Conflicts Of Interest In Medical Research: Are Authors Declaring Them All?

Most authors whose work appeared in two of the world’s most influential medical journals – the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) – failed to declare conflicts of interest in the form of payments received. That’s according to an analysis examining 31 research articles published in each of the aforementioned journals in 2017.

The analysis used a US government database called OpenPayments, to which device and drug companies must report all payments made to physicians and other healthcare providers. While not yet peer-reviewed, the analysis reports concerning figures. The 23 authors who received the most payments – a total of $6.32 million for speaking, consulting, travel, food and more – left 47.6% of the money undisclosed. This included all money received in the three years prior to the submission of an article for publication, as this is what is required by International Committee of Medical Journal Editors (ICMJE) guidelines.

When evaluating a study, knowledge of potential conflicts of interest is of great importance, as they can influence the way authors present their results. An NEJM spokesperson told STAT that editors do review all of the disclosure forms submitted by authors, but don’t have access to the primary records upon which the information is based. In other words, the ICMJE guidelines are more of a suggestion than a rule. The NEJM expects authors to take the initiative when it comes to disclosing financial agreements, and unfortunately that expectation seems to be misplaced, at least during the time period studied.

This problem extends beyond medical journals, with concerns that areas like clinical practice guidelines, teaching hospitals and medical textbooks may also be influenced by undisclosed conflicts of interest. Six of nine widely used psychopharmacology textbooks (for which there are no disclosure requirements) had at least one editor or author who had received payments from drug makers, according to one recent analysis.

Brian Piper, one of the authors of the analysis of NEJM and JAMA studies, suggests there may be relatively easy solutions to the problem. For example, a journal could review the OpenPayments database to find payments made to specific authors, and provide a link or screenshot of said payments within the relevant publication.