Conflict of Interest: Full Transparency.

COI or conflict of interest are three letters and a phrase that we often hear at presentations and are included in published manuscripts. Typically, authors are asked to list their financial relationships with vendors or declare that they have no disclosures relevant to the presentation or article. Often, they state that the full disclosure can be found at a website such as aaos.org, which requires effort in the part of the audience or reader to investigate whether a conflict of interest is relevant.

Conflict of interest is defined as a situation in which the aims of two parties are incompatible or in which a person is in a position to derive personal benefits from actions or decisions that are made in their official capacity [1]. There is a conflict between personal interest and professional capacity. The primary interest is, therefore, unduly influenced by a secondary interest [1,2].

This is a very important issue. There are several reasons as to why this matters:

Introduction of bias—What if the decision or action is not based on truthful scientific methods but intentionally or unintentionally leads to profit to an individual?

Introduction of harm—What if the decision or action, based on invalid and unscientific principles, covers up the truth and causes harm to the public? For example, a scientist performs creative data analyses to yield positive treatment results about a drug and that drug is released to the public, when in reality, it provides no benefit or has harmful side effects, then the public and society at large have been harmed. This diminishes the merits and validity of the research and undermines the sacred trust that the society has with physicians, scientists, and researchers.

In a monograph from the Ethics Committee of the American Chemical Society [1], it was stated that the core value of trust between scientists, the government, and the public is essential. The authors expressed the need for objectivity in the execution, interpretation, and dissemination of research.

Conflict of interest by itself does not equate to misconduct in performing research. True misconduct involves fabrication, falsification of data, or plagiarism. However, conflict of interest can introduce more subtle forms of bias such as in formulating the research question, study design, data analysis, and presentation of the findings. Knerr and D’Amelia gave an example of presenting a glass as half full or half empty [1]. The actual quantity of liquid in the glass is the same, but its amount is framed differently, depending on the author’s bias.

There is no harm in being more stringent with requiring strict disclosures. The concern that strict disclosures will reduce collaboration between industries and scientists is unfounded. Industrial research depends on well-trained scientists to create, perform, and analyze the investigations.

Studies by Okike et al. [3] and Mayo et al. [4] reported that articles with positive findings tended to have authors who reported COI in terms of receiving royalties or having employee status or consultancy agreements. Other studies have also shown that investigations funded by industry tended to have positive findings.

To address conflict of interest, strategies include avoidance of potential conflict, disclosing fully, and recusing oneself if a decision needs to be made. This will not eliminate all the problems with COI. Full disclosure of COI clearly does not give someone a license to engage in unethical behavior. One cannot fall back on the argument that the readers or audience were forewarned by the disclosure. To this end, greater transparency in disclosure is essential. Investigators should not only list all the entities with whom they have relationships but also define the nature of those relationships. The authors should disclose all their relationships, not just the ones that they feel are relevant. Readers should decide for themselves whether the conflicts of interest are relevant. The investigators of a study, regardless of transparent disclosure, have a responsibility to conduct their studies in a rigorous scientific manner. By the same token, peer reviewers must do the same, even if they lose some personal benefits, financial or otherwise. The overriding principle should be based on facts and truth. It is our collective responsibility to hold our scientific community accountable and be keepers of the trust bestowed upon us.

To that end, Arthroplasty Today is committed to transparency and the principle that best ethics in publication requires full disclosure and inclusion of COI for all submissions and published articles.

Conflicts of interest

The authors declare there are no conflicts of interest. For full disclosure statement, refer to https://doi.org/10.1016/j.artd.2022.01.019.