Facts and frictions: conflicts of interest in medical research.

I'm going to give you a bird's eye view, as an editor-in-chief, of why conflict of interest in medical research is such a vital problem today in medicine. By the time I am finished, I hope that I will convince you that we physicians and medical scientists need to make sure we take control of our profession to protect our patients in a way that only we can do. The first definition of "conflict of interest" that I could find goes back to 1850 in Webster's Dictionary: "To conflict between the private interests and the official responsibility of a person in a position of trust." That sounds familiar to all of us in medicine, because that's who we are. Why do authors and reviewers have conflicts of interests? Career advancement, peer recognition, competing research interests, competition for research grants, intellectual biases and passions, and financial conflicts that we sometimes let get in the way. Editors have conflicts of interest because we want to promote our journal and improve our "impact factor"--a measure of the average number of citations to articles published in scientific journals. The impact factor is often used to gauge the relative importance of a journal within its field. I would love to do away with this. It is the most manipulative thing in the world because journal editors have to live by it, and departments use the impact factor as a mechanism for promotion. Editors also want to increase subscriptions and increase the financial profitability of their journals; sometimes, they have a conflict of interest because they're trying to eliminate or decrease stress, hostility, or harassment. In fact, I invite anyone who doesn't think a journal editor deals with stress, hostility, or harassment to spend a day with me.