EDITORIAL

CONFLICT OF INTEREST IN SCIENTIFIC PUBLICATIONS:

A HISTORICAL REVIEW AND UPDATE
Claire Johnson, DC, MSEd

ABSTRACT

There is a stigma surrounding the reporting of conflicts of interest (COIs) that should be overcome. This article provides
a discussion about COI, a brief historical review of requirements, and an update of policy for the Journal of
Manipulative and Physiological Therapeutics that includes the alignment of the International Committee of Medical
Journal Editors new COI form requirement. This article reviews types of COI and suggests that professions (eg,
chiropractic, physical therapy, acupuncture) not directly affiliated with pharmaceutical and device companies, though
they may be faced with different circumstances, should still comply with current COI reporting standards. There should
be no disgrace in properly declaring interests; instead, COI declaration should be considered an important part of
publication and recognized as an honorable action. Declaration of COI helps to provide transparency and disclosure to all
involved including editorial staff, peer reviewers, and the readers. (J Manipulative Physiol Ther 2010;33:81-86)

C
onflict of interest (COI) policies continue to evolve
as the relationships between researchers, their
research, funding bodies, journal staff, and publish-
ers become more complex. One may argue that the COI of
those researchers who are involved with pharmaceutical or
device companies are different from those doing research in
manipulative therapies or other conservative care profes-
sions. However, transparency of affiliations and full
disclosure should be offered for all professions no matter
what the research focus.1-4 The purpose of this article is to
review historically the COI policy for the Journal of
Manipulative and Physiological Therapeutics (JMPT), to
discuss COI issues for professions not directly affiliated with
pharmaceutical and device companies (eg, chiropractic,
physical therapy, acupuncture), and to provide an update
on how the JMPT is aligning its policy to current standards
Editor, Journal of Manipulative and Physiological Therapeutics,
Lombard, Ill.
Professor, National University of Health Sciences, Lombard, Ill.
Submit requests for reprints to: Claire Johnson, DC, MSEd,
Editor, JMPT, and Professor, National University of Health
Sciences, 200 E. Roosevelt Rd, Lombard, IL 60148
(e-mail: cjohnson@nuhs.edu).
0161-4754/$36.00
Copyright © 2010 by National University of Health Sciences.
doi:10.1016/j.jmpt.2010.01.004
as set forth by the International Committee of Medical
Journal Editors (ICMJE).5
HISTORY OF COI AND THE JMPT
The JMPT published its first issue under the editorship of
Roy W. Hildebrandt, DC, in 1978 (Fig 1). It should not be
surprising that the first set of instructions for authors did not
include a statement requiring authors to declare COI. The
concept of declaring COI was not standard, no other
biomedical journal included such a policy,1 and COI was
just beginning to be used in codes of ethics for the medical
profession in the 1970s.6 One of the first biomedical journals
to implement a COI policy was the New England Journal of
Medicine in 1984.1,7,8 However, it was not until later, in
1994, that the JMPT included the first mention of COI in the
instructions for authors; an editorial discussed the topic 4
years earlier.9 The updated 1994 policy did not require that
the authors declare COI but that they should be ready to
answer any questions that the editor may have (Table 1).
It was not until 2005 that the JMPT included a policy that
clearly defined COI and required authors to declare their COI
in a cover letter to the editor (Table 1). At that time, affiliations
or declared COI would be printed in the author affiliations
section and not in a separate section dedicated to COI. In 2009,
a separate heading was included in peer-reviewed papers to

