Conflicts of interest and medical publishing.

Conflicts of interest are important considerations whenever we have relationships with more than one entity and are thus at risk of favoring the interests of one entity over another. This situation presents itself daily to practicing physicians when we simultaneously try to meet the needs of patients, ourselves, employers, facilities in which we work, medical companies providing the tools of our trade, and society. For example, every time we decide whether or not to use a sophisticated new approach to perform a procedure, we must consider not only what is best for our patients but also other factors such as institutional and personal reputations and income, relationships with industry, teaching responsibilities, and hospital requirements for maintenance of privileges, to name just a few. Authors deal with conflicts of interest at a number of levels. The primary entity of concern for each author must be our patients because of the potential for each published work to affect their health. Often overlooked entities of concern are the authors themselves and the institutions they represent, both of whom benefit in numerous ways from manuscript publication. The most obvious entities are the medical companies whose products are necessary for us to provide care, because many authors depend on them for either personal or research-related financial support. In recent years, research funding had become increasingly difficult to obtain, and, as a result, the percentage of published manuscripts performed with industrial support continues to increase. Despite the best intentions of companies, it is impossible to separate research from sales completely; every positive study is a potential advertising tool, and a negative study can be catastrophic for sales. Although companies often are organized into distinct research, marketing, and sales divisions, every employee should be invested in the company’s success. This cornerstone of capitalism is certainly important for the business of medicine at all levels. Because conflicts of interest are frequently unavoidable, the standard approach has been for authors to acknowledge their industrial relationships. In theory, this allows readers to take published findings “with a grain of salt”—to balance the persuasiveness of the conclusions against any special interests of the authors and their sponsors. Failure to acknowledge an industrial relationship can result in withdrawal of a published article and can have significant ramifications for authors as well. Although acknowledging conflicts of interest helps readers understand study context, it does not negate the conflicts. Editors, reviewers, and readers should be aware of the ways in which conflicts of interest can affect medical publications. Beneath the surface is the well-appreciated fact that only a portion of the studies performed under industrial auspices are published (ie, selective reporting), and those that are published almost universally favor industrial interests. A publicly accessible, Internet-based registry of clinical trials (ClinicalTrials.gov) was created at least in part to improve transparency from this perspective. It is the policy of Obstetrics & Gynecology to confirm that all submitted clinical Dr. Hurd is the Associate Editor (Gynecology) for Obstetrics & Gynecology; e-mail: whurd@ greenjournal.org.