Conflict of interest for a given manuscript exists when a participant in the peer review and publication process—author, reviewer, and editor—has ties to activities that could inappropriately influence his or her judgment, regardless of whether judgment is, in fact, affected. Financial relationships with industry (for example, employment, consultancies, stock ownership, honoraria, expert testimony), either directly or through immediate family, are usually considered the most important conflicts of interest. However, conflicts can occur for other reasons, such as personal relationships, academic competition, and intellectual passion.

Public trust in the peer review process and the credibility of published articles depend in part on how well conflict of interest is handled during writing, peer review, and editorial decision making. Bias can often be identified and eliminated by careful attention to the scientific methods and conclusions of the work. Financial relationships and their effects are less easily detected than other conflicts of interest. Participants in peer review and publication should disclose their conflicting interests, and the information should be made available, so others can judge their effects for themselves. Because readers may be less able to detect bias in review articles and editorials than in reports of original research, some journals do not accept reviews and editorials from authors with a conflict of interest.

Authors

When they submit a manuscript, whether an article or letter, authors are responsible for recognizing and disclosing financial and other conflicts of interest that might bias their work. They should acknowledge in the manuscript all financial support for the work and other financial or personal connections to the work.

Reviewers

External peer reviewers should disclose to editors any conflicts of interest that could bias their opinions of the manuscript and they should disqualify themselves from reviewing specific manuscripts if they believe it appropriate. The editors must be made aware of reviewers' conflict of interest to interpret the reviews and judge for themselves whether the reviewer should be disqualified. Reviewers should not use knowledge of the work, before its publication, to further their own interests.

Editors and Staff

Editors who make final decisions about manuscripts should have no personal financial involvement in any of the issues they might judge. Other members of the editorial staff, if they participate in editorial decisions, should provide editors with a current description of their financial interests, as they might relate to editorial judgments, and disqualify themselves from any decisions where they have a conflict of interest. Published articles and letters should include a description of all financial support and any conflict of interest that, in the editors' judgment, readers should know about. Editorial staff should not use for private gain the information gained through working with manuscripts.