Journals Joust Over Financial Ties

Pulling no punches, three top medical journals have squared off over whether and how to disclose conflicts of interest that may color research findings. The dispute pits Boston's venerable New England Journal of Medicine (NEJM)--which upholds a tough policy that requires full disclosure of authors' financial interests and bans editorials by anyone with a financial stake in the topic being discussed--against The Lancet of London and Epidemiology of Newton, Massachusetts, both of which argue that it is wrong to screen authors based on financial interest.

The debate, which has been going on quietly for years, burst into view this week with the publication of a letter to The Lancet (19 April) signed by Marcia Angell, NEJM's executive editor. Angell writes that "The Lancet was sleeping on the job when it neglected to inform readers" of what she regards as a "conflict of interest" involving authors of an article in the 15 February Lancet. She lights into the article itself, which described the use of markers for autoimmune disease to monitor women who have had breast implants, claiming it suffered numerous technical flaws. Angell goes on to note that the authors, Scott Tenenbaum of Duke University and a colleague at Tulane University, share in royalties earned by Tulane every time the test they devised is used.

The authors respond by dismissing Angell's attack, noting that they gave The Lancet's editor, Richard Horton, a detailed financial disclosure statement long before their article was published. The Lancet did not publish the disclosure initially, but added it to Tenenbaum's response this week. Similar disclosures follow each of six other comments on the Tenenbaum study, including Angell's. She is identified as the author of a book, Science on Trial. It is a razor-sharp attack on those (like Tenenbaum) who support the notion that breast implants may have caused systemic autoimmune disease.

Horton also takes up the pen in the same issue to defend The Lancet's policy. He denounces what he calls the move toward "censorship" in denying authors editorial space because of potential conflicts of interest, arguing instead for voluntary disclosure of conflicts. For support, he points favorably to a discussion in the May issue of Epidemiology, in which a former drug-company consultant describes how she was subjected to "an emotionally distressing ordeal" in the media after editors at NEJM identified her and another author as having violated NEJM's conflict rules last year. The result, writes Kenneth Rothman, Epidemiology's editor, was that the author was "pilloried" in a kind of "editorial police action" by NEJM.

Neither Angell nor NEJM Editor in Chief Jerome Kassirer was available to comment. But in written statements, they have endorsed an uncompromising policy: "Because editorials involve interpretation and opinion," they wrote last October, "we require that authors be free of financial associations ... with a company that stands to gain from the use of a product (or its competitor) discussed in the editorial."