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Effect of revealing authors’ conflicts of interests in peer review: randomized controlled trial

BMJ 2019; 367 doi: (Published 06 November 2019) Cite this as: BMJ 2019;367:l5896

Commercial influence in health: from transparency to independence

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Declaring interests and restoring trust in medicine

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Competing interests in peer review

We read John et al’s paper and the accompanying editorial with interest. [1,2] The trial findings suggest that authors’ financial conflicts of interest (COI) disclosures have no effect on the quality of peer-review. The study was limited to manuscripts submitted to the Annals of Emergency Medicine. We are unclear about the extent to which financial COI may contribute to practice in the discipline of emergency medicine. If this trial had been carried out with manuscripts from a specialty that relies more on the pharmaceutical industry such as oncology or cardiology, would similar results have been reported?

We also note that the authors refer exclusively to financial COI. We would suggest that this is a narrow interpretation as conflicts may arise from several other avenues during the peer-review process. Colleagues working in the same department or institution, and those collaborating on scientific projects might be conflicted in delivering balanced reviews. Similarly, competitors working on cognate research could offer reviews that favour subsequent publication of their own work. Previous employment or aspirations for future employment could also affect reviews. Manuscripts from panel members on funding boards who may, in turn, consider a reviewer’s grant could also introduce conflict. These examples extend beyond finances and demonstrate the rationale for adopting the term ‘competing interests’ rather than COI. Several medical journals including the British Journal of General Practice already use this term to encourage consideration of conflict declarations in a more complete way.

While we highlight additional competing interests as important to this discourse, we also acknowledge that the relative contributions of each conflict type to the overall quality of peer-review remains uncertain. It is also plausible that different conflicts might be more or less important depending on the study design and the discipline. Further research will be required if we are to achieve balanced and honest scientific reviews that can ‘restore trust in medicine’ as the authors claim. [1,2]


1 John LK, Loewenstein G, Marder A, et al. Effect of revealing authors’ conflicts of interests in peer review: randomized controlled trial. BMJ 2019;:l5896. doi:10.1136/bmj.l5896

2 Heneghan C, McCartney M. Declaring interests and restoring trust in medicine. BMJ 2019;:l6236. doi:10.1136/bmj.l6236

Competing interests: No competing interests

11 November 2019
Hajira Dambha-Miller
NIHR Clinical Lecturer in General Practice & Editorial Board member, British Journal of General Practice
Roger Jones, Editor British Journal of General Practice
Department of Population Health and Primary Care, Aldermoor Health Centre, Southampton, OX65ST