81
82 Johnson
COI in Scientific Publications
Fig 1. Cover of the first JMPT volume 1 number 1.
state funding and declared conflicts for authors. This
standardized section was included to help readers know
where to find this information so that they may read the paper
with a full understanding of authors' disclosures.
In 2010, the JMPT implemented the ICMJE's policy on
COI, which provides a structured form in which each authors
must declare their financial and professional interests.
Although the updated ICMJE process may initially seem
cumbersome, it helps to define COI, improve clarity, and
better communicate this information with the editor and
readers. The JMPT Editorial decisions are not based solely
on declared COI. Manuscripts will go to blinded peer review
and be judged on quality and contribution to the literature.
Should a manuscript get accepted for publication, a COI
statement will be published with the final manuscript.
DEFINING AND RECOGNIZING COI
According to the ICMJE, the body that has established the
uniform requirements for manuscripts, “Conflict of interest
exists when an author (or the author's institution), reviewer,
or editor has financial or personal relationships that
Journal of Manipulative and Physiological Therapeutics
February 2010
inappropriately influence (bias) his or her actions (such
relationships are also known as dual commitments, compet-
ing interests, or competing loyalties). These relationships
vary from negligible to great potential for influencing
judgment. Not all relationships represent true conflict of
interest” (http://www.icmje.org/ethical_4conflicts.html).
The World Association of Medical Editors outlines
several types of COI (http://www.wame.org/conflict-of-
interest-in-peer-reviewed-medical-journals). These include
the following.
Financial Ties
A financial tie is included if an author has or will receive
money, equipment, or anything of value (eg, salary, royalties,
patents, gifts, stocks, honoraria, reimbursement for travel or
meeting registration) related to the study or study topic. Money
received directly or indirectly is included in this category. An
author may own a patent, stock options, or receive consultancy
fees related directly to a product or company that was discussed
in an article. Another relationship may be when a researcher's
spouse or family member receives a salary from a company that
makes the product under investigation or may have financial
investments in that company. This information should also be
declared. Information about type of practice is also included
here. The World Association of Medical Editors COI document
states, “Clinicians have a financial competing interest if they are
paid for clinical services related to their research, for example, if
they write, review, or edit an article about the comparative
advantage of a procedure that they themselves provide for
income.” This would suggest that an author who practices or
teaches a particular technique should declare this as a potential
COI.
Academic Commitments
Academic commitments are the beliefs held by the
researcher about science, methods, and ideas. It is possible
that 2 scientists may each use sound research methods but
their beliefs and approaches may be very different. For
example, one may be biased toward qualitative research and
the other toward quantitative research. Because of these
differences, they may have conflicts or bias against each
other's work and therefore judge the other's work more
harshly than it deserves. The opposite may be true in that 2
researchers of similar mindset may judge each other's work
more favorably than it deserves and may miss flaws that
should be mentioned during peer review.
Personal Relationships
Personal relationships include close relationships such as
with family, friends, competitors, and peers as they relate to
the article or research. Personal relationships may be biased
either favorably (eg, friends) or unfavorably (eg, opponents)
and should be declared.
Journal of Manipulative and Physiological Therapeutics Johnson 83
Volume 33, Number 2 COI in Scientific Publications

Table 1. Conflict of interest policies for the JMPT

Year
implemented Policy Importance
1994 “Conflict of interest—in recognition that it may at times be difficult to judge material from authors First mention of COI in the
where proprietary interests are concerned, authors should be ready to answer requests from the instructions for authors
editor regarding potential COIs. The editor makes the final determination concerning the extent of
information released to the public.”

2005 “Conflict of interest exists when an author has financial or personal interests that may influence his First requirement for authors
or her actions in regard to the authors' work, manuscript, or decisions. Conflicts of interest that to declare COI at time of
exist, or that are perceived to exist, for individual authors in connection with the content of this submission of manuscript
paper should be disclosed to the JMPT in the cover letter to the editor and in the authorship form. In
recognition that it may be difficult to judge material from authors where proprietary interests are
concerned, authors should be ready to answer requests from the editor regarding potential COIs. The
editor makes the final determination concerning the extent of information released to the public.”

