Dearth of authors

NEJM liberalizes conflict-of-interest policy

For almost 200 years, The New England Journal of Medicine has been widely considered one of the country's most prestigious medical journals—reporting on and reviewing new research and treatments in medicine.

In June, NEJM editor Dr. Jeffrey Drazen, A68, announced that the publication is changing its conflict-of-interest policy, blaming it for the small and shrinking pool of authors eligible to evaluate drugs for the publication. But some wonder if the change will ultimately hurt the NEJM's longstanding credibility.

Many authors have been prevented from contributing to the NEJM because of minor financial ties with pharmaceutical and biomedical firms. The new policy allows reviewers to receive up to $10,000 from a drug company each year.

"The addition of the word 'significant' [to the conflict of interest policy] acknowledges that not all financial associations are the same," Drazen wrote in a NEJM editorial on the policy change. "Some, such as the receipt of honorariums for occasional educational lectures sponsored by biomedical companies, may be appropriately viewed as minor and unlikely to influence an author's judgment."

Drazen also emphasized that the publication will note any financial ties the author has at the bottom of each review, and the NEJM editorial board will continue to review all submissions prior to publication.

"In the end, we as editors are responsible for weighing the available facts about each prospective author and for making decisions we believe will bring the best scientific and medical information to the Journal," Drazen wrote. "No Journal editor who makes these decisions has any financial relationship with any biomedical company."

The old policy, Drazen said, made it too difficult for the NEJM to find qualified authors without any ties to the industry to review drugs. "We have concluded that our ability to provide comprehensive, up-to-date information, especially on recent advances in therapeutics, has been constrained," Drazen wrote in the editorial.

In an interview with ABC News, Drazen said the old policy was preventing the Journal from publishing much-needed reviews. "There are areas where we simply have not published anything because we didn't think we could get a person who was good to write in an area that had absolutely no interaction with a commercial entity," Drazen told the network.

But Dr. Jerome P. Kassirer, a professor at Tufts School of Medicine who served as NEJM editor-in-chief from 1991 to 1999, told ABC that he is surprised at the lack of available authors. "There is a lot of depth in academic medicine, sufficient depth so that it's almost always possible to find a first-class person to write an editorial or review article in which they do not have a financial conflict of interest," Kassirer said.

Sheldon Krimsky, professor of urban and environmental policy and planning at Tufts and a nationally renowned expert who has studied conflicts of interest in scientific journals, worries about the message the Journal's new policy sends. "I'm afraid it'll send out a signal [to journals with less-strict policies] that the pendulum is moving in another direction," Krimsky told the Chronicle of Higher Education.

"The sadness of it is that I understand what they're doing," Krimsky said. "That they have to pull back tells us just how bad the contamination has been in the scientific community. Alas."