Conflict of interest policies and disclosure requirements among European Society of Cardiology National Cardiovascular Journals.
ABSTRACT Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed.
- SourceAvailable from: Izet Masic[Show abstract] [Hide abstract]
ABSTRACT: European Society of Cardiology (ESC) National Society Cardiovascular Journals (NSCJs) are high-quality biomedical journals focused on cardiovascular diseases. The Editors´ Network of the ESC devises editorial initiatives aimed at improving the scientific quality and diffusion of NSCJ. In this article we will discuss on the importance of the Internet, electronic editions and open access strategies on scientific publishing. Finally, we will propose a new editorial initiative based on a novel electronic tool on the ESC web-page that may further help to increase the dissemination of contents and visibility of NSCJs. The National Society Cardiovascular Journals (NSCJs) of the European Society of Cardiology (ESC) are high-quality biomedical journals devoted to publishing original research and educative material on cardiovascular diseases. These journals officially belong to the corresponding ESC National Cardiac Societies. Many of them have achieved major international recognition, are included in most important bibliometric databases, and have made major scientiﬁc impact. Some NSCJs offer full-text English content and are freely available in electronic editions. However, NSCJs are largely heterogeneous and some of them are only published in local languages with a limited visibility. The main goal of biomedical journals is to publish high-quality scientiﬁc information. To achieve this goal, journals should compete for the best research carried out in their ﬁeld, the ‘prestige’ of the journal being the main driver to attract original contributions. In turn, a journal’s prestige is based on credibility, diffusion and scientiﬁc impact. To ensure that the scientiﬁc process is fully respected, journals rely in the ‘peer review’ system. This process not only allows the editors to select the best possible material for publication, but also assures the readers that the quality of the information follows the highest scientiﬁc standards. In fact, the process significantly improves the ﬁnal quality of manuscripts eventually published. Once an article is definitely accepted for publication, the journal should guarantee its expedited publication and widespread diffusion among the scientiﬁc community. The Editors’ Network of the ESC provides a unique platform for devising editorial initiatives aimed to improve the scientiﬁc quality, and facilitate diffusion of the contents of NSCJs. Herein we will discuss the importance of the internet and electronic editions in scientiﬁc publishing. We will also review the growing relevance of open access (OA) strategies. Last but not least, we will propose a new initiative based on a novel electronic tool that may further help to increase the diffusion, dissemination and overall visibility of NSCJs. This tool, located on the ESC website, should foster collaboration among the different NSCJs and also broaden exposure from diverse scientiﬁc sites and ESC ofﬁcial journals. Hopefully, this will help to further expand the scientiﬁc impact of European cardiovascular research. Key words: European Society of Cardiology (ESC), National Society Cardiovascular Journals (NSCJs), scientific contents.Medical Archives 10/2013; 67(5):308-313.
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ABSTRACT: Providing a perfect instruction to authors can prevent most potential publication ethics errors. This study was conducted to determine the quality of ethical considerations in the instructions to the authors of Iranian research scientific journals of medical sciences (accredited by the Commission for Accreditation and Improvement of Iranian Medical Journals) in October 2011. Checklist items (n=15) were extracted from the national manual of ethics in medical research publications, and the validity of the manual of ethics was assessed. All the accredited Iranian journals of medical sciences (n=198) were entered into the study. The instructions to the authors of 160 accredited Iranian journals were available online and were reviewed. The ANOVA and Kendall Correlation coefficient were performed to analyze the results. A total of 76 (47.5%) of the 160 journals were in English and 84 (52.5%) were in Farsi. The most frequently mentioned items related to publication ethics comprised "commitment not to send manuscripts to other journals and re-publish manuscripts" (85%, 83.8%), "aim and scope" of the journal (81.9%), "principles of medical ethics in the use of human samples" (74.4%), and "review process" (74.4%). On the other hand, the items of "principles of advertising" (1.2%), "authorship criteria" (15%), and "integrity in publication of clinical trial results" (30.6%) were the least frequently mentioned ones. Based on the study findings, the quality of publication ethics, as instructed to the authors, can improve the quality of the journals.Iranian Journal of Medical Sciences 03/2013; 38(1):57-61.
- Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 08/2013; · 1.41 Impact Factor
Conflict of interest policies and disclosure requirements
among European Society of Cardiology national
F. Alfonso & A. Timmis & F. J. Pinto & G. Ambrosio &
H. Ector & P. Kulakowski & P. Vardas &
on behalf of the Editors’ Network European Society
of Cardiology Task Force
Published online: 1 June 2012
#Springer Media / Bohn Stafleu van Loghum 2012
Abstract Disclosure of potential conflicts of interest (COI) is
used by biomedical journals to guarantee credibility and trans-
parency of the scientific process. COI disclosure, however, is
not systematically nor consistently dealt with by journals.
