When the International Committee of Medical Journal Editors came out with a new conflict of interest disclosure form last month there were mixed reviews. An article in American Medical News outlined the issue.
Much of the problem of reporting disclosures to begin with is a problem of the journals themselves. As JAMA Editor-in-Chief Catherine D. DeAngelis, noted herself, there are “over 1,500 biomedical journals and everyone has their own author form with different requirements, and it's extremely confusing for authors." She even indicated that the authors have a lot of “legitimate confusion."
Merrill Goozner, a member of the Center for Science in the Public Interest, an advocacy group, helped convene a group of journal editors to come up with the uniform disclosure form. The results of their work are slated for publication in a forthcoming issue of Addiction, the journal of the Society for the Study of Addiction.
Some parts of the new form seem reasonable: authors submitting for publication must disclose any payment for the research that generated the article as well as other kinds of industry relationships such as consultancies, honoraria or stock options from the last three years.
Other parts of the form could be considered an invasion of privacy. For example, the form also asks authors to disclose whether spouses or children have financial relationships with "entities that have an interest in the content of the submitted work." The form even goes as far as asking authors to provide "any relevant nonfinancial associations or interests" of a personal, political or religious nature "that a reasonable reader would want to know about." For example, authors who write about the clinical consequences of abortion who are ardently anti-abortion.
Jerome P. Kassirer, MD, former editor of NEJM noted that "asking people to declare nonfinancial conflicts of interest is likely not to be fruitful." As a result, he acknowledged that a form that includes this irrelevant information dilutes the importance of these financial conflicts."
J. Michael Gonzalez-Campoy, MD, PhD, a medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology, a private practice near Saint Paul, and an ACRE leader also had objections. He particularly felt that "It is an unwarranted extreme to require spouse, partner or children information."
Do we know who the spouses of our favorite politicians work for? How about their staffers? What about the spouses of lobbyists who work on the Hill or in industry? While Dr. Gonzalez-Campoy certainly believes "in disclosure of working relationships that may have bearing on a publication or presentation," he said the ICMJE form goes too far.
Revealing financial relationships
Among other things, the form asks authors to disclose whether, in the previous three years, they or their institutions had financial relationships "with any entities that have an interest related to the submitted work, including:
Board membership
Consultancy
Employment
Expert testimony
Gifts
Grants/grants pending
Honoraria
Payment for manuscript preparation
Patents (planned, pending, or issued)
Royalties
Payment for development of education presentations, including service on speakers' bureaus
Stock/stock options
Travel/accommodations expenses covered or reimbursed
Source: International Committee of Medical Journal Editors Uniform Disclosure Form for
Potential Conflicts of Interest (www.icmje.org/coi_disclosure.pdf)
While the ICMJE form is undergoing beta-testing and will be finalized at the committee's April 2010 meeting, journal editors should begin discussing what relevant information they could use from these questions that people have objected to. If the main goal of having a uniform disclosure form is to reduce conflicts of interest, then financial disclosures should be the main priority for those directly involved, plain and simple, at least until evidence suggests otherwise.
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