To the Editor:—Adriane Fugh-Berman raises some important issues in describing irresponsible publication practices.1 However, unlike her, we believe that voluntary reporting of competing interests is the only practicable solution. We also believe that journal editors have an important duty in obtaining such disclosures.
One underlying problem has been the way in which most journals list authors, without any indication of who did what. The move towards listing each individual's contribution2 increases transparency and should reduce the incidence of ghost and guest authorship.
Two recent guidelines address many of the ethical pitfalls involved in industry-sponsored publications. Good Publication Practice (GPP) for pharmaceutical companies was published in 2003 and has been adopted by several drug companies and communication agencies.3 More recently, the European Medical Writers Association (EMWA) has published guidelines aimed at professional medical writers who prepare publications on behalf of others.4 Both guidelines recommend that an outline should be discussed with the author before a full draft is prepared and that authors should have sufficient time to comment on articles. The EMWA guidelines also recommend explicit acknowledgement of funding sources (e.g., Dr. Jane Doe provided writing assistance on behalf of XYZ Pharmaceuticals), as well as pointing out some of the professional and ethical responsibilities of medical writers. We encourage journal editors to promote both guidelines by providing links from their instructions to contributors and by requiring an explicit statement that publications involving commercial sponsorship have followed GPP and that publications drafted by professional medical writers have followed the EMWA guidelines.
One problem with registers of interests is the difficulty and cost of keeping them up-to-date. As a freelance writer and director of a small consultancy company, we work for dozens of companies and would have to update the register every time we take on a new piece of work. We also doubt whether most readers would bother to check the register, and therefore suggest that they are better served by full disclosure for each publication. As Fugh-Berman has clearly demonstrated, journal editors and conference organizers must be alert for commercial involvement and of nonfinancial author interests affecting any publication, not just those focusing on particular products.
Conflicts of interest are inevitable and readers are not best served by journals that attempt to disenfranchise authors with interests, as these may be the best qualified to write on a topic.5 Similarly, setting limits on acceptable levels of interest produces arbitrary and therefore unhelpful rules. Journal editors must therefore strive to create an environment in which all interests are disclosed so that readers can make up their own minds.