Recent joint editorial efforts paved the way towards the imple-
mentation of uniform vehicles for COI disclosure. This paper
provides a comprehensive editorial perspective on classical
COI-related issues. New insights into current COI policies
and practices among European Society of Cardiology national
cardiovascular journals, as derived from a cross-sectional sur-
vey using a standardised questionnaire, are discussed.
This is a joint simultaneous publication initiative involving all
interested National and Affiliated Cardiovascular Journals of the
European Society of Cardiology
Loizos Antoniades1, Mansoor Ahmad2, Eduard Apetrei3, Kaduo Arai4,
Jean-Yves Artigou5, Michael Aschermann6, Michael Bohm7, Leonardo
Bolognese8, Raffaele Bugiardini9, Ariel Cohen10, Istvan Edes11,
Joseph Elias12, Javier Galeano13, Eduardo Guarda14, Habib Haouala15,
Magda Heras16, Christer Höglund17, Kurt Huber18, Ivan Hulin19,
Mario Ivanusa20, Rungroj Krittayaphong21, Chi-Tai Kuo22, Chu-Pak
Lau23, Victor A Lyusov24, Germanas Marinskis25, Manlio F
Marquez26, Izet Masic27, Luiz Felipe Pinho Moreira28, Alexander
Mrochek29, Rafael G Oganov30,31, Dimitar Raev32, Mamanti
Rogava33, Olaf Rødevand34, Vedat Sansoy35, Hiroaki Shimokawa36,
Valentin A Shumakov37, Carlos Daniel Tajer38, Ernst E van der Wall39,
Christodoulos Stefanadis40, Jørgen Videbæk41, Thomas F Lüscher42.
1Editor-in-Chief, Cyprus Heart Journal;2Editor-in-Chief, Pakistan
Heart Journal;3Editor-in-Chief, Romanian Journal of Cardiology;
4Editor-in-Chief, Avances Cardiologicos;5Editor-in-Chief, Archives
des maladies du coeur et des vaisseaux Pratique;6Editor-in-Chief, Cor
et Vasa;7Editor-in-Chief, Clinical Research in Cardiology;8Editor-in-
Chief, Giornale Italiano Di Cardiologia;9Editor-in-Chief, Journal of
Cardiovascular Medicine;10Editor-in-Chief, Archives of
Cardiovascular Diseases;11Editor-in-Chief,Cardiologia Hungarica;
12Editor-in-Chief, Heart News;13Editor-in-Chief, Journal of the
Paraguayan Society of Cardiology;14Editor-in-Chief, Revista Chilena
de Cardiologia;15Editor-in-Chief, Cardiologie Tunisienne;16Editor-in-
Chief, Revista Espaòola de Cardiologia;17Editor-in-Chief, Svensk
Cardiologi;18Editor-in-Chief, Journal für Kardiologie;19Editor-in-
Chief, Cardiology Letters/Kardiologia;20Editor-in-Chief, Kardio List;
21Editor-in-Chief, Thai Heart Journal;22Editor-in-Chief, Acta
Cardiologica Sinica;23Editor-in-Chief, Journal of the Hong Kong
College of Cardiology;24Editor-in-Chief, Russian Cardiology Journal;
25Editor-in-Chief, Seminars in Cardiovascular Medicine;26Editor-in-
Chief, Archivos de Cardiologia de Mexico;27Editor-in-Chief, Medical
Archives;28Editor-in-Chief, Arquivos Brasileiros de Cardiologia;
29Editor-in-Chief, Cardiology in Belarus;30Editor-in-Chief,
Cardiovascular Therapy and Prevention;31Editor-in-Chief, Rational
Pharmacotherapy in Cardiology;32Editor-in-Chief, Bulgarian
Cardiology;33Editor-in-Chief, Cardiology and Internal Medicine XXI;
34Editor-in-Chief, Hjerteforum;35Editor-in-Chief, Archives of the
Turkish Society of Cardiology;36Editor-in-Chief, Circulation Journal;
37Editor-in-Chief, Ukrainian Journal of Cardiology;38Editor-in-Chief,
Revista Argentina de Cardiologia;39Editor-in-Chief, Netherlands
Heart Journal;40Editors-in-Chief, Hellenic Journal of Cardiology;
41Editor-in-Chief, Cardiologisk Forum;42Editor-in-Chief,
F. Alfonso (*)
Clinico San Carlos,
Department of Cardiology, London Chest Hospital,
F. J. Pinto
Department of Cardiology, Lisbon University Medical School,
Neth Heart J (2012) 20:279–287
The scientific process relies on trust and credibility [1–5]. The
scientific community demands high ethical standards in bio-
Duringthe pastdecade,disclosureof conflicts ofinterest(COI)
(also called competing loyalties, competing interests or dual
commitments) has been considered as key to guaranteeing the
credibility of the scientific process [6–10]. Biases in design,
sponsors have vested interests [6–10]. Therefore, COI should
be made clear to the readers to facilitate their own judgement
and interpretation of their relevance and potential implications.
