Medical journal editors remind authors: Full financial disclosure is necessary

Researchers say financial assistance is essential to continued advancements in orthopedic surgery.

Issue: October 2006

Medical journal editors are responsible for publishing the financial ties disclosed by authors, but just how far their responsibility goes when authors fail to disclose financial ties is still in question.

In August, Catherine D. DeAngelis, MD, MPH, editor in chief of the Journal of the American Medical Association (JAMA), wrote an editorial in JAMA restating the journal's policy to disclose relevant financial ties.

Her editorial followed three Harvard Medical School researchers failing to disclose their financial ties with drug companies, which was later revealed by authors and readers. In response, Harvard Medical School agreed to send letters to its 8,000 faculty members, outlining the disclosure policies of the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine.

DeAngelis and JAMA strengthened the journal's statement on financial disclosures and "emphasize the seriousness of the failed disclosures." JAMA published letters from the authors with corrections, apologies to the readers and, in one case, an editorial, DeAngelis said.

The Journal of Bone and Joint Surgery (JBJS) has not encountered problems like the ones JAMA experienced with financial disclosures, but the editors — as with any other medical journal — require that researchers sign a statement fully disclosing financial ties relevant to the study topic. The journal then publishes those financial ties and leaves it up to the reader to determine if a conflict of interest exists, according to James D. Heckman, MD, editor and chairman of JBJS.

A study author may be on the payroll of the company sponsoring a study, "but he also may well be a first-class scientist doing first-class research that's being funded by industry or the drug company ... and so then it's up to the reader to take those two pieces of information ... and decide how important that is," Heckman told Orthopedics Today.

Ensuring disclosure

One option that DeAngelis discussed for ensuring financial disclosure: temporarily banning publication of authors who violate a journal's policy. However, DeAngelis said such action would only lead authors to publish in another journal. "It cleans our house by messing others," she said.

And if all editors agreed to temporarily ban the violating authors, they could be at risk of an antitrust suit, she explained.

That leaves journals with a few other options. Writing editorials and articles that stress the importance of financial disclosure is one solution, according to Scott Boden, MD, JBJS consulting editor and Orthopedics Today editorial board member.

If the journal editors have ample evidence that an author did not reveal financial ties, investigations by their academic institutions and subsequent publishing of reckless violations may be necessary, Boden told Orthopedics Today.

Heckman said JBJS has already relied on academic institutions for investigating other "misbehaviors" and would turn to an investigation by an author's academic institution in this instance as well.

"Academic institutions are very concerned about maintaining the integrity of the process and maintaining the respect of that institution," Heckman said. "They have the resources and they're much closer at hand to the individual or individuals involved to conduct an investigation."

Maintaining surgeon-inventors

In her editorial, DeAngelis explained that, above all, industry assistance — although extensive — is essential to the discovery of new medications, devices and techniques.

This especially applies in orthopedics, Heckman said. After all, orthopedic surgeons worked with the industry to develop advances such as total hip and knee replacement devices and the arthroscope.

"To inhibit that and to stifle creativity because somebody perceives that there might be a conflict of interest, I think, could have a detrimental effect on advances in orthopedics and other surgical disciplines where the surgeon-inventor exists," Heckman said.

Medical journal editors are not the only ones struggling with the financial disclosure issue. A February study in Academic Medicine found that just 48% of medical centers have formal policies requiring financial disclosures to potential patient participants.

However, the type of information disclosed and its presentation varied among the centers. The authors found the need to develop a national consensus on what constitutes a conflict of interest and how to present the information to potential patient participants.

Finally, a lack of financial ties does not necessarily ensure that other conflicts of interest, such as academic, political or egotistical, do not exist, Boden said.

"Ultimately, the reliability of scientific data is only as good as the integrity of the author," he said.

For more information:
DeAngelis CD. The influence of money on medical science. JAMA. 2006;296(8):996-8. Epub 2006 Aug 7.
See also: Medical centers vary in disclosing conflicts of interest. 1st on the Web, May 5, 2006. Click here.