The last presenter at the session “Disclosures of Potential Conflicts of Interest: Authors and Beyond,” Heather Pierce, was speaking of the secure online disclosure system Convey (created by the Association of American Medical Colleges) when she said, “If I seem biased in thinking this could change the small world we live in, you’re right.” Pierce and fellow speakers Gary Curhan and Christine Laine addressed the importance of disclosing conflicts of interest, and each had suggestions for resources that authors and journals can use to collect and share this information.
Laine opened the session with a review of conflicts of interest. She noted that references to the phrase were uncommon before 1992, when articles on the topic “exploded.” Subsequent research showed evidence that authors’ employers could influence their results, and journal editors began requesting information about authors’ financial dealings as well as nonfinancial relationships such as friendships and academic competitions.
“Our concern is the overall risk for bias, rather than a specific case,” Laine clarified. “The existence of a conflict does not imply an individual relationship is improper, just that the possibility exists that it could become problematic.” The speakers emphasized the use of the word “disclosure” rather than “conflict,” as a journal’s goal should be to identify any potential association before it becomes a conflict. As Laine summarized, “the lack of disclosure can cause a variety of problems.”
The International Committee of Medical Journals Editors (ICMJE) has spent several years developing conflict-of-interest policies. In 2009, they created a standard form for disclosures, which has since been revised and is currently in use at hundreds of journals. The process of disclosing potential conflicts can be frustrating for authors, and Laine suggested that use of the ICMJE’s form could save time for all parties. The ICMJE form can also be used by medical professionals to compare their personal records with those listed in the federal Open Payments system.
At the Clinical Journal of the American Society of Nephrology (CJASN), Gary Curhan and his colleagues use the ICMJE form to collect a list of disclosures before appointing editors. The journal then updates the form annually for each editor. Editorial Board member disclosures are also collected and updated annually. Scanned copies of the editors’ forms and the Editorial Board member disclosures are then posted on the CJASN website. Curhan noted that this process can be time consuming and that the ICMJE form is not expressly designed for this purpose. However, he added, “authors are routinely asked for disclosures at the time of manuscript submission, while editors and reviewers are the ones who decide what gets published.” Curhan concluded that disclosure information should be collected from decision makers and shared, but there is a need to find better methods for collecting and validating this information.
In 2013, an Institute of Medicine– convened working group approached the Association of American Medical Colleges about creating a more effective system for reporting disclosures. “One individual discloses probably 160 times a year, on a different form each time,” said Heather Pierce, “usually ten minutes before the form is due and with information remembered off the top of his head.” Under these circumstances, forms could be completed inconsistently, creating negative consequences for the author and the journal. Pierce explained that Convey is intended to be a secure, centralized data repository that simplifies the process.
Authors will be able to create profiles in Convey to collect information about their financial interests. They can then use that information to create tailored disclosures that capture the information required by a journal or other organization, such as in the ICMJE form. Individuals will always have control over what information is sent to a journal or organization, Pierce said, “and no matter who they are disclosing to, they will go through a process that looks familiar each time.” Pierce also noted that the database will not be source verified, so it will still be the responsibility of the discloser to disclose accurately.
The team at Convey is hopeful that the system will be available beginning in the fall of 2015. They plan free access for individuals, but institutions will be charged an annual subscription rate. Initially, the system will only be available to subscribing institutions in the United States, though authors from anywhere in the world will be able to create personal profiles. “If you think ‘this wouldn’t work for me,’ we want to hear that,” Pierce said in closing. “This is an ideal time to be involved, whether you subscribe now, or later, or never.” If you have questions or would like to provide feedback to AAMC about Convey or the disclosure process, please contact Heather Pierce at firstname.lastname@example.org or email@example.com.