Authors are responsible for fully disclosing potential COI
[6–10]. Failure to do so has shaken the confidence of the
public, health professionals and scientists in the peer-
reviewed medical literature [6–10].
According tothe International Committee of Medical Jour-
institution), reviewer or editor has financial or personal rela-
tionships that inappropriately influence (bias) his or her
actions [1, 11, 12]. The potential for COI exists regardless of
whetherthe individualbelievesthatthe relationships affecthis
or her scientific judgement. Aside from financial relation-
ships,COImay emergefrompersonalrelationships, academic
competition and intellectual passion. To prevent ambiguity,
authors should be explicitly asked to state whether COI exist
or do not exist. Editors should publish this information if they
believe it is important in judging the manuscript [1, 11, 12].
Traditionally, biomedical journals have followed stan-
dard practices to ensure COI disclosure. Further efforts to
improve transparency and protect the integrity of research,
including specific recommendations and guidelines to dis-
close COI, have been recently proposed by many organ-
isations [1–10]. However, ensuring adequate reporting of
all sources of financial support is becoming increasingly
challenging for editors as a result of the growing complex-
ity of funding mechanisms. Furthermore, journals have
different policies about COI disclosure which can cause
confusion as the same author may report different infor-
mation in different journals which, in turn, might jeopar-
dise the confidence of the readers [11, 12]. To overcome
these problems, the ICMJE proposed the use of a common
vehicle to report COI and, in October 2009, launched an
electronic ‘uniform’ format for COI disclosure [11, 12].
The Editors’ Network of the European Society of Cardi-
ology (ESC) is committed to promoting the dissemination
and implementation of high-quality editorial standards
among ESC National Societies Cardiovascular Journals
(NSCJ) [13–16]. This report examines the issue of COI from
a global and didactic perspective and provides new insights
into current policies and practices among ESC NSCJ.
Conflict of interest questionnaire and survey
To determine the status of COI and disclosure requirements
among ESC NSCJ a web-based, comprehensive, structured
and standardised questionnaire was specifically devised.
The questionnaire was exhaustive and dealt with all relevant
editorial topics related to COI. Previous publications on COI
(from year 2005 to 2010) were retrieved from PubMed
(Medline search terms: ‘conflict of interest’, ‘competing
interest’ and ‘disclosure’) and carefully reviewed to identify
issues relevant to COI. Items included in the questionnaire
were eventually determined after an internal discussion
among the nucleus members of the Editors’ Network. For
the sake of simplicity some related items and confusing or
redundant topics were subsequently removed from the final
questionnaire. Eventually, a total of 48 different items were
included in the survey. Questions were grouped into three
main areas of interest: (1) authors; (2) reviewers; (3) editors.
Furthermore, additional feedback about the interest generat-
ed by the ICMJE ‘uniform’ COI disclosure initiative was
also explicitly requested. Spaces for free text comments
were made available for each main area of interest.
In June 2010 the web-based survey was sent from the
ESC European Heart House to all editors-in-chief of the
ESC NSCJ and, in a second wave (July 2010), to the ESC
Affiliated Cardiac Societies. A specific claim was made for
the editor-in-chief in person to complete the survey. The
invitation suggested that a meeting between the editor-in-
chief, associated editors and corresponding journal staff
should be organised, to discuss the results of the requested
information, before returning the questionnaire. A URL link
to the web-based survey was provided in the invitation letter
to allow editors to enter the survey. When no answer was
obtained the corresponding National Cardiac Society was
contacted directly. Conventional mailing was also used as
required. Up to five separate requests were sent over the
University of Perugia School of Medicine,
3000, Leuven, Belgium
Cardiology Department, Heraklion University Hospital,
280Neth Heart J (2012) 20:279–287
year and thereafter missing journals were classified as non-
The final electronic records were carefully analysed by
ESC personnel at the European Heart House and by the
nucleus members of the ESC Editors´ Network. Attention
was paid to detecting missing data, major inconsistencies or
errors. Additional clarifications were requested from the
corresponding editors as needed. Data are presented as
global results and anonymised for individual journals.
