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:, ..... Commentary Conflict of Interest and Scientific Publications Lawrence Charles Parish, M.D.,* Joseph A. Witkowski, M.D.,t and Larry E. Millikan, M.D.t Once upon a time, writing a paper for a medical jour- nal was a seemingly easy task. The physician of the eighteenth century made an observation in his practice and reported it to a local medical society. The transac- tions of the society were then published when enough case reports had been accumulated to warrant the ex- pense. Because medical periodicals were new, few ref- erences were needed, and the writer's observations were taken at face value.' As we now approach the twenty-first century, the situation is drastically different. There is still the urge to share an experience with a colleague, further facili- tated by photography and computer-generated word processing. References can be rapidly obtained at the writer's desk through on-line services to the National Library of Medicine such as Grateful Med or BSR Colleague. These citations, when presented to most journals, must now conform to the Vancouver style.2T Objectivity in clinical research is essential to its value in the medical literature. Unfortunately, ambi- tion and secret agendas sometimes override the origi- nal mission, or at least the acceptable goals. Publish or perish can begin to obscure reality. In a recent editorial, the Council of Dermatology Editors addressed the issue of dual publication, a situa- tion to be condemned.3 We now wish to call attention to conflict of interest. Secret Agendas For the past few years, there has been increasing con- cern about financial interests in projects. There is nothing wrong with receiving remuneration for a day's labor. Participation in pharmaceutical trials and evalu- ation of devices often are scientifically useful, but the readers of the International Journal of Dermatology have every right to know where the authors of pub- lished papers stand.4 * Editor in-Chief. j- Associate Editor. Address correspondence to: Lawrence Charles Parish, M.D., 1819 John F. Kennedy Boulevard, Philadelphia, PA 19103. $ An example of a journal citation in Vancouver style is: Lebwohl, M., Contard, P.: Interferon and condylomate acuminata. Int J Der- matol 1990; 29:699-705. Because of our concerns over conflicts of interest, the Editor-in-Chief, in consultation with the Associate Editors, appointed an Ad Hoc Committee on Medical Ethics. Alton I. Sutnick, M.D., Vice President of the Educational Commission for Foreign Medical Gradu- ates, Philadelphia, and Ernst H. Beutner, Ph.D., Pro- fessor of Microbiology, SUNY-Buffalo, School of Medicine and Biomedical Sciences, both of the Edito- rial Board, agreed to.serve as Chairman and Vice Chairm^.n, respectively, of the Committee.s§ Conditions for Acceptance of Manuscripts As a result of their recommendations, the following conditions for publishing in the International Journal of Dermatology will be implemented immediately: Henceforth, all manuscripts considered by the In- ternational Journal of Dermatology must have a cover- ing letter containing the following information: 1. a. In consideration of the International Journal 2. ofDermatology taking action in reviewing and editing my (our) submission, the author(s) under- signed hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership to the Interna- tional Society of Dermatology: Tropical, Geo- graphic and Ecologic, Inc. in the event that such work is published in the Journal. b. If a manuscript has been authored by (an) em- ployee(s) of the government of the United States of America as part of official duties the following paragraph may be substituted: The submitted manuscript is a work of au- thorship prepared as part of my (our) official duties as an officer or employee of the govern- , ment of the United States of America and is therefore in the public domain. I (we) certify that I (we) have sufficiently partici- pated in the study or studies reported to warrant inclusion of my (our) name(s) and that I (we) can produce the source documents to substantiate the validity of the presentation. This submission has not been published before, unless so indicated. § Other members of the Committee include: John T. Crissey, M.D., Pasadena, CA; Michael J. Fellner, M.D., New York, NY; Jere D. Guin, M.D., Little Rock, AK. 250 Apri1 1991, Vol. 30, No. 4

No. 4 Conflict of Interest • Parish, Witkowski, and Millikan 3. I(we) certify that I (we) have no affiliation with or significant financial involvement in any orga- nization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript, except as disclosed here. This in- cludes employment, honoraria, consultancies, or relevant stock ownership. (Such information will be held in confidence by the Editor-in-Chief or his/her designate during the review process. If the manuscript is accepted, the Editor-in-Chief or his/her designate will discuss the situation with the designated corresponding author.) References 251 1. Garrison FH. The medical and scientific periodical of the 17th and 18th centuries. Bull Inst Hist Med. 1934;2:285-343. 2. Hanke CW, and Arndt KA, Dobson RL, et al. Dual publication and manipulation of the editorial process. Int J Dermatol. 1990;29:711-712. 3. Uniform requirements for manuscripts submitted to biomedical journals. Lancet. 1979;1:428-431. 4. Petersdorf RG. A matter of integrity. Acad Med. 1989;64:1 19- 123. 5. Shippley DJ. Permission granted by American Medical Associa- tion, December 11, 1990. ........... 1 t Wrongdoing: Conflict of Interest It is not difficult to determine that overt fraud has occurred; a much more difficult and complex matter is to define the wrongdoing that has been termed conflict of interest. Several recent examples constitute cases in point. 1. At a hearing before a subcommittee of the Committee on Government Operations of the House of Representatives on 29 September 1988, several investigators were taken to task because they were stock- holders in a company whose product they were investigating. It was alleged that they could not judge im- partially the efficacy of the product while they held a financial interest in the company that produced it. 2. At the same hearing, an investigator was accused of interpreting data on the effectiveness of an anti- microbial in a way that favored the company that supported his research and that had paid him honoraria for promoting the drug at scientific meetings. 3. An investigation by a medical school showed that researchers held a major financial interest in a com- pany that was manufacturing a drug while they were still investigating it. Not only that, the investigators claimed that the drug was effective when in fact it was not, falsely elevating the price of the company's stock. In 1980, Relman called to our attention the conflict of interest confronting physicians owning pharmacies, hospitals, and, more recently, magnetic resonance imaging machines and lithotripters who referred patients to these facilities. Present-day practices in which scientists hold directorships, obtain grants to support their own research from companies in which they have financial interests, and employ graduate students and postdoctoral researchers who work for the university as well as the company in which the scientists are in- volved are equally suspect. It is not uncommon for a scientist who is supported by public funds to make a major discovery, only to transfer the product of his or her research from a university laboratory to a private company for fun and profit, all the while remaining on the university payroll. Although these issues are often complex, the ethics of such practices can easily be called into question.-Petersdorf RG. A matter of in- tegrity. Academic Med. 7989;64:1 i9-123. 11