Conflict of interest policies for editors and peer reviewers in medical journals: cross-sectional study

Editors and peer reviewers of research articles may have conflicts of interest that impact their evaluations. We aimed to characterize medical journals' conflict of interest policies for editors and peer reviewers. In this cross-sectional study, we randomly sampled 277 medical journals from Clarivate Journal Citation Reports. Two authors independently retrieved public conflict of interest policies and disclosures for editors and peer reviewers from journal websites and retrieved publishers' policies when journals also referred to them (January to June 2024). We used content analysis to analyze policies and multivariable mixed-effects logistic regressions to estimate the associations between journal characteristics and having a policy. After excluding 27 journals, we included 250 medical journals in English, of which 177 (71%) had a conflict of interest policy for editors and 174 (70%) for peer reviewers. Of journals with a policy, 137 (77%) and 129 (74%) described disclosure requirements, 160 (90%) and 163 (94%) described management strategies, 124 (70%) and 106 (61%) described policy enforcement strategies, and 17 (10%) and 15 (9%) described processes for appealing decisions. All 4 concepts were addressed in 16 (9%) policies for editors and in 11 (6%) for peer reviewers. Having a policy for editors was associated with higher journal impact factor (adjusted odds ratio (OR): 1.28; 95% confidence interval (CI): 1.05–1.56) and Committee on Publication Ethics membership (OR: 3.50; 95% CI: 1.42–8.65). Having a policy for peer reviewers was associated with higher journal impact factor (OR: 1.16; 95% CI: 0.97–1.37) and open access journal (OR: 4.59; 95% CI: 1.11–18.93). For a subgroup of journals referring to their publishers' policy, the content was concordant for 5 (11%) of 45 journals for editors and 4 (9%) of 47 journals for peer reviewers. Of 250 journals, 14 (6%) had public declarations of interest from editors, and 3 (1%) from peer reviewers. More than two-thirds of medical journals have conflict of interest policies for editors and reviewers; however, policies vary in comprehensiveness. There is potential to improve the content of conflict of interest policies and the transparency of interests in medical journals. Before a scientific study is published as a research paper in a medical journal, it is evaluated by the journal editors and other researchers, known as peer reviewers. This process is used to assess and ensure the quality and trustworthiness of the research and to assist editors in deciding whether to publish the paper. Editors and peer reviewers, however, are not necessarily neutral and may have personal interests that can influence their opinions. For example, they may have personal relationships with the study authors or have financial relationships with a company whose product is investigated in the study, which could result in conflicts of interest. Although most journals have policies addressing study authors' conflicts of interest, little is known about the practices and policies of medical journals concerning editors' and peer reviewers' conflicts of interest. In our study, we randomly selected 250 medical journals and examined their public conflict of interest policies for editors and peer reviewers, as well as whether these policies aligned with their publishers' policies. In addition, we assessed whether the interests of editors and peer reviewers were publicly disclosed. We estimated the proportion of journals with available policies, assessed which journal characteristics were associated with having a policy, and analyzed the content of policies. Of the 250 medical journals, we found that 177 (71%) journals had a conflict of interest policy for editors and 174 (70%) for peer reviewers, but their interests were very rarely publicly disclosed. The policies often contained limited information and were often only described in detail in the publishers' policies, and sometimes information in the journal's and the publisher's policies was in disagreement. Finally, policies rarely describe how journal staff assess interests, how these assessments may influence the journal's editorial process, and how journals enforce the consequences of policy violations. There is substantial potential for medical journals to improve their conflict of interest policies for editors and peer reviewers, as well as the transparency of their interests in medical journals.