Conflict of interest survey results
A total of 46 journals answered the survey. Of these, 35
belong to the ESC NSCJ and 11 to journals of Affiliated
Cardiac Societies. This represents a response of 83 % (35/
42) of known NSCJ and 58 % (11/19) for Affiliated Cardiac
Societies. ESC NSCJ are highly heterogeneous in
objectives, format and in scientific content . According-
ly, some editors declined to answer the survey because they
felt that COI policies did not apply to their journals (lack of
original articles, small bulletins, contents with just social
news, etc.) (data not shown).
Table 1 summarises the main data regarding authors’ COI.
Nearly half of the journals had a specific policy on author COI.
In most cases, emphasis was only on financial COI and on COI
directly related to the submitted work. Few journals provided
definitions or examples of COI. In nearly all cases where COI
were requested this policy affected all kinds of submitted
However, procedures to verify the accuracy of authors’ COI
disclosure were rarely implemented, although, under special
circumstances,most editors eventually contact authors to clarify
COI-related issues. Policies to deal with authors who fail to
disclose COI were seldom in place. In most journals the editors
decided when authors’ COI should be published but, in some
Table 1 Journals policies on authors’ conflicts of interest
1) The journal has a specific policy on authors’ COI: 20/45 (44 %)
a. Described in the instruction for authors: 19/20 (95 %)
b. Described in dedicated forms required for manuscript submission: 12/19 (63 %)
2) The journal provides definition of different types of COI: 6/45 (13 %)
3) The journal provides examples of different COI: 5/45 (11 %)
4) COI are detailed by items and specified according to journal’s definition: 9/45 (20 %)
a. Financial COI are specifically considered: 8/9 (89 %)
b. Non-financial COI are specifically considered: 2/9 (22 %)
5) Editors recommend an “inclusive” policy where all potential COI (even those minor and vaguely related) 1) should be disclosed: 13/44 (30 %)
6) Editors favour a “restrictive” policy where only potential COI that are relevant and directly related to the submitted work, should be disclosed:
19/42 (45 %)
7) Resources from third parties received via the authors’ institution are considered: 8/42 (19 %)
8) Financial relationships involving family members are specified: 4/44 (9 %)
9) COI are just disclosed as free text directly by the authors: 29/40 (73 %)
10) Authors must submit a written attestation of potential COI: 18/44 (41 %)
a. Signature is required only from the corresponding/responsible author:10/18 (55 %)
b. Every author should sign the form: 6/18 (33 %)
11) Authors’ COI disclosures apply to “all” submitted articles: 23/44 (52 %)
12) Specific procedures are followed to verify that authors’ COI disclosures are accurate: 6/44 (14 %)
13) Under specific circumstances efforts are made to contact authors owing to concerns about disclosed or undisclosed COI (eg, complaint by
reviewers/readers): 27/41 (66 %)
14) Specific policies to deal with authors who fail to disclose COI of published papers: 11/45 (24 %)
15) Specific policies to “restrict” author publication of articles with a stated COI: 10/44 (23 %)
16) The journal “publishes” all the authors’ COI disclosures in all submissions: 13/40 (33 %)
17) The editors decide, on an individual basis, when authors’ COI should be “published”: 23/43 (53 %)
18) If authors’ COI are not published, the information is made available upon request: 21/46 (46 %)
Data from the 46 journals answering the questionnaire (number of journals answering each question is presented). Not all journals responded to all
questions. COI conflicts of interest
Neth Heart J (2012) 20:279–287281
journals, this information was systematically published
Table 2 discloses data related to reviewers’ COI. Only
one-quarter of the journals had policies for reviewers’
COI. In more than half of the journals reviewers were
asked to decline the invitation to review if potential
COI existed. However, recusal of reviewers due to po-
tential COI was rare.
Table 3 displays the status of editors’ COI among the
corresponding journals. In most cases, policies in this regard
were not implemented. Furthermore, very few journals had
policies for delegating decisions to other editors or to invited
guest editors. Only one-third of the editors were familiar with
the new ‘Uniform Disclosure Form’ ICMJE initiative when
they received the survey invitation. However, 90 % of the
editors considered the ICMJE COI proposal of potential value
totheir particularjournalsand mostofthem declaredthatthey
werewilling to implement it withina relativelyshort periodof
time (Table 4).
