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Surgery journal bans authors who hide conflicts of interest

Susan Mayor

The Journal of Thoracic and Cardiovascular Surgery has announced that it will ban authors who deliberately fail to disclose any conflicts of interests from publishing again in the journal for at least a year, in an effort to emphasise how important it considers full disclosure.

The journal’s editor, Andrew Wechsler, who is also chairman of the department of cardiothoracic surgery at Drexel University College of Medicine, Philadelphia, United States, has decided that any authors who are found to have failed to disclose conflicts of interests will be barred from publishing in the journal for one to two years, depending on the seriousness of the failure.

The journal announced the measure after finding that authors of two papers published last year had failed to disclose a potential conflict of interest (Journal of Thoracic and Cardiovascular Surgery 2005; 129:1322 – 1329; 2005; 130: 797 – 802). In one of the cases, it found that Dr Randall Wolf, a surgeon at the University of Cincinnati, had not fully disclosed the financial associations that he had with AtriCure, a company that makes a system to treat atrial fibrillation, which had shown favourable results in a paper he wrote.

Dr Wolf included with the paper that he authored a disclosure to the journal stating that he and two coauthors had received educational grants from AtriCure and that these grants were not used to fund the research, according to Dr Wechsler. In an article in the Wall Street Journal (28 December 2005) a journalist, David Armstrong, reported that Dr Wolf "has lucrative ties to AtriCure."

He reported that an AtriCure filing in August 2005 with the Securities and Exchange Commission, the agency responsible for administering federal securities laws in the US, reported that Dr Wolf owned 18 402 shares of company stock and had warrants or options to purchase 13 913 additional shares of stock.

He also noted that in November 2005, AtriCure reported a four year royalty agreement with Dr Wolf "that will pay him a minimum of $200 000 (£113 174; €165 037) a year up to a total of $2m over the entire length of the agreement." The agreement related to a surgical device that Dr Wolf had developed, known as the Wolf Dissector. Both the AtriCure filing and evidence of the royalty agreement have been seen by the BMJ.

When the journalist alerted Dr Wechsler to the issue, he said that Dr Wolf had not disclosed his stock options or the royalty agreement with AtriCure when he submitted his study to the journal.

To deter authors from failing to disclose conflicts of interest, Dr Wechsler introduced a new form that asks authors specifically about a range of potential conflicts of interest, in addition to introducing the ban on publishing again in the journal. "Depending on the seriousness of the failure to disclose, authors won’t be able to publish again in the journal for one to two years," Dr Wechsler explained. "The journal has the highest impact factor for cardiac surgery journals, so it may be considered a serious deterrent for people working in this field," he said. "This is our way of telling people that we are serious about the issue of conflict of interest."

Dr Wechsler thinks that some authors might not disclose conflicts of interest because they fear that this will reduce their chances of having a paper accepted for publication. However, he said that the journal would never preclude an article because of conflicts of interest: "We need absolute transparency for our readers so they can read papers in the context of any conflicts of interest that an author has declared."

Dr Wolf was asked to comment, but no reply was received by the time the BMJ went to press.

Michael Callaham, professor of emergency medicine at the University of California in San Francisco and vice president of the World Association of Medical Editors (although commenting on this issue as an individual), considered that banning authors who fail to disclose conflicts of interests would not solve the problem. "In my experience, the criteria for banning are completely arbitrary and vary greatly from journal to journal. Secondly, the author can so easily just go to another journal and publish all their material anyway, so it doesn’t prevent publication of anything and is a failure as punishment."

Professor Callaham thinks that it is better to report failure to disclose conflicts of interest as possible scientific misconduct to the author’s supervising institution. "Those institutions usually have a potentially much better investigative capacity, plus they may be aware of other violations (which the journal would know nothing of), so that a relatively minor infraction might in fact be part of a continuing chronic pattern of unethical behaviour." He added, "We are never going to succeed in addressing this problem if we don’t hold universities to high ethical expectations and they don’t get on board with those expectations."

Michael Farthing, the principal of St George’s Hospital Medical School, London, and former chairman of the Committee on Publication Ethics, said, "Banning authors might have an impact on reoffending. I know of several people who have been blackballed by journals, which, when it becomes widely known, is something of which they are not proud." And he thinks that imposing a ban could be particularly effective in small specialties, which have relatively few journals in which specialists could publish.

"The most important thing is to make it absolutely clear to authors what a journal means by conflicts of interest. I have found that many people have no idea what it means," said Professor Farthing. And asking authors who are submitting a paper to complete a form asking about all conflicts of interest is helpful: "I think we will see journals asking for increasingly detailed declarations, including information about amounts of money given by companies to authors for speaking at meetings, acting on advisory boards, or other consultancy work."

Professor Farthing said that the amount of an author’s personal involvement in a product or company was important: "A one off fee for giving a lecture may be very different from having a large, personal, financial involvement in a particular product," he said, although noting that even a small payment might affect what an author says or avoids saying. "Acting as an adviser to a government or other non-commercial body may also provide incentives, such as going on the New Year’s honours list, which may cause conflicts of interest," he added.