In light of several recent instances in which authors have failed to fully disclose their potential conflicts of interest, Dr. Catherine DeAngelis, JAMA’s Editor in Chief, wrote a very interesting editorial in this week’s journal about the ability of medical journals to enforce full disclosure policies.
Dr. DiAngelia acknowledges that for-profit companies fund the discovery of new medications and devices. However, conflicts arise when the quest for profits inappropriately influences research findings or the way in which the findings are presented, such as incomplete reporting of adverse events or concealing negative clinical trial data.
As Dr. DeAngelis points out, for-profit companies must have the best people working on medical problems, either as paid employees or consultants, if they hope to advance medical science. Yet, the majority of these experts are academicians, the same people who publish most of the research and articles in medical journals. So, how can editors preserve the integrity of their journals while ensuring dissemination of scientific information?
First and foremost, journals must have rigorous peer review and editorial evaluation processes to ensure that all published articles are scientifically sound and as objective and unbiased as possible. In addition, full disclosure of financial relationships and potential conflicts of interest is essential so that readers can interpret articles in the light of that information. In an effort to present readers with reliable information, JAMA has combated such conflicts of interest with several policies. JAMA requires all industry-sponsored studies to undergo an independent statistical analysis by an academic researcher to ensure the data’s legitimacy. Also, JAMA requires that all authors sign a specific agreement disclosing all their financial sponsors. Just last month JAMA published a stronger statement of this policy and publicly announced the failures of some authors to make full disclosures.
However, despite these efforts, Dr. DeAngelis contends that there is no way to guarantee that all potential conflicts of interest are disclosed. It is not feasible to independently investigate the financial relationships of every author since there is no comprehensive, up-to-date source for this information. Even if one journal bans an author who fails to appropriately disclose information, that author can send his or her articles to another journal. One possibility is that a group of editors such as the International Committee of Medical Journal Editors could agree to share information about authors who have failed to report their funding and ban those authors across the board. Unfortunately, as Dr. DeAngelis points out, this solution might violate antitrust law. Thus, Dr. DeAngelis concludes that the best solution is a full investigation by the deans of the author’s institution with appropriate corrective actions.
While we certainly agree that disclosures MUST happen, the pursuit for full disclosure should not come at the expense of obtaining expert opinion. Rather, journals need to develop a system whereby authors fully disclose their financial relationships (with meaningful penalties for non-disclosure) in enough detail so that readers can make their own judgments, just as they make their own judgments about the validity of trial results. JAMA’s policies are a step in the right direction, but all journals must voluntarily follow suit in order to make this effort a success. Furthermore, as Dr. DeAngelis suggests, academic institutions must share in the responsibility for full disclosure by instituting similar disclosure policies, investigating cases of non-disclosure, and implementing corrective actions as necessary. Finally, full disclosure is only part of the solution. The scientific community must also enact other measures, such as clinical trial registries, to ensure that complete results from clinical trials are reported, including all adverse events and negative results.