Industry-sponsored studies: friend or foe?
Research is becoming progressively complex and quality
standards increasingly demanding [17–24]. As a result, con-
ducting clinical studies is becoming more expensive and the
role of sponsors to ensure the viability of research projects is
becoming critical. However, funding from different sources
may directly affect investigators and COI may inappropri-
ately influence their actions or judgement [17–24]. Subtle
biases in design and interpretation may arise when a sponsor
stands to gain from the report .
Pharmaceutical and technological companies are respon-
sible for most important advancements in medical knowl-
edge [17–24]. Patients, doctors and society as a whole
benefit from this unique effort and should be grateful for
the research commitment by the industry. More than 75 % of
all clinical trials are funded by drug companies [25, 26].
Likewise, the bulk of research has moved from academic
centres to direct contracts between sponsors and private
organisations [27, 28]. For-profit, contract research organ-
isations currently consume more than 60 % of research
funding from industry [25–28]. This could be a result of
their ability to complete trials more rapidly than academic
institutions [8, 25]. This phenomenon explains the gradual
loss of the academic establishment’s influence on the
‘research agenda’ [25–29]. Although the most cited articles
continue to be generated by authors with academic affilia-
tions, the number of trials financed exclusively by industry
has increased exponentially .
This paradigm shift has major consequences [25–29]. First,
many scientifically relevant issues are decreasingly likely to be
investigated (orphan studies). Second, many studies [8, 31, 32]
suggest that, in comparison with non-sponsored research,
Table 2 Journals policies on peer-reviewers’ conflicts of interest
1) The journal has a specific policy on reviewers’ COI: 11/43 (25 %)
2) Reviewers are required to explicitly state whether they have potential COI: 10/43 (23 %)
3) Reviewers must submit a written attestation of potential COI: 7/43 (16 %)
4) Frequency of request to disclose potential COI: only first invitation: 7/46 (15 %); always: 10/46 (22 %); yearly: 5/46 (11 %)
5) Specific procedures are followed to verify that peer-reviewers’ COI disclosures are accurate: 5/44 (11 %)
6) It is suggested to reviewers that they “decline” the invitation if potential COI exists: 21/39 (54 %)
7) There is a policy for “recusal” of reviewers with a declared COI: 6/42 (14 %)
8) Peer-reviewers’ COI are always published: 1/44 (2 %)
9) Editors decide, on an individual basis, when reviewers’ COI should be published: 20/44 (45 %)
10) If reviewers’ COI are not published, the information is made available upon request: 15/46 (33 %)
COI conflicts of interest
Table 3 Journals policies on
editors’ conflicts of interest
COI conflicts of interest
1) The journal has a specific policy on editors’ COI: 8/45 (18 %)
2) Editors must submit a written attestation on potential COI: 6/8
3) Frequency to disclose potential COI: only when appointed: 5/6; yearly: 1/6
4) Specific procedures are followed to verify that editors’ COI disclosures are accurate: 3/8
5) There is a policy for “recusal” of editors with a declared COI: 3/8
6) There is a policy for “delegating” handling decision to other (invited) editors: 4/7
7) Editors’ COI are always published: 2/7
8) If Editors’ COI are not published, the information is made available upon request: 5/6
282Neth Heart J (2012) 20:279–287
sponsored trials are published less frequently, raising the con-
cern of publication bias . Although the industry has been
blamed for preferential publication of studies with positive
outcomes, this problem also affects government-funded re-
search [8, 31–35]. Toreducetheeffectofpublicationbias,trials
must be registered in publicly accessible repositories .
ple reporting of studies with positive outcomes [8, 36]. This
practice might affect results of subsequent reviews, meta-
analyses and even clinical practice guidelines. Alternatively, in-
Finally, industry-sponsored trials have a three- to four-fold
differences do not appear to be related to inferior methodology
in industry-financed trials. Bekelman et al.  performed a
systematic review of 1140 original studies demonstrating a
and pro-industry conclusions. The study showed that financial
relationships between industry, scientific investigators and aca-
demic institutions were widespread and that COI arising from
these ties might significantly influence biomedical research. It
was considered possible, however, that given limited resources,
industry became selective enough to fundonlypotentially ‘win-
ing treatments’ . More recently, in a provocative study that
journals with the highest impact factors, Ridker and Torres 
analysed the probability of positive results according to the
source of finance. Industry-financed trials more frequently
by not-for-profit organisations. This was particularly evident in
trials using surrogate endpoints .
