See Orentlicher, D. Hehir, M.K. II, “Advertising Policies of Medical Journals: Conflicts of Interest for Journal Editors and Professional Societies,” Journal of Law, Medicine & Ethics, 27 (1999): 113–21.Google Scholar

This is as true for physicians as for corporations, which some claim have worked against society's interest for years through indiscriminate use of tests and therapies that have fueled the rise in health care costs. Financial interests are perhaps the most public and provocative conflicts of interest, but nonfinancial personal, professional, institutional, legal, and other interests can conflict as well. See Huth, E.J., “Conflicts of Interest in Industry-Funded Research,” in Spece, R.G. Shimm, D.S. Buchanan, A.E., eds., Conflicts of Interest in Clinical Practice and Research (New York: Oxford University Press, 1996): 389–406; and Horton, R., “Conflicts of Interest in Clinical Research: Opprobrium or Obsession?,” Lancet, 349 (1997): 1112–13.Google Scholar

International Committee of Medical Journal Editors, “Uniform Requirements for Manuscripts Submitted to Biomedical Journals,” JAMA, 277 (1997): 927–34, at 933. See also the International Committee of Medical Journal Editors, “Statement on Project-Specific Industry Support for Research,” Canadian Medical Association Journal, 158 (1998): 615–16 (reproduced here as the Appendix to this commentary). More pointedly, and perhaps more effectively, Lancet's editors ask contributors to reveal interests that, if revealed after publication, could prove “embarrassing.” See “The Politics of Disclosure,” Lancet, 348 (1996): 627.Google Scholar

Troubling “covert” instances include those in which articles are ghostwritten by corporate sponsors, and those in which researchers are pressured by sponsors to withhold submitting research reports to medical journals because the findings could compromise financial interests. See Larkin, M., “Whose Article Is it Anyway?,” Lancet, 354 (1999): 136; and Deyo, R.A. et al., “The Messenger Under Attack—Intimidation of Researchers by Special-Interest Groups,” N. Engl. J. Med., 336 (1997): 1176–80.Google Scholar

International Committee of Medical Journal Editors (1997), supra note 3, at 934.This material was originally published in the British Medical Journal, 308 (1994): 1692, and subsequently integrated into the recent “Uniform Requirements” updates provided by the International Committee of Medical Journal Editors. See International Committee of Medical Journal Editors (1998), supra note 3. For a glimpse of how well journals have implemented these recommendations, see Wilkes, M.S. Kravitz, R.L., “Policies, Practices, and Attitudes of North American Medical Journal Editors,” Journal of General Internal Medicine, 10 (1995): 443–50.Google Scholar

Fletcher, R.H. Fletcher, S.W., “Pharmaceutical Advertisements in Medical Journals,” Annals of Internal Medicine, 116 (1992): 951–52, at 952.Google Scholar