Most editors of top medical journals receive industry payments: report

When examining the roles of conflicts of interest in academic publishing, most research focuses on transparency around the payments authors receive. But what about journal editors? According to a new Peer J preprint, two-thirds of editors at prominent journals received some type of industry payment over the last few years – which, at many journals, editors are never required to disclose. (The findings echo those reported by another recent paper in The BMJ, published six days later.) We spoke with Victoria Wong at The Queens Medical Center in Hawaii, first author of the Peer J preprint.

Retraction Watch: In studies of academic integrity, most people concentrate on the authors who submit to journals, and on the articles published by journals, as a way to assess the integrity of science publications.  What drew your attention to the individual editors and their possible influence on the process?

Victoria Wong: Since reading JG Ray’s 2002 editorial “Judging the judges: the role of journal editors,” I’ve been interested in studying journal editors as a group: their qualifications, their training, and their biases. When you think of the process behind how science gets published and how to keep that process objective and unbiased, there are many safeguards in place. The focus of these various restrictions and reporting requirements, however, is largely on scientist authors and those who peer review their work. But journal editors are the ones who choose which manuscripts are sent out for peer review, who those peer reviewers are, and ultimately decide what gets published and what doesn’t. Because of their large role in shaping science, the biases of journal editors should be under closer scrutiny. Presently, there are only vague recommendations regarding medical editor conflict of interest by the International Committee of Medical Journal Editors, which stand in marked contrast to very specific declaration requirements for authors.

RW: Almost two-thirds of the “top-tier” physician-editors in your sample received industry payments of some form over the course of the study period, August 1, 2013 to December 31, 2016. Within each specialty, editors received more in payments than the average doctor — the opposite of what you predicted. Although there were big ranges in payments, some of the extremes appear to be concerning. For instance, in an average year, 4 out of 10 editors received payments; more than 1 in 7 were given more than $10,000 — to them directly, not their institution. Are these numbers concerning to you?

VW: Yes, these numbers are concerning and suggest we’d like to know more about the editorial activity of physician-editors with significant financial conflicts of interest, such as manuscripts that they accepted and rejected. The higher payments to editors compared to all doctors within the field was initially surprising, since there is a desire to think of academic endeavors like journal editing as unbiased and non-commercial. That said, medical editors are generally leaders and experts in their academic field, so it makes sense that their opinions would be most respected by practicing clinicians and thus, most important to producers of medical products.

RW: Which fields showed higher payments than others?

VW: Cardiology stood out as a field in which a large majority of United States-based cardiologists (both physician-editors and all physicians in the field) received general industry payments, with 44% of cardiology editors in our study receiving over $10,000 in payments in the year 2015. When a majority of top-tier editors in the top five cited cardiology journals are receiving industry payments, there is certainly a concern for the potential of financially driven decision making at the expense of good science, so mandating transparency becomes even more important.

RW: Looking at your Figure 2, it looked like payments dropped in 2016, and larger payments (>$5,000) have been dropping overall year to year.  Do you think that increased calls for transparency might have anything to do with this, or the economy, or is there some other factor?

VW: Though it’s difficult to illustrate a trend with only three years of complete data, it is possible that this is the exact effect the Physician Payments Sunshine Act was supposed to produce. With increased transparency about financial conflicts of interest, it is now easier to shine a spotlight on the biases of physician practices from research to prescribing practices, and of course, scientific publication.

RW: You suggest banning all editors-in-chief from receiving industry funds, but wouldn’t this be an undue burden for burgeoning journals where an editor’s salary might not be sufficient to allow physicians to limit their research or practice?   Isn’t it somewhat advantageous to have editors with direct research involvement/knowledge?

VW: It would be ideal for most editors to have some significant research experience, but not at the expense of losing objectivity and transparency. The more funds that come from industry, the greater the likelihood that editorial decisions are not objective. It is unfortunate that we’re discussing the incomes of the very people who are the gatekeepers of the medical research that drives health care policy and expenditure, yet our current system does not think it important enough to provide them with a dedicated and unbiased source of income to do this job.

RW: You made an important point that the disclosure requirements for authors are (as a rule) far more stringent than those for editors, and some journals do not seem to have any disclosure requirements for editors.  Part of your recommendations are that journals/publishers adopt a conflict of interest/financial disclosure process at least as vigorous as they have for authors. Have you spoken with journals/publishers to see how receptive they are to this idea?

VW: Ultimately, this type of policy change is within the purview and authority of organizations such as the World Association of Medical Editors (WAME), the Committee on Publication Ethics (COPE), the International Committee of Medical Journal Editors (ICMJE), and the Council of Science Editors (CSE). These committees have created sets of scientific publication guidelines with recommendations on topics such as authorship, scientific misconduct, and conflicts of interest. I would like to see additional guidelines related to journal editor oversight come out of our study results.

RW: We noticed a recent paper in The BMJ that also looks at industry payments to physician journal editors. How is this study different from yours?

VW: We read the BMJ article with interest, as their study group collected data from the same Open Payments database we used. Our study included complete 2013 to 2016 Open Payments data for editors of the top five journals from each of seven disciplines, whereas their study examined 2014 Open Payments data for editors of the top two journals from each of 26 medical disciplines. Our nearly four years of data allowed for tracking of trends over time. Additionally our deeper focus on fewer disciplines allowed for side-by-side comparison between physician-editors and all physicians within their field.

The BMJ study group chose their top journals based on impact factor, whereas we chose journals based on total citations, which allows for measurement of a journal’s impact within the full universe of citations by all medical journals.

The Open Payments database includes three types of payments, the third category of which is “Associated Research Funding.” This category is defined as “Payments to a research institution or entity where a physician is named as a principal investigator on the research project.” This category was excluded by the BMJ study, but we felt it was important to include in some of our calculations. Although this money is not being pocketed directly by the physician-editor, it remains beneficial to them indirectly through their institution and thus is a potential source of bias when they are making manuscript decisions.

Ultimately, both our studies picked up on the one physician-editor who received greater than a $10 million industry payment in a single year, and both studies came to a similar conclusion: A strong recommendation for increased transparency in editor conflict of interest.

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