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Mayo Clinic Proceedings received a large number of letters to the editor and other communications in response to the commentary by Hirsch and the accompanying editorial by Lanier, both addressed bidirectional conflicts of interest (COIs) at medical journals, published in the September 2009 issue of the journal. These communications were evaluated individually and in aggregate by a panel that consisted of both editorial board members and other invited peer reviewers. Submissions were selected for publication on the basis of attributes such as the novelty and clarity of the messages, unique speculative synthesis of information, or introduction of new concepts that the panel thought deserved additional attention. Several of the authors were asked to revise their submissions to improve the quality of the communication and eliminate unnecessary repetition with other submissions. The results of this process, as well as responses from Hirsch and Lanier, are provided herein.