Intended for healthcare professionals

Feature Essay

Justifying conflicts of interest in medical journals: a very bad idea

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2942 (Published 02 June 2015) Cite this as: BMJ 2015;350:h2942
  1. Robert Steinbrook, professor adjunct of internal medicine1,
  2. Jerome P Kassirer, distinguished professor2,
  3. Marcia Angell, senior lecturer on social medicine3
  1. 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
  2. 2Tufts University School of Medicine, Boston, MA, USA
  3. 3Harvard Medical School, Boston, MA, USA
  1. Correspondence to: robert.steinbrook{at}yale.edu

A series of articles in the New England Journal of Medicine has questioned whether the conflict of interest movement has gone too far in its campaign to stop the drug industry influencing the medical profession. Here, three former senior NEJM editors respond with dismay

A seriously flawed and inflammatory attack on conflict of interest policies and regulations appeared recently in a most unexpected location: the venerable and trusted New England Journal of Medicine (NEJM). In a series of rambling articles, one of the journal’s national correspondents, Lisa Rosenbaum, supported by the editor in chief, Jeffrey Drazen, tried to rationalise financial conflicts of interest in the medical profession.1 2 3 4 As former senior editors of the NEJM, we find it sad that the medical journal that first called attention to the problem of financial conflicts of interest among physicians would now backtrack so dramatically and indulge in personal attacks on those who disagree.

Physicians and the public rely on journals as unbiased and independent sources of information and to provide leadership to improve trust in medicine and the medical literature. Yet financial conflicts of interest have repeatedly eroded the credibility of both the medical profession and journals.5 6 As the Institute of Medicine explained in its 2009 report, a conflict of interest is “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.” The key issue is that “a conflict of interest exists whether or not a particular individual or institution is actually influenced by the secondary interest.”7 The report drew heavily on a 1993 NEJM article by …

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