Previous editorial surveys on conflicts of interests
In 1997, Krimsky and Rothenberg found that only 16 % of
addition, existing editorial policies were often not readily avail-
able to submitting authors . However, a substantial increase
most journals only required authors to disclose potential COI.
Subsequently, journals encouraged authors to sign COI disclo-
sure statements. If signed statements are not obtained from all
authors, it remains possible that only the first author has
reviewed the COI policy of the journal, leading to systematic
under-reporting .Interestingly,somejournalsthat theoretical-
ly adhere to ICMJE recommendations do not have clear COI
highest impact factors are more likely to have published COI
policies [6, 41].
To better characterise COI policies,in 2006,Cooper et al. 
performed a cross-sectional web-based survey of a convenience
survey included questions about the existence of specific poli-
cies for authors, peer reviewers and editors, specific restrictions
based on COI and the public availability of these disclosures.
Ninety-three per cent of journals reported having an author COI
policy but only 82 % of these required a written attestation.
While 77 % reported collecting COI information on all author
per cent of journals reported restricting author submissions
based on COI. A minority of journals reported having a policy
on reviewers’ COI (46 %) or editors’ COI (40%); amongthese,
25 % and 31 % of journals stated that they require recusal of
peer-reviewers and editors if they report a COI. Only 3 % of
respondents published COI disclosures of peer reviewers and
Table 4 Feedback on the
ICJME “uniform disclosure
COI conflicts of interest; ICMJE
international committee medical
1) Editor was familiar with the ICMJE initiative “before” receiving the survey: 15/42 (36 %)
2) The initiative was considered of value to the “particular” journal: 38/42 (90 %)
3) Editors willing to implement the initiative within 3 years: 31/46 (67 %)
4) Main perceived advantages of the initiative (top 5):
a. Provides a common “uniform” platform for all journals: 42
b. All relevant information about COI is nicely presented and explained: 18
c. Allows easy update of the requested information: 12
d. Facilitates sequential submissions (if the paper is rejected by a journal): 11
e. Allows archiving of the requested information: 10
5) Main perceived disadvantages of the initiative (top 6):
a. Increases the complexity of the submission process: 29
b. Publishing in the journal all potential COI of every author is not feasible: 17
c. Verification of the disclosed/undisclosed COI remains impossible: 17
d. Increases editorial bureaucracy: 15
e. Too detailed and exhaustive: 14
f. The meaning of some potential COI (travel grants to meetings, etc.) might be perceived differently by
American and European authors/journals/readers: 14
Neth Heart J (2012) 20:279–287283
12 % published editors’ COI disclosures, while 11 % and 24 %,
respectively, reported that this information was available upon
request. In this survey, estimates were directly provided by the
corresponding editors but no information was taken directly
from the actual publications .
available directly from the journals yielding a different perspec-
tive. Interestingly, some of these studies focused on COI dis-
closures in cardiology. Weinfurt et al.  searched in PubMed
for English-language articles published in 2006 that provided
evidence orguidance about the use of coronary arterystents. As
a premise, it was considered reasonable to expect that authors’
COI were disclosedin similar ways inarticles onthe same topic
published around the same time. A total of 746 articles with
2985 authors published in 135 journals, were analysed. Articles
were examined to determine whether authors’ financial interests
were consistently reported. Eighty-three per cent of the articles
did not contain disclosure statements for any author, 72 % did
not identify any funding source and only 6 % of authors had an
article with a disclosure statement. Additionally, author disclo-
sure statements varied significantly from article to article. Nota-
bly, articles published in journals that endorsed the ICMJE
guidelines were more likely to have disclosure statements for
statements were more likely to appear in journals with higher
impact factors (median impact factor 11.6 vs 3.1). These inves-
tigators concluded that even rarely disclosed financial interests
were not disclosed consistently, suggesting that there are prob-
lems with transparency in the cardiac literature with potential
implications for patient care. Data suggested that the observed
inconsistencies were a result of both journals’ policies and
authors’ behaviour . Many would argue that an inconsistent
system of disclosure is more harmful than no disclosure at all.
tions to authors and manuscript submission documents were
ardised form. A total of 262 journals were analysed. Of these,
policies on COI were found within the instruction for authors in
only 25 % of journals. Although 77 % of journals provided
definitions on COI, signed disclosure statements were required
12 % of journals. Interestingly, journal category influenced COI
disclosure requirements. This request was higher for internal
medicine journals than for specialty journals, for journals in the
Our data on ESC NSCJ COI policies and disclosure
requirements suggest that this topic remains controversial
and is not uniformly addressed by journals. We relied on
self-reporting by journal editors. However, given the
anonymous nature of our survey, we do not believe there
is any reason to question the accuracy of their reports.