2009 Funding and COIs section included for each peer-reviewed paper. First standard section in peer-
reviewed manuscripts
declaring COI

2010 Conflict of interest Alignment of journal COI

Authors—Each author is required to complete a COI form (created by the ICMJE) and submit this policy with ICMJE standards
form at the time of initial submission. COI exists when an author has financial or other interests that First requirement of a COI
may possibly influence his or her actions in regard to research efforts, manuscript development, or form
decisions. COI that exist, or that are perceived to exist, for individual authors in connection with the Inclusion of all people
content of the paper shall be disclosed to the JMPT at the time of submission. In addition to the handling manuscripts in COI
form, any concerns or additional COI issues that are not covered in the form should be included in policy, including authors,
the cover letter to the editor. Authors must also disclose to the editor in the cover letter the COIs of peer reviewers, and editorial
any other person or entity involved with the paper (eg, nonauthor, contributor, funding body). In staff
recognition that it may be difficult to judge material from authors where COI are concerned, authors First publication of disclosure
should be ready to answer requests from the editor regarding potential COI. statements for journal
Editorial decisions will not be based solely on declared COI. Manuscripts will go to blinded peer editorial staff
review and be judged on their quality and contribution to the literature. Should a manuscript get
accepted for publication, the COI statement will be published with the final manuscript. The editor
makes the final determination concerning the extent of information included in the published paper.
It is expected that authors are truthful when declaring conflicts on their submission materials. An
editor's role is not to be police officer or detective, so the burden is upon the author to properly
declare COI. If an author did not accurately and completely declare COI upon submission, and this
is discovered after publication, the editor will follow up with an ethics investigation. Fail to disclose
COI may result in rejection or retraction of the paper, prevention of future submissions, and
notification of ethical misconduct to the proper authorities.
Editorial staff and peer reviewers—it is expected that those involved with handling manuscripts for
the journal will properly disclose their financial and professional interests that may be viewed as
potential COIs and recuse themselves from any actions in which their COIs would hamper their
judgment or actions. Peer reviewers should inform the editor if they feel they are not able to properly
peer review a manuscript and recuse themselves from reviewing that manuscript. Editorial staff
should disclose information that readers may perceive might influence decisions in journal editing.
Disclosure statements about potential COIs for the journal staff should be published regularly.
Please refer to ICMJE Web site for more information on COI.

Political or Religious Beliefs that sells, markets, distributes, or benefits from a

