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Conflict of interest in medical publishing exists when a participant’s private interests compete
with his or her responsibilities to the scientific community, readers, and society. While conflict of
interest is common, it reaches the level of concern when “a reasonable observer might wonder if
the individual’s behavior or judgment was motivated by his or her competing interests”.1 Having
a competing interest does not, in itself, imply wrongdoing. But it can undermine the credibility
of research results and damage public trust in medical journals.
In recent years, the extent of conflict of interest in medical journal articles has been increasingly
recognized. Medical journals and the popular media have published numerous examples
of competing interests that seemed to have biased published reports.2,3,4 Organizations have
expressed concern for the effects of conflicts of interest on research,5 publication1,6,7 teaching8
and continuing medical and nursing education.9
The World Association of Medical Editors (WAME) is one of the institutions engaged in
this discussion. WAME was established in 199510,11 to facilitate worldwide cooperation and
communication among editors of peer-reviewed journals, improve editorial standards and
promote professionalism in medical editing.12 Membership in WAME is open to all editors of
peer-reviewed biomedical journals worldwide; small journals in resource-poor countries are
well represented. As of December 2009, WAME had 1595 individual members representing 965
journals in 92 countries. WAME has broad participation as there are no dues and WAME activities
are largely carried out through the member list serve and the member password-protected
website.
In March 2009, WAME released an updated policy statement, “Conflict of Interest in Peer-
Reviewed Medical Journals”.1 It details the issues WAME believes journals should address when
establishing their own policies for conflict of interest. The editors of this journal thought that
the issues were important enough to share with its readers. A summary of the statement is
presented in Table 1and the full statement1 can be found on WAME’s website.12
How does this Statement differ from earlier conflict–of-interest statements?
First, WAME expands the scope of competing interests. Other statements have been concerned
almost exclusively with conflicts of interest related to financial ties to industry – companies that
sell healthcare products. The assumption is that financial incentives are especially powerful and
are not readily recognized without special efforts to make them apparent. WAME has extended
the concept of financial conflict of interest to include the effects of clinical income. For example,
physicians who earn their livelihood by reading mammograms or performing colonoscopies
may be biased in favor of these technologies. WAME has also included non-financial conflicts of
interest (or the appearance of one) related to scholarly commitment: “intellectual passion,” (the
GUEST EDITORIAL
4 PhiliPPine Journal of otolaryngology-head and neck Surgery
Conflict of Interest in Peer-Reviewed
Medical Journals: The World Association of
Medical Editors (WAME) Position
on a Challenging Problem
Correspondence: Lorraine E. Ferris
University of Toronto, Dalla Lana School of Public Health,
500 University Ave, Suite 390, Toronto, Ontario,
Canada M5G 1V7
Email: lorraine.ferris@utoronto.ca.
Conflict of Interest
As a WAME Director, Lorraine Ferris did not participate in
the WAME Board vote to approve the statement or the vote
to endorse the editorial.
The authors have no conflicts of interest to declare.
“This Editorial may appear in other medical and biomedical
journals whose editors are members of WAME.”
© 2010 by WAME.
Lorraine E. Ferris1 and Robert H. Fletcher2
1Dalla Lana School of Public Health
University of Toronto
Clinical Epidemiology Unit
Sunnybrook Health Sciences Centre
Toronto, Ontario, CANADA
Chair, WAME Ethics Committee
2Harvard Medical School, Boston MA, U.S.A.
Chair, WAME Policy Committee
PhiliPPine Journal of otolaryngology-head and neck Surgery Vol. 25 no. 1 January – June 2010
GUEST EDITORIAL
PhiliPPine Journal of otolaryngology-head and neck Surgery 5
tendency to favor positions that one has already espoused or perhaps
even established); personal relationships (the tendency to judge the
works of friends/colleagues or competitors/foes differently because
of the relationship); political or religious beliefs (the tendency to favor
or reject positions because it affirms or challenges one’s political or
religious beliefs); and institutional affiliations (the tendency to favor or
reject results of research because of one’s institutional affiliations).