ICMJE uniform disclosure initiative
In October 2009 the ICMJE proposed an electronic ‘uniform’
authors’ associations with entities that supported the submitted
manuscript (indefinite time frame), associations with commer-
cial entities with potential interest in the general area of the
spouse and children and, finally, non-financial associations po-
tentially relevant to the submitted manuscript. Each author
should disclose resources received directly, or via the
corresponding institution, which were used to complete the
investigation. Additionally, all sources of revenues relevant to
the submitted work paid by any third party before the submis-
sion and any relevant long-term relationship, even if ended,
should be disclosed. Financial revenues should be disclosed
regardless of the amount. A guide for authors and a completed
sample was provided in PDF format. The reporting form was
made available at www.icmje.org/coi_disclosure.pdf to be
downloaded, completed and sent to the journal . The form
a new manuscript. Each author should submit a separate form
and is responsible for the accuracy and completeness of the
submitted information .
The ICMJE allowed a period of beta-testing until April 2010
when submission of suggestions was encouraged . As a
result of the feedback comments, the form was modified. Con-
cerns raised were mainly technical and ethical regarding inqui-
ries about non-financial associations. Accordingly, clarity was
enhanced for non-native English speakers (including a glossary
of terms). Additionally, owing to the difficulties detected in
defining non-financial COI, this section was also modified to
be less intrusive (currently presented as an open query) while
keeping its locus. Finally, queries about COI in familymembers
were removed from the updated form .
The idea behind this initiative was to facilitate and standard-
authors and less confusing to readers. This uniform ‘universal’
vehicle allows authors to save the electronic forms that can be
updated as needed and eliminates the need for reformatting
disclosure information for each new submission. Finally, this
will eliminate apparent inconsistencies in the report of COI as a
result of different journal policies [11, 12].
Additional editorial perspectives regarding conflicts
Concerns about COI are not new. In his play Le Malade
Imaginaire Molière satirised the relationship between the
doctor and the druggist as they exploited the hypochondriac
284Neth Heart J (2012) 20:279–287
Argan for their own economic benefit . Biomedical
journals are particularly vulnerable to COI-related problems.
As Richard Smith, the former editor-in-chief of the British
Medical Journal, stated ‘the quality of the journal will bless
the quality of the drug’ . Therefore, it is easy to under-
stand the extra scrutiny of industry-sponsored research by
reviewers and editors . Some editors require that authors
of industry-associated research have their data analysis con-
firmed by a different source and others even ask for the raw
data to be analysed by an independent academic statistician
[20, 33]. Some editors do not commission editorial or
review articles from authors with potential COI as these
may blur objectivity [19, 44, 45]. These pieces rely espe-
cially on interpretation and objectivity. However, assessing
the importance of COI in opinion articles may be challeng-
ing. The dilemma is obvious: those authors with the greatest
expertise are usually those with clearer potential COI .
Last, but not least, editors should also avoid the existence of
marketing masquerading as education in their journals. Of
note, industry support accounts for most of the funding of
accredited continuing medical education (CME) pro-
grammes . Some suggest that CME has become an
insidious vehicle for the aggressive promotion of drugs
and medical devices (even with off-label indications).
Others consider CME a marketing machine and a lucrative
process—with concealed payments to doctors—that under-
mines the independence of medical societies [19, 46].
Sometimes medical literature is produced in obscure
ways. Professional writers, hired by the industry, may act
as ‘ghostwriters’ to produce papers for which credibility will
be subsequently increased by inviting academic physicians
to act as a ‘guest author’ . Unfortunately, these guest
authors rarely make significant contributions to the design,
analysis and data interpretation . Conversely, many
deserving industry scientists may be removed from the
byline directly by the sponsors. Affiliation with a drug
company should not be viewed as evidence of wrongdoing
because, as previously emphasised, most important medical
discoveries are generated by the pharmaceutical industry.
Journals typically use two main weapons to deal with
COI: disclosure and exclusion . However, as discussed,
policies for COI vary widely among editors. Disclosure
should not be considered as a panacea to deal with COI
but, from an editorial perspective, casting daylight on the
relationship between doctors and pharmaceutical companies
represents the best way to untie this Gordian knot .