These include any strong views or agendas that may
interfere with sound scientific process. For example, an
author who strongly believes in antiabortion or antiimmuni-
zation movements may be biased against research that
support opposing views, regardless of the scientific quality
of the manuscript.
Institutional Affiliations
Institutional affiliations include relationships between
those who are affiliated with a company or institution
particular product. This may include direct relationships,
such as a researcher who is employed by the company
that makes the product. An indirect relationship may be
when a researcher is studying a device made by a
company that is contributing funding to his institution.
Although the funding is not directly going to the author
or the research project, the author may receive pressure
from the administration to show positive findings in order
for the institution to maintain continued funding.
Therefore, this relationship should be declared in the
COI statement.
84 Johnson
COI in Scientific Publications
Having or declaring COI does not imply wrongdoing;
instead, full disclosure assists with honesty and trans-
parency.1 Because someone has an interest in the work
that they are involved in does not mean that they are being
deceitful or unethical. The goal is to declare these potential
conflicts within reason and not hide this information from the
editorial staff or readership. For the JMPT, the goal of
declaring COI is not to prevent anyone from publishing in
the journal or contributing to the scholarly process but
instead to be forthcoming.
ICMJE UNIFORM REQUIREMENTS FOR MANUSCRIPTS
COI FORM
A new ICMJE form was developed and adopted by
major biomedical journals as a standard for reporting COI
(http://www.icmje.org/coi_disclosure.pdf). The ICMJE form
asks the authors to declare both financial and nonfinancial
information.10 The content includes the following:
Section 1—author/manuscript information (eg, name,
manuscript title)
Section 2—information about COI for the manuscript
(eg, funding, in kind support)
Section 3—information about COI not related to
manuscript (eg, other relationships, funding)
Section 4—information related to relatives' and/or
friends' financial interests
Section 5—information about nonfinancial associations
At first glance, this process may seem burdensome and
extensive. However, for those authors who are submitting to
journals on a regular basis because many journals are
requiring this form, filling out the form once and then
updating when there is new information is all that is needed.
Thus, this form will save time in the long run. Overall, the
declaration is simple and depending upon how many entities
the author is involved with, should only take a few minutes
to complete. For many authors who are not involved with
pharmaceutical and device companies, the form is very easy
to complete. Once it is completed, the same form can be used
for future submissions to other journals that require ICMJE
COI declaration. The ICMJE also provides a sample form so
that authors who are new to disclosing conflicts may see an
example of how the form should be completed (http://www.
icmje.org/sample_disclosure.pdf). As the ICMJE updates the
form and procedures, the JMPT will follow these updates.
Using the ICMJE COI form should help reduce confusion
about what authors should declare and provide consistency
between publications.
In addition to authors, it is expected that anyone making
decisions about a manuscript, such as peer reviewers or those
making accept/reject decisions, should be transparent and
disclose information. Peer reviewers and editorial staff
Journal of Manipulative and Physiological Therapeutics
February 2010
should consider potential COIs and disclose these when
processing or handling manuscripts.5,11
Regarding peer reviewers, it is expected that an editor will
select fair and unbiased peer reviewers to review manuscripts
and avoid those who may be biased strongly either for or
against the manuscript due to potential COIs. Reviewers
should be selected based upon their ability to critically
appraise the information and their content area of expertise.
It is also the responsibility of a peer reviewer to declare to the
editor if they are strongly biased or are unable to provide fair
peer review, and they should recuse themselves from the
review.1,5 Although it may be easy to suggest that an editor
avoid selecting a biased peer reviewer or one who may be
familiar with authors' work, it is sometimes impossible when
the field is very narrow and the people involved are limited,
such as in specialty areas or professions that have few
numbers. If the field is small, there may be only a few who
are capable of providing appropriate review. In these cases,
the editor must do his/her best to select fair reviewers to
judge the work.
COI AND HEALTH CARE PROFESSIONS
The medical equipment and pharmaceutical industries
have a strong influence on the medical profession,6 and we
have recently witnessed an increase in the examples of ethical
misconduct.1,12 A researcher involved with a pharmaceu-
tical company may face issues regarding influence of the
industry and large financial incentives. These COIs may be
strong, but these types of financial conflicts seem to be
more clearly recognizable than other types of COI. Profes-
sions that are not directly involved with pharmaceutical
companies or device companies may have a different set of
difficulties with recognizing and declaring COI.
Researchers studying complementary and alternative
medicine or nonpharmaceutically based professions (eg,
chiropractic, physical therapy) or those who are involved in
researching noncommercially driven techniques (eg, techni-
ques that do not require the sale of a product, such as use of
mind body, exercise, manual therapies) may have fewer
financial temptations because of fewer funding opportunities.
However, this does not mean that COI is not present. Conflict
of interest may arise between proponents of one technique or