Second, WAME did not prescribe a universal standard for
when meaningful conflict of interest exists. Rather, it defined
and recommended elements of conflict of interest policies and
encouraged journals to establish their own standards. WAME left
operational definitions and standards on the basic issues to member
journals, recognizing that journals exist in very different contexts
across the globe, standards for conflict of interest are evolving, and
some journals already have well-established policies and standards.
WAME does not presume to judge which conflicts require action and
what the appropriate action may be, although its policy does offer
factors to consider.1 Obviously, excessive concern for these and more
comprehensive lists of possible competing interests could paralyze the
peer review and publication process and is not feasible. Editors must
make judgments as to the strength of the conflict, but to do so must
have uncensored information. Similarly, readers need transparency
about conflicts, and therefore editors should publish with every article
all relevant author disclosures.1
Third, WAME confirms the seriousness of failure to disclose conflict of
interest by indicating that editors have a responsibility for investigating,
and if relevant acting, if competing interests surface after a manuscript
is submitted or published. The intent is that allegations of failure to
declare conflicts of interest must be taken seriously by journals.
Finally, WAME has addressed in a single statement the conflicts of
interests threatening all participants in the research and publication
continuum, including authors, peer reviewers, and editors. Conflicts
between editors and journal owners, which might affect both the
accuracy of articles and the credibility of journals, have been addressed
in another WAME policy statement.13
What can be done about conflict of interest in medical
journals?
Conflicts of interest cannot be eliminated altogether but it can be
managed so that it has the smallest possible effects on journal content
and credibility. The backbone of managing conflicts of interest is
full written disclosure; without it, nothing else is possible. Currently,
authors may not reveal all of their competing interests and even if they
do, journals too often do not publish them,14 so there is plenty of room
for improvement. Even so, disclosure alone is an imperfect remedy;
editors still must determine whether a conflict has sufficient potential
Table 1. Summary of key elements for peer reviewed medical journal’s conflict of
interest policies
Element aspects Key Comments
A clear definition the journal uses
as to what is conflict of interest
and who is captured in the
definition.
A clear statement of examples of
the types of competing interests
(and their definitions) the journal
says must be declared. Should
include the following as examples
but there could be others:
(a) Financial ties
(b) Academic commitments
(c) Personal relationships
(d) Political or religious beliefs
(e) Institutional affiliations
Clear statements on (a) what
is to be declared, when and to
whom; (b) format for declaration;
(c) a journal’s role in asking
additional questions or seeking
clarification about disclosures;
and, (d) consequences for
failing to disclose before or after
publication.
A clear statement on how conflict
of interest will be managed by
the journal, including the position
that all relevant conflict of interest
disclosures (or the declaration
of no conflict of interest) will be
published with the article and
clarity about what conflict of
interest situations will result in a
manuscript not being considered.
1. Definition and
Scope
2. Types of
Competing
Interests
3. Declaring
Conflict of
interests
4. Managing
conflict of
interests
Sample definition: Conflict
of interest exists when a
participant in the publication
process (author, peer
reviewer or editor) has a
competing interest that
could unduly influence (or
be reasonably seen to do so)
his or her responsibilities
in the publication process
(submission of manuscripts,
peer review, editorial
decisions, and communication
between authors, reviewers
and editors).
There is a need to consider
a wide range of competing
interests (and a recognition
that they can coexist) which
the individual assess as to
whether they unduly influence
(or be reasonably seen to do
so) his or her responsibilities
in the publication process.
Examples and definitions of
what competing interests
should be declared needs to
be articulated with Journals
moving beyond just financial
conflict of interest.
Journals rely on disclosure
about the facts because
routine monitoring or
investigation is not possible.
This creates a particular
onus on the declarer
to report carefully and
comprehensively. It also
means that journals should
ask about conflict of interest in
such a way that there will be
a high likelihood of reporting
relevant conflict of interest.
Journals use various rules
about how they will deal with
conflict of interest and conflict
of interest disclosures and
these need to be made known
to all those involved in the
publication process.
