Con ict of Interest - Serious Issue on Publication Ethics for Indian Medical Journals

Introduction: There are several vested interest lies on research publication hence the editorial policy is the sole important factor to control and regulate ethical publications in medical sciences especially on ‘con ict of interest’ issue. The study was aimed to assess on awareness of ‘con ict of interest’ issue in medical research and publication among the editorial staff, peer reviewers and authors of Indian medical journals. Methods: Total 61 authors who have published research articles recently in Indian medical journals from 2008-2012, 56 peer reviewers who reviewed the manuscripts during same period and 35 editorial board members of various Indian medical journals were assessed by questionnaire and telephone interview regarding their understanding and knowledge on ‘con ict of interest’ issue for ethical publication. Results: Only 7 (12%) of the authors knew about the ‘con ict of interest’ issue and 11 (19%) of the medical authors have just heard about it. Out of 12% of authors who knew ‘con ict of interest’ issue only 15% provided that statement to the journals. Among the peer reviewers only 17 (30%) knew about ‘con ict of interest’ of which 51 (91.5%) stated that they do not bother about this issue while reviewing the manuscripts. But interestingly 42 (75%) of the peer reviewers confessed that they had a bias on the topics written by their friends or students. Among the editorial board members of Indian medical journals only 14 (25%) have any idea on ‘con ict of interest issue’. Conclusions: Results clearly shows poor understanding of ‘con ict of interest’ like important ethical issue among Indian medical scientists or journals. _______________________________________________________________________________________


INTRODUCTION
Among the various types of complications are faced by academic journal-the most dif culty for an Indian journal is facing today is the 'con ict of interest'.There are several vested interests lies in research publication and hence the editorial policy is the only important factor in controlling and regulating ethical publications in medical sciences especially with regard to 'Con ict of Interest' (COI).A con ict of interest exists when an individual's professional or ethical obligations might be compromised by self-interest. 1 COI in medical publishing affects everyone with a stake in research integrity including journals, research/ academic institutions, funding agencies, the popular media, and the public.Con icts of interest increase the temptation to commit misconduct. 2 If the potential gain is large, however, then principles that guide responsible conduct in research may be compromised.The International Committee of Medical Journal Editors has recommended both to authors and editors that nancial associations that 'may pose a con ict of interest should be disclosed. 3nce, the study was aimed to assess on awareness of the 'con ict of interest' issue in medical research and publication among the editorial staff, peer reviewers and authors of Indian medical journals.

METHODS
A descriptive study from march, 2011 to December, 2012 was conducted to ascertain what percentage of Indian medical journals editorial board members, peer reviewers and authors of Indian nationality had knowledge and understanding of COI, we have selected a study sample as following:-Number of Indian Journals consulted (n = 15); Authors (n = 61); Peer Reviewers (n=56) and Editorial Board Members (n=35).
All the journals which are considered for the study are indexed in Pubmed / Scopus / EMBASE / Chemical Abstract.Authors are considered based on their published articles in per article / per corresponding author.Peer reviewers were selected by telephonic and email contact from this investigator's contact list and they are not Editorial Members of any journals.Editorial Board members are also selected by present investigator's contact list and net searching.They may be peer reviewers too.Identity of the journals, authors, peer reviewers and editorial members were kept con dential (Figure 1).Shows the distribution of authors, peer reviewers and editorial board members among Indian medical journal editors in preclinical (Physiology, Biochemistry, Anatomy), para-clinical (Pharmacology, Pathology, Microbiology, Forensic Medicine etc.) and clinical subjects (Medicine, Surgery, Obstetric & Gynecology, Pediatrics, Orthopedics, Otorhinolaryngeology etc).We have prepared questionnaire and telephone interview regarding their understanding and knowledge on 'con ict of interest' issues for ethical publication.The Questions are simple and straight forward (Table 1-3).
It is also surprising that 24 (42%) of peer reviewers and 20 (58%) of medical journal editorial board members too did not hear about 'con ict of interest' issue (Table 2,3).More interestingly, even the peer reviewers who knew about 'con ict of interest' issue hardly bother to verify the statement of that in manuscript 16 (94%) and returned the manuscript on possible potential COI 17 (100%).It is also interesting to know that majority 42 (75%) of peer reviewers have confessed that they review the manuscript even after knowing that the author is either their colleague/friend or students (Table 2).51 (91%) peer reviewers and 27 (77%) editorial board members said that neither they nor editorial of ce have ever interact with each other on this COI issue.
The medical journals have better understanding on COI issue than editorial board members (30% vs 25%) (Figure 2).The distribution of understanding of COI issue among Pre, Para and Clinical journals in India are varies(Figure 3).The results clearly indicate that authors and peer reviewers of pre-clinical medical journals are slightly better aware than their para-clinical and clinical counterparts whereas among editorial board members the para-clinical members are found to be better aware on con ict of interest issue in medical journals.

DISCUSSION
The results clearly show the poor understanding of this important ethical issue among Indian medical scientists and journals.The problem of 'con ict of interest' is very common in Indian medical journals.Most of the medical institutions in India receive hardly any government research funds but publication is mandatory for their survival.In this context the in uence of the pharmaceutical industry on medical research has been a major ethical issue on 'con ict of interest'.In 2009 a study found that "a number of academic institutions" do not have clear guidelines for relationships between Institutional Review Boards and industry. 4Although the "Publish or Perish" situation is not that serious in Indian scenario but once again the promotion policy of faculty members in medical or scienti c institutions is strongly based on research publications as per University Grants Commission (UGC) and Medical Council of India (MCI) guidelines.
Poor infrastructure, lack of support from universities or government organizations, very weak ethical regulations (many institutions do not even have a proper institutional regulatory board!) cast a shadow on ethical research in medicine and leads to multiple con icts of interest in publications.In the complex scenario of medical publication, Indian medical journals need to pay more serious attention to publication ethics, especially 'con ict of interest'.Probably regular workshops either in person or online, training for peer reviewers and editorial board members may help in improving this issue.Prior screening of peer reviewers and editorial board members before selection/election of these groups may be a good option if journals take a serious call on this.Authorities of medical journals and medical institutions should come forward and handle these ethical challenges together.

Figure 1 .
Figure 1.Distribution of Authors, Peer reviewers and Editorial Board Members amongIndian Medical Journals