Conflicts of Interest - Ethical and Legal Considerations

AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Conflicts of Interest
Ethical and Legal Considerations

Of all the causes which conspire to blind

Man’s erring judgment, and misguide the mind,

What the weak head with strongest bias rules,

Is pride, the never-failing vice of fools.

Alexander Pope1

5.5.1 Definition, History, and Rationale for Journal Policies.

A conflict of interest occurs when an individual’s objectivity is potentially, but not necessarily, compromised by a desire for prominence, professional advancement, financial gain, or a successful outcome. Conflicts of interest that