Ethics, economics, and the publication policies of major medical journals.

OBJECTIVE: To evaluate aspects of the publication process that may affect the quality of the literature in clinical economics and biomedical ethics, and to learn about the policies of medical journals regarding disclosure of relationships between investigators and research sponsors.
DESIGN: Mail survey. PARTICIPANTS: Editors in chief of 15 major medical journals.
RESULTS: Twelve editors responded to the survey. Ten reported having statisticians among their editors, while only two had health economists and none had ethicists. Clinicians in the specialty field were almost always the primary reviewers of submissions, while methodologists (statisticians, health economists, or ethicists) were involved less frequently. Journals reported little knowledge of the training of their reviewers in these fields. While nine journals requested disclosure of the financial relationship between author and sponsor, only one inquired whether the sponsor's written approval was required prior to manuscript submission, and only one knew whether there was an independent steering committee for the study.
CONCLUSIONS: These findings suggest that the peer review process can be strengthened to improve the quality of the medical literature in clinical economics and biomedical ethics. Journal editors also need to better understand the terms of research sponsorship agreements.