Conflict of interest and bias in publication.

In his excellent article about commercial conflict of interest, Mark Wilson quotes Dennis Thompson, a political scientist who provided a searching analysis of the concept of conflict of interest (Col). Using Thompson's analysis, Wilson writes: "Determining whether factors such as ambition, the pursuit of fame and financial gain had biased a judgment was challenging. Motives are not always clear to either the conflicted party or to an outside observer." In this commentary, I aim to broaden the discussion beyond the narrowly commercial aspects of Col. I argue that bias can be introduced in major scientific journals by the editors' choices and policies. The context is a controversy that erupted in 2013 over the adequacy of informed consent in a clinical trial involving extremely premature infants. In this, as in Wilson's example, the players included the New England Journal of Medicine (NEJM), as well as the highest officials of the US National Institutes of Health (NIH).