Public trust in the peer-review process and the credibility of published articles depends in part on how well conflict of interest is handled during writing, peer review, and editorial decision making. Conflict of interest exists when an author (or the author’s institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions.

Such relationships are also known as “dual commitments”, “competing interests”, or “competing loyalties”. These relationships vary from being negligible to having great potential for influencing judgment.

Not all relationships represent true conflict of interest. On the other hand, the potential for conflict of interest can exist regardless of whether an individual believes that the relationship affects his or her scientific judgment. Financial relationships (such as employment, consultancies, stock ownership, honoraria, and paid expert testimony) are the most easily identifiable conflicts of interest and the most likely to undermine the credibility of the Journal, the authors, and of science itself. However, conflicts can occur for other reasons, such as personal relationships, academic competition, and intellectual passion.

All participants in the peer-review and publication process must disclose all relationships that could be viewed as potential conflicts of interest. Disclosure of such relationships is also important in connection with editorials and review articles, because it can be more difficult to detect bias in these types of publications than in reports of original research. Editors may use information disclosed in conflict-of-interest and financial-interest statements as a basis for editorial decisions. Editors should publish this information if they believe it is important in judging the manuscript.

Potential Conflicts of Interest Related to Individual Authors’ Commitments

When authors submit a manuscript, whether an article or a letter, they are responsible for disclosing all financial and personal relationships that might bias their work. To prevent ambiguity, authors must state explicitly whether potential conflicts do or do not exist. Authors should do so in the manuscript on a conflict-of-interest notification page that follows the title page, providing additional detail, if necessary, in a cover letter that accompanies the manuscript.

Authors should identify individuals who provide writing or other assistance and disclose the funding source for this assistance.

Investigators must disclose potential conflicts to study participants and should state in the manuscript whether they have done so.

Editors also need to decide whether to publish information disclosed by authors about potential conflicts. If doubt exists, it is best to err on the side of publication.

Potential Conflicts of Interest Related to Project Support

Increasingly, individual studies receive funding from commercial firms, private foundations, and government. The conditions of this funding have the potential to bias and otherwise discredit the research.

Scientists have an ethical obligation to submit creditable research results for publication. Researchers should not enter into agreements that interfere with their access to all of the data and their ability to analyze them independently, and to prepare and publish manuscripts. Authors should describe the role of the study sponsor, if any, in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. If the supporting source had no such involvement, the authors should so state. Biases potentially introduced when sponsors are directly involved in research are analogous to methodological biases. Some journals, therefore, choose to include information in the Methods section about the sponsor’s involvement.

Editors may request that authors of a study funded by an agency with a proprietary or financial interest in the outcome sign a statement, such as “I had full access to all of the data in this study and I take complete responsibility for the integrity of the data and the accuracy of the data analysis.” Editors should review copies of the protocol and/or contracts associated with project specific studies before accepting such studies for publication. Editors may choose not to consider an article if a sponsor has asserted control over the authors’ right to publish.

Potential Conflicts of Interest Related to Commitments of Editors, Journal Staff, or Reviewers

Editors should avoid selecting external peer reviewers with obvious potential conflicts of interest - for example, those who work in the same department or institution as any of the authors. Authors often provide editors with the names of persons they feel should not be asked to review a manuscript because of potential, usually professional, conflicts of interest. When possible, authors should be asked to explain or justify their concerns; that information is important to editors in deciding whether to honor such requests.

Reviewers must disclose to editors any conflicts of interest that could bias their opinions of the manuscript, and they should recuse themselves from reviewing specific manuscripts if the potential for bias exists. As in the case of authors, silence on the part of reviewers concerning potential conflicts may mean either that conflicts exist and the reviewer has failed to disclose them or conflicts do not exist. Reviewers must therefore also be asked to state explicitly whether conflicts do or do not exist. Reviewers must not use knowledge of the work, before its publication, to further their own interests.

Editors who make final decisions about manuscripts must have no personal, professional, or financial involvement in any of the issues they might judge. Other members of the editorial staff, if they participate in editorial decisions, must provide editors with a current description of their financial interests (as they might relate to editorial judgments) and recuse themselves from any decisions in which a conflict of interest exists. Editorial staff must not use information gained through working with manuscripts for private gain. Editors should publish regular disclosure statements about potential conflicts of interests related to the commitments of journal staff.