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May 2, 2017

Medical Journals, Publishers, and Conflict of Interest

Author Affiliations
  • 1Senior Vice President and Publisher, Periodical Publications, The JAMA Network
JAMA. 2017;317(17):1759-1760. doi:10.1001/jama.2017.3421

Publishers of scientific journals must be as invested as editors in defining and managing conflict of interest policies and practices, because the credibility and integrity of their publications constitute their most important asset. How and why a publisher engages in this effort are increasingly complex, given the exponential changes in biomedical journalism over the last 15 years. In addition, the world of medical journalism is affected by wider cultural trends in the media; in general, issues around conflict of interest have arguably never been more prominent. The veracity, independence, and objectivity of the media are under siege, with public confidence in the “fourth estate” reaching dangerous lows. At the same time, the public has become increasingly cynical, and public disillusionment centered on conflict of interest is on the rise.

For these reasons, it is more important than ever that editors and publishers of medical journals work intelligently, and together, to redefine their policies about conflict of interest issues and to reaffirm their values focused on public trust for the integrity and independence of the editorial process. Publishers can play a role in 3 critical ways: first, by charting a viable, long-term financial course for their business; second, by cultivating and implementing a deep understanding and respect for editorial culture and values; and third, by ensuring that governance structures separate editorial decisions from publishing decisions, while simultaneously encouraging respectful collaboration.

The most important way a publisher can protect editorial independence is to ensure the long-term viability and integrity of the business model, especially for journals published by not-for-profit entities such as the American Medical Association (AMA).1 Doing this successfully not only requires a strong operating plan to manage expenses in line with anticipated revenues from year to year, but also requires that the publisher work closely with the editorial leadership to ensure a long-term strategy, whereby business plans support editorial vision.

For many years, the AMA publishing program had contributed to a surplus in the AMA’s operations; beginning in the mid-2000s, however, the decline of print as the primary platform for readership and usage of clinical research and related content introduced significant challenges, as print readership and income began a steady and sometimes precipitous decline that has stabilized over the past few years. However, during this decade, publishing has been able to realign revenue and expenses to support a new editorial vision, operationally focused on a forward-thinking digital-first model.2 More importantly, as others have recommended,3 the process to align editorial vision and business strategy must be an ongoing one, not an episodic one engaged only in times of sometimes extreme conflict. By engaging continuously around alignment, journals and their editors and publishers can meet the challenges that can disrupt the foundation of the relationship among editors, publishers, and organizational leadership.

In 2014, the editorial and publishing staff at JAMA began considering the expansion of The JAMA Network and the addition of new titles to the existing group of clinical research journals.4,5 After aligning around an editorial vision to create an enhanced portfolio of journals united as part of The JAMA Network coupled simultaneously with a reinvigorated digital strategy, it was clear that an opportunity existed to expand journal titles. At such a time, it is most critical for publishers to respect and understand editorial values, culture, and independence while still ensuring the viability of the business model. At JAMA, this meant that the first priority in considering expansion had to be the intellectual value of the content that could be published in new disciplines, and not the commercial viability of a new journal. Is the discipline rich in new areas of discovery? Does the future for research and practice in a potential new title hold intellectual promise? Can the journal serve an important role or editorial niche in bringing a new title to market? These were the primary questions that were asked first, and they were answered primarily by the editor in chief, not the publisher. If the genesis for new titles had begun in the publisher’s domain, without full respect for editorial values and independence, relationships between the editorial staff and publishing staff could have become strained and the tension between leaders could have derailed progress, as has happened with many publishers in the past.

Publishers can also adversely affect editorial policy when they allow commercial interests to overrule clearly stated conflict of interest policies or when the lines between business and editorial are blurred, either intentionally or otherwise. Just as important, publishers of journals, especially clinical research journals, need to understand both the research and practice communities they serve and need to understand community standards and ethical business practices unique to these communities. An example of this comes from the news media, when the Los Angeles Times published a special issue of the Times Magazine to commemorate the opening of the Staples Center in 1999. The opening of the Staples Center was an event of cultural and business significance in Los Angeles, worthy of a special edition of the magazine. Publishing leadership, however, crossed a line during the development of this special issue by entering into a profit-sharing agreement with the Staples Center and, further, not informing editorial leadership of this arrangement. In retrospect, the publisher acknowledged that the mistake was the result of a “fundamental misunderstanding of editorial principles in the newspaper industry.”6 If a knowledge gap exists between a medical publisher and the editorial principles and values of medical journalism, creating conflict of interest is inevitable, whether unintentionally or otherwise. Regular communication between publisher and editor is necessary to reduce the likelihood of infringement of editorial independence.

As in many effective professional relationships, the collaboration between editors and publishers is best fostered by mutual respect and goodwill, but a solid governance structure and process are also required to provide definition of roles, guardrails, and a substructure on which to rely when conflicts inevitably arise. A governance structure designed to ensure editorial independence can take many forms, including a committee on publications, journal oversight committee (JOC), governance council, or structure that relies more explicitly on the Committee on Publication Ethics (COPE) standards. At JAMA, an independent JOC ensures the editorial independence of the editor in chief.7 Among other responsibilities, the JOC has sole responsibility for reviewing the performance of the editor in chief. A detailed governance plan defines the structure and representation of the JOC members. In addition, as recommended by the International Committee of Medical Journal Editors (ICMJE), the editor in chief has a contract defining the terms and length of employment. In this structure, while there is collaboration between editor and publisher, there is also a strict separation of editorial and business functions and responsibilities; if the editor were to have authority and responsibility for business matters, readers could not be certain whether business or editorial priorities were taking precedence.

Medical journal publishers succeed only when their journals ensure the content they publish is credible and editorial independence is authentic, and accordingly publishers must care as much about conflict of interest as editors do. A journal can succeed in the long term only if its audience perceives that the journal has not compromised its principles to generate revenue and, just as important, that the journal clearly upholds an authentic commitment to conflict of interest standards.

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Article Information

Corresponding Author: Thomas J. Easley, American Medical Association, 330 N Wabash Ave, Chicago, IL 60611 (

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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