Conflict of interest in medical journals.

Conflict of interest (COI) affects every aspect of medicine, including clinical care, teaching, and research. According to one definition, “A conflict of interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity of research) may be influenced by a secondary interest (such as financial gain). Perceptions of conflict of interest are as important as actual conflicts of interest.”1 Over the past decade, there has been increasing attention to virtually every aspect of COI in medicine, including reports from authoritative national committees,2 federally mandated reporting of industry payments to physicians,3 enhanced policies and procedures governing COI at academicmedical centers and research institutions, and efforts to harmonize reporting of COI overall4 and in scientific publications.5 This theme issue of JAMA is devoted to presenting new information on the evolving nature of COI. The issue includes 23 scholarly Viewpoints that represent the multifaceted aspects and complexity of COI from numerous perspectives, ranging from academic medical centers and industry to patients and the public. Harvey Fineberg, MD, frames the theme issue by emphasizing that understanding, dealing with, and continually improving what is known about COI is critical if physicians are to retain the trust that patients have placed in the profession.6 William Stead, MD, provides an overarching editorial on the various multidisciplinary aspects of COI covered in the Viewpoints and suggests that a systematic approach is needed in which all stakeholders in the health professions and biomedical sciences work together to protect professional judgment and integrity while ensuring medical progress.7 In addition, 2 research reports in this issue of JAMA present findings on COI involving physicians. In one study, Tringale and colleagues8 analyzed data from the Open Payments reports of industry payments to physicians in 2015 and found that 449864 (approximately 48%) US physicians were reported to have received a total of $2.4 billion in industryrelated payments, with a higher likelihood and higher value of payments to physicians in surgical specialties than those in primary care specialties and to male physicians than female physicians. In another study, Larkin and colleagues9 used information from a data set that includedmore than 16million prescriptions and comparedprescribing by2126physicians at 19 academic medical centers that implemented policies between January 2006 and June 2012 that restricting pharmaceutical representative sales visits to physicians (“detailing”) with prescribing by a control group of 24 593matched physicians who were not subject to such policies. Introduction of academic medical centers’ detailing policies was associated with a 1.67-percentage point decrease in the market share of detaileddrugs (representingan8.7%relative reduction inmarket share following the intervention) and a 0.84-percentage point increase in the market share of nondetailed drugs (representing a 5.6% relative increase in market share). COI is a critically important issue for biomedical journals and editors. This editorial reviews journal policies governing COIanddiscusses importantdecisionsand issueseditorsmust address regardingCOI related to research reports andopinion articles, resolvingundisclosedCOIs, and safeguarding against COI in the editorial decision process.