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Author disclosure of financial associations with commercial entities that have an interest in the research published in medical journals is common practice. The information provided in the disclosure helps readers assess the degree of commercial influence over the work. Recently, however, differing journal policies have led to unintentional omissions and there have been calls for medical journals to standardize their conflict of interest policies.
To address the complaints, editors at some of the world’s leading medical journals have agreed to adopt a new standard conflict of interest disclosure form for researchers. The new rules, which were drafted by the International Committee of Medical Journal Editors (ICMJE), requires that authors disclose both financial and non-financial interests. Authors will now be asked to disclose four types of information :
- Associations with commercial entities that provided support for the work reported in the submitted manuscript.
- Associations with commercial entities that could be seen as having an interest in the general area of the submitted manuscript.
- Any similar financial associations involving their spouse or their children under 18 years of age.
- Non-financial associations that may be relevant to the submitted manuscript.
At least a dozen publications have agreed to use the new disclosure form, including The Lancet, The Journal of the American Medical Association (JAMA), The New England Journal of Medicine (NEJM) and The British Medical Journal (BMJ). According to a story published online in the Wall Street Journal, the form will be phased in over the next several months .
An article in The Scientist, a magazine for life science professionals, pointed out that inclusion of peer reviewers would be useful for medical journal editors so that they can select reviewers that don’t have an interest in the research being evaluated . However, the new disclosure guidelines set forth by the ICMJE only apply to authors.
Other issues with medical journals
Medical journals exert a great deal of influence over the health of millions of people everyday, affecting everything from how doctors treat patients to the actions taken by public health agencies. In 2007, Richard Smith, former editor of the British Medical Journal (BMJ) and chief executive of the BMJ Publishing Group, wrote a book titled The Trouble with Medical Journals. In the book, Smith addresses the failure of medical journals to effectively manage conflicts of interest. The new standard conflict of interest disclosure form described above should help journals do a better job at identifying commercial influence over published research. Smith goes on to discuss how money can taint objectivity in scientific publishing. Drawing from his own extensive experiences, he argues that medical journals have become “creatures of the drug industry”– fraudulent research and articles ghost written by pharmaceutical companies are widespread practices.
Many journals publish clinical trials funded by pharmaceutical companies. The results of these studies are rarely unfavorable to drug companies, not because the research is fraudulent, but in large part because of the types of questions asked by researchers (for more on this, see the video below). The larger problem is that medical journals often come to depend on income from the sale of article reprints to the very company which funded the trial. From the drug company’s perspective, a favorable clinical trial, advertising from worldwide distribution of the medical journal, and the media coverage of the study is worth the cost of thousands of article reprints. Indeed, since research quality has traditionally been measured by journal quality, physicians receiving the reprints typically equate the quality of the drug with the quality of the journal publishing the trial.
Smith also highlights the poor science that often appears in medical journals, with reports that rarely allow confident conclusions due to the lack of statistical power or controls. Many are Individual cases — anecdotal evidence at best — that cannot applied to the population.
Yet another issue with medical journals is the increasing exposure of research and contradictory findings in the mass media. Scientists and physicians typically wait for a series of studies to be done before evaluating the data; the way patients are treated doesn’t change on the basis of results from a single study. That’s how biomedical science works: knowledge accumulates and preponderance of data guides our understanding and conclusions. Nonetheless, medical journals are a combination of science and journalism, and frequently distribute press releases on new studies appearing in their pages.
Conflict of interest? Possibly, when the press release doesn’t properly frame the study results and implications. This is one of problems with “medical reporting by press release”.
You can read an edited introduction of the book published by the Journal of the Royal Society of Medicine .
In 2007, Peter Mansbridge, host of the Canadian CBC News program Mansbridge One on One, had a conversation with Richard Smith and discussed many of these issues . The interview is presented below.
How do you identify research published in medical journals that really matters? Smith suggests that you ask yourself two questions when reading published biomedical studies or reports of published research:
- Is the study truly telling you something that you need to know?
- Are the conclusions reliably supported by the methods and the data?
Smith is a supporter of open access publishing. During his tenure as editor of the BMJ, when the journal first moved to online publishing, he made the journal’s archives freely available. Today, Richard Smith is the executive director of the Ovations Chronic Disease Initiative, a campaign to combat chronic disease in the developing world. He also is a member of the board of directors for the Public Library of Science (PLoS) and is editor-in-chief of the open-access Cases Journal, which plans to create an online database of medical case reports.
- Uniform Format for Disclosure of Competing Interests in ICMJE Journals. The International Committee of Medical Journal Editors. 2009 Oct.
- New Conflict Rules at Medical Journals. The Wall Street Journal. 2009 Oct 14.
- Med journals adopt disclosure rules. The Scientist. 2009 Oct 14.
- Smith R. The trouble with medical journals. J R Soc Med. 2006 Mar;99(3):115-9.
- Interview with Richard Smith. Mansbridge One on One. 2007 Nov 24.