Editors should decide whether to publish the information
disclosed by authors about potential COI. Editors have the
‘discretion’ to decide if the potential COI is important
enough to be revealed . However, it is unclear how
editors decide whether to publish disclosures. Moreover,
the extent to which such ‘secret disclosure’ may affect the
integrity of the journal or the published work remains
unknown . Some journals systematically disclose all
reported potential COI . However, this strategy consumes
major editorial resources and has been blamed for introduc-
ing prejudice in the judgement of manuscripts by readers
and for tainting the full content of the article. The value of
an exhaustive systematic disclosure of all potential COI
remains highly controversial. This practice does not guaran-
tee that the readers will be able to determine whether COI
are meaningful or not. Indeed, this practice may be
misleading because bias may be perceived when not
present and overlooked when relevant. Although COI
do not imply any improper behaviour, a McCarthyesque
reaction to the term would wrongly support the pre-
sumption of guilty until proven innocent [23, 33, 47].
The pendulum is swinging towards increased oversight,
but responsible editors should ensure that their readers
enjoy the sweet spot in the middle, at least for the time
Editors are very busy and cannot conduct a forensic
check on every submitted trial. Our survey is consistent with
prior reports  suggesting that almost no journal has a
formal policy of ‘verification’ of COI disclosures . Edi-
tors are not policemen but, at the same time, it becomes
clear that some action is expected when misconduct is
detected. Many times editors behave as a ‘toothless watch-
dog’ regarding COI. Alternatively, other editors suggest that
allegation of under-reported COI should be rigorously
investigated . However, editors do not have the resources
required to conduct a full investigation to clarify elusive and
multifaceted COI-related issues. In most cases their final
role is just to raise the issue with the corresponding dean.
Notably, formal ‘corrections’ about COI are rarely
All authors of this review support the importance of
disclosing potential COI when a scientific paper is submit-
ted for consideration to any ESC NSCJ. Moreover, when in
doubt it is better to err on the side of over-disclosure and let
the editors make the decision. The ICMJE Uniform Disclo-
sure Initiative represents a milestone in this regard and
paves the way for further transparency in biomedical pub-
lishing [11, 12]. Therefore, we encourage ESC NSCJ to
progressively adapt their policies in order to be able to
adhere to this editorial proposal. However, in this journey,
some potential caveats should be carefully heeded. First,
exhaustive disclosure of multiple, minor and vaguely related
potential COI might ‘dilute’ the relevance of real major COI
that most readers would be interested to know. Second,
some relevant institutional COI are not openly disclosed to
all corresponding researchers and, accordingly, these may be
impossible to declare. Third, many major journals frequent-
ly allow senior international opinion leaders with clear (de-
finitive and well-known) COI to systematically declare the
absence of COI in their papers. Young scientists may
Neth Heart J (2012) 20:279–287 285
perceive this as confusing and disturbing while others will
regard this inconsistency as evidence that the whole process
is completely hypocritical. Finally, major sociocultural dif-
ferences among countries should be also taken into account.
Most European doctors (including most editors in the byline
of this article) frequently receive occasional travel grants
from diverse pharmaceutical companies to attend medical
society meetings and, up to now, these have not been sys-
tematically disclosed as potential COI. The situation, how-
ever, is quite different on the other side of the Atlantic where
such practices have been considered inadequate or even
misconduct for a number of years. In North America, direct
support (including travel) of CME programmes by industry
is prohibited while this practice is considered acceptable in
most European countries . NSCJ editors should be
alerted to the need to deal with these vexing problems in
their respective journals in line with local policies and
practices . Progressive steps should be taken to
ensure a systematic approach to these COI-related edi-
torial issues. However, commonsense and reason should
prevail in order to achieve a balance between the prag-
matic and utopian.
Consumers of medical scholarship expect a reliable system of
disclosure, in which journals and authors make disclosures
appropriately and consistently. There is a stigma surrounding
the reporting of COI that should be progressively overcome.
The ESC has recently defined a general policy for COI .
This review provides another framework to better understand
COI from an editorial perspective. This survey on ESC NSCJ
COI policies and disclosure requirements confirms that this
topic is poorly—and not uniformly—dealt with by journals.
Further actions are required to increase awareness of the
importance of COI disclosure and to promote policies aimed
at enhancing transparency in biomedical research.
Iris Chapuis, Lone Kristoffersen, Isabelle Collin and Muriel Mioulet
from the ESC National Cardiac Societies Relations Department at the
We are grateful for the support and assistance of
potential conflict of interest that needs to be disclosed in relation to
None of the editors authors of this paper had any
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