PhiliPPine Journal of otolaryngology-head and neck Surgery Vol. 25 no. 1 January – June 2010
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6 PhiliPPine Journal of otolaryngology-head and neck Surgery
ACKNOWLEDGEMENT
The authors wish to warmly thank the World Association of Medical Editors (WAME) Officers for
their helpful comments on an earlier version of this editorial. Many thanks to President Margaret
Winker (USA); Past President Michael Callaham (USA); Vice-President John Overbeke (Netherlands);
Treasurer Tom Lang (USA); and Secretary Farrokh Habibzadeh (Iran).
The WAME Statement on Conflict of Interest in Peer-Reviewed Medical Journals was approved by
the WAME Board in March 2009. Many thanks to the members of the WAME Ethics Committee and to
the WAME Editorial Policy Committee for their insightful and helpful comments on an earlier version
of the statement. Warm thanks to the WAME Board for their input and comments: Margaret Winker;
Michael Callaham; John Overbeke; Tom Lang; Farrokh Habibzadeh; Adamson Muula (Malawi) and Rob
Siebers (New Zealand).
REFERENCES
1. WAME statement on conflict of interest in peer-reviewed medical journals http://www.wame.
org/conflict-of-interest-in-peer-reviewed-medical-journals
2. Bekelman JE, Li Y & Gross CP. Scope and impact of financial conflicts of interest in biomedical
research: a systematic review. JAMA 2003; 289(4); 454-65.
3. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research
outcome and quality: systematic review. BMJ 2003;326(7400);1167-1170.
4. Altman LK “For science’s gatekeepers, a credibility gap”. The New York Times May 2 2006. http://
www.nytimes.com/2006/05/02/health/02docs.html?scp=58&sq=conflict+of+interest+%26+
medicine&st=nyt
5. Institute of Medicine “Conflict of interest in medical research, education, and practice”.
Washington, DC: National Academies Press, 2009 (April) http://www.iom.edu/Reports/2009/
Conflict-of-Interest-in-Medical-Research-Education-and-Practice.aspx
6. International Committee of Medical Journal Editors (ICMJE) “Uniform requirements for
manuscripts submitted to biomedical journals; ethical considerations in the conduct and
reporting of research: conflicts of interest http://www.icmje.org/ethical-4conflicts.html
7. International Committee of Medical Journal Editors (ICMJE) “Uniform format for disclosure of
competing interests in ICMJE journals. October 2009. http://www.icmje.org/format.pdf
8. American Association of Medical Colleges. “Industry funding of medical education: report of an
AAMC task force”. June 2008.
9. Hager M, Russell S, & Fletcher, SW (eds). “Continuing education in the health professions:
improving healthcare through lifelong learning. Josiah Macy J Foundation, November 2007.
http://www.josiahmacyfoundation.org/documents/pub_ContEd_inHealthProf.pdf
10. Squires BP & Fletcher SW “The World Association of Medical Editors (WAME): thriving in its first
decade” Science Editor 2005, 28(1); 13-16.
11. Launching the World Association of Medical Editors: report of the conference to promote
international cooperation among medical journal editors 1995. http://www.wame/org/
Bellagio.htm
12. WAME Website. http://www.wame.org
13. WAME policy on the relationship between journal editors-in-chief and owners (formerly titled
Editorial Independence). http://www.wame/org/resources/policies#independence
14. Bhargava N, Qureshi J, & Vakil N “Funding source and conflict of interest disclosures by authors
and editors in gastroenterology specialty journals”. American J of Gastroenterology; 2007;
102(6); 1146-1150.
to impair an individual’s objectivity such that the article should not be
published. Even more work may be needed on reviewers’ and editors
competing interests, given their critical role as gatekeepers for the
medical literature.
No statement will solve the conflict of interest problem, nor will it
ever be solved altogether. As understanding of the problem and its
management evolves, journals should be given latitude to establish
their own standards, matching their policies to the best standards of
their discipline and culture. WAME believes journals should make these
policies readily accessible to everyone. All of us—editors, authors,
reviewers, and readers--should be paying more attention to conflict
of interest than we have been. We hope this statement serves that
purpose.