profession against another. For example, a researcher who is a
manual therapist from one profession may perceive that his/
her method is superior to another profession although
certification and years of training may be the same. The
researcher may bias his/her representation of the one
technique over another or deliberately introduce bias into
the study design. Various types of methodology or
philosophical underpinnings may also create COIs. Research
approaches used by vitalists are different than those used by
mechanists.13,14 Those who believe that the chiropractic
profession should be focused only on treating spinal
Journal of Manipulative and Physiological Therapeutics
Volume 33, Number 2
conditions may be biased against those who believe that the
sole purpose of chiropractic is to find and fix “spinal
subluxations” and remove “nerve interference” or those who
have a broad-based, primary care view of chiropractic. It may
be difficult for scholars from these diametrically opposed
groups to recognize that their philosophies may create bias
and therefore disclose their ideals as COI. The COI issues in
these factions may be more difficult to recognize and
challenging to address than simple financial conflicts.
LIMITATIONS OF DECLARING COI
It is important to state what a COI declaration does not do.
No matter how many policies or good intentions a journal
may have, authors may still neglect to declare their COI. This
may be because they are unaware that a conflict exists or they
may be concerned that declaration may taint their reputation.
An editor's role is not to be a police officer or detective, so the
burden is upon the authors to properly declare COI. It is
expected that authors are truthful when declaring conflicts
when submitting their materials. If authors do not accurately
and completely declare their interests upon submission, and it
is discovered later, the editor will follow up with an ethics
investigation. The results may include rejection or retraction of
the paper and notification of the proper authorities.
Some journals have a policy to reject certain papers in
which authors have declared COI.1,15 This may potentially
cause problems by creating an environment in which authors
may avoid declaring COI. Not all authors who are asked to
declare COI are properly doing so.16 As well, some suggest
that declaring COI does not prevent the interest from
influencing the researcher and the resulting manuscript. It is
suggested that declaring COI may have a negative effect and
make the author feel free to do as they please and not
properly represent the research findings. 17 The COI
declaration also does not prevent research fraud. These are
issues that are not easily solved using COI.
Another question that should be raised about COI is
“How far should we go in declaring interests?” Should one
declare all items of value received from a company (eg, that
give away pen that was picked up from a booth while
attending the last conference) or should one only declare if
the value is over a certain amount (eg, $100, $1000, or $10
000?). When choosing a particular cutoff amount for value to
declare, does $9995 influence someone less than $10 000?
Selecting a cutoff amount becomes a slippery slope. Should
we list the lunch we ate at a scientific conference that was
partially sponsored by a company on the COI form or only
those private lunches at the hospital sponsored by pharma-
ceutical companies? How far back should we declare? Is a
financial or professional relationship from 4 years ago less
influential than one 3 years ago? How far out does one
declare relationship influences? If one's daughter attends
pharmacy college and she has received a scholarship from a
Johnson 85
COI in Scientific Publications
pharmaceutical company, should this be declared? What
about our second cousin twice removed? What happens with
the possible COI that an author may not be able to recognize?
Imagine what would happen if all potential or perceived COI
were required to be published in a manuscript that has 5
authors and each author has a career length of a minimum of
10 years. The information would not only be cumbersome
for readers to sift through, I suggest that it would actually
create lack of transparency. Ultimately, COI is a challenging
issue that we will do our best to address, but there is no
perfect system for declaring all relevant COIs for everyone.
Our next best step is to use the standard ICMJE form and
evolve with the process as more information comes to light.
CONCLUSION
There is a stigma surrounding the reporting of COI that
should be overcome. There is no disgrace in properly
declaring financial or other interests related to one's work.
Instead, COI declaration should be considered an important
part of publication and recognized as an honorable action.
Declaration of COI is not meant to punish or reprimand those
involved but to provide transparency and disclosure to the
readers. The JMPT continues to evolve with standard
publication practices and is now requiring the ICMJE COI
form for each other. We hope that this will help our authors
more easily recognize and declare COI and help our readers
better understand author declarations.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
No funding was received for this article. Disclosure
statement: Claire Johnson, DC, MSEd, is the editor of
the JMPT; a full-time professor at the National University
of Health Sciences; peer review chair for the Association
of Chiropractic Colleges; a board member of NCMIC; and
a member of the American Chiropractic Association,
American Chiropractic Board of Sports Physicians, Inter-
national Chiropractors Association, Association for the
History of Chiropractic, Counsel of Science Editors,
American Public Health Association, Committee on
Publication Ethics, World Association of Medical Editors,
American Medical Writers Association, and American
Educational Research Association.
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