Publishing Commentary by Authors with Potential Conflicts of Interest: When, Why, and How

While some journals do not publish opinion pieces written by authors with declared potential conflicts of interest, Annals sometimes does. In this editorial, we discuss a recent instance that helped us to crystallize our thinking about this prickly topic.

The story began when we received an unsolicited critique of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized study of hypertension therapy (1). The author disclosed financial relationships with several pharmaceutical firms that make drugs for hypertension. We thought that the piece raised important, controversial issues about an influential study. Positive and thoughtful comments from external reviewers and a lively, serious discussion among the associate editors and senior editors convinced us that many readers would be likely to find it interesting. We invited the author to revise the commentary on the basis of the reviewers' and editors' suggestions, and then published the revision as a Perspective along with the author's conflict of interest disclosure (2).

After the Perspective appeared in print, several readers wrote to express disappointment and surprise that we had published an opinion piece from someone with industry ties (3). Shortly thereafter, the ALLHAT investigators asked us to consider a detailed response to the commentary. With our encouragement, they submitted a manuscript that addressed many criticisms and misperceptions about ALLHAT, including those raised by the commentary that started this story. That article appears in this issue (4), along with a Letter from a reader who asked us to describe our policy about conflict of interest (3).

We think that the initial Perspective and the ALLHAT papers provide an open, reasoned, and critical exchange of views about a study that …