perception and potential scrutiny of peer-reviewer and editor COI.
We found that almost no journal has a formal policy of verification of COI disclosures by all journal contributors (authors, peer-reviewers, and editors). Such verification would be cumbersome, and journals appear to rely on the professionalism of the authors, peer-reviewers, and editors.
Few journals (about 10%) reported having written policies regarding recusal of authors, editors, or peer-reviewers in the event of a specific COI (e.g., writing a review on a specific treatment of a disease produced by a biotechnology firm that the author has a financial stake in). There may be reasons why limited COI can, under certain circumstances, actually be beneficial. It may be advantageous to have authors with competing COI provide commentary in a pro and con debate of a topic. Similarly, it may be advantageous to have rival researchers serve as peer-reviewers of each other's work, as their expertise might provide additional insight into the research. These advantages come with potential hazards when rival researchers peer-review each other's works. Authors may be concerned that competitors would appropriate ideas or use the review process to delay a competitor's research publication. With full disclosure of COIs, the editor adjudicating the publication decision can make a fair and informed decision. A policy of editor recusal or peer-reviewer recusal seems warranted in cases in which the COI may be perceived to affect adversely the honest appraisal and decision to publish a manuscript.
Finally, our study highlights the relative lack of public acknowledgment of the COI that is disclosed to journals. Although author COI is frequently collected, almost a quarter of journals do not collect this information for all submissions. More importantly, more than 40% of journals do not publicly disclose author COI statements for all submissions. This is far more true of the few peer-reviewer and editor COI data that are less frequently collected and only rarely published. We agree with the ICMJE, WAME, and COPE recommendations that journals have policies and procedures for disclosure and management of COI for all who participate in the peer-review process.12–14
International Council of Medical Journal Editors and WAME both recommend public disclosure of editor COI.12,13
We believe that editors and peer-reviewers should be held to the same professional standard as authors, given their ability to influence biomedical publications. The failure of journals to publicly disclose author COI for all contributions, and/or failure to disclose COI for those most influential in the publication of scientific articles is of concern. The credibility of the medical literature requires greater transparency, not secrecy. We question the concept of COI “disclosure” that remains hidden from public scrutiny.
As we surveyed a convenience sample of journals, and because the response rate was 67%, we cannot estimate the prevalence of COI policies among all journals, nor can we make meaningful comparisons based on impact factor or country of publication. We do not believe that this greatly limits the value of our findings, as it clear from this sample that there are substantial gaps in journal COI policies, even among high-impact journals, and with regard to all 3 categories of journal contributors (authors, peer-reviewers, and editors). The implications of our results would not change whether this was even truer of journals with smaller readership or impact in the field, as we suspect is likely, or if it was limited to the journals we sampled.
We relied on self-report of journal editors, and did not attempt to verify the accuracy of their statements. Surveys were completed by individuals who we believe are reliable (editors in chief, or their designates), and knowledgeable about their journal's policies; furthermore, given the anonymous nature of the survey, we do not believe there is any reason to doubt the accuracy of their reports. To the extent that these self-reports may have been incomplete or less than perfectly accurate, we suspect that it would likely be in the direction of overstating the nature and rigor of COI disclosure policies.
Finally, we chose not to specify or define COI, or ask editors how their policies define COI (financial, nonfinancial, or both), for a number of reasons. First, we wanted to increase our capture of journals with any COI policy whatsoever; narrowing the definition of COI would have risked misclassifying journals as having no policy any time their definition did not match ours. Second, we wanted to decrease responder burden in order to insure a good survey response rate. Finally, although many journals reported COI policies, it is unclear to what extent these COI policies are consistent in their definitions across journals. It may be important in future research to ascertain the types of COI disclosure that journals require, and to evaluate whether and to what extent variations in such policies limit them from achieving their intended goals.