A Common Standard

Several years ago, the American Academy of Orthopaedic Surgeons invited the editors of all US-based orthopaedic surgery journals to meet regularly to discuss topics of mutual interest. Since then, this informal organization has assembled annually during the AAOS winter meeting. I think that most members have found the get-togethers worthwhile, as reflected in their high rate of attendance. The editor of a medical journal is confronted with challenges that only another journal editor can fully appreciate; the opportunity to share experiences and discuss common problems can be a valuable and even therapeutic experience. One of the primary motivations for the formation of this group was to attempt to agree upon common standards on matters ranging from the preferred methods of reference citation and level of evidence classification to appropriate sanctions for ethical misconduct such as plagiarism or duplicate publication. Editors tend to be an independent lot, however, and it soon became apparent that widespread agreement on such issues would be difficult to achieve. This year, however, members of this group representing 18 orthopaedic journals have demonstrated impressive solidarity in their decision to embark on a common course of action. Last fall I was invited by the AAOS to participate in a small project team to devise a policy on author disclosure that could be supported by most if not all orthopaedic journals. The 6 participants quickly agreed that the adoption of a common declaration standard would promote greater compliance by authors and increase transparency in the reporting of relationships that might be perceived as conflicts of interest. This consensus echoed the view of others who have called for the adoption of common reporting standards by the general community of medical journals. Our project team reviewed the declaration form recently adopted by the International Committee of Medical Journal Editors (ICMJE) (www.icmje.org/coi_ disclosure.pdf). We concluded that the ICMJE form, while not perfect, had the virtues of being thorough, vetted through pilot use, already adopted by prominent journals outside of orthopaedic surgery, and supported by a respected international organization. When the full complement of orthopaedic journal editors convened at the February 2011 meeting of the AAOS, they discussed the project team’s proposal for the adoption of the ICMJE form by all orthopaedic journals as a minimum standard for the reporting of potential conflicts of interest by authors. Since then, a large number of orthopaedic journals have agreed to support this policy and to publish a common statement announcing their intention. This statement and the names of the concurring editors and their journals can be found at the end of this editorial. When Donna Tilton, the American Journal of Sports Medicine senior editorial and production manager, and I compared the ICMJE declaration with the form that the AJSM had developed, we found that the AJSM form included questions in a number of areas that were not covered by the ICMJE. One of these asked whether any immediate family members of the authors had any of the same relationships that the authors themselves were expected to declare. This provision was actually included in the original ICMJE pilot form but dropped from the final format. Other additional questions in the AJSM form are directed at the existence of any unnamed contributors to the work and any restrictions that may have been placed upon the authors’ access to the experimental data or their authority over the final content of the paper. AJSM also requires its editors and reviewers to declare their commercial relationships. Since the purpose of the orthopaedic journal editors’ initiative was to enhance transparency in the reporting of potentially competing interests and not diminish it, AJSM will continue to maintain these additional aspects of its declaration requirements. Henceforth, authors will have a choice. One option will be to sign the AJSM’s own form, which has been augmented with 2 items from the ICMJE declaration not explicitly included in previous versions. The other option will be to submit the ICMJE form along with an addendum covering the additional items required by AJSM. The AJSM Editorial Board approved this procedure at its July 2011 annual meeting. Studies in the medical literature testify to the imperfect nature of conflict of interest policies. Recent publications have revealed incomplete declaration of potentially competing financial relationships among medical school deans, writers of clinical cardiovascular treatment guidelines, and contributors to preeminent medical journals. When Okike et al compared the public disclosures of 5 major manufacturers of hip and knee prostheses with the declarations from the 2008 annual meeting of the AAOS, they found that over 28% of meeting participants failed to disclose consulting relationships with the commercial entities. A similar study of published journal articles reported that authors who were each paid more than $1 million for consulting in 2007 only declared these relationships about 50% of the time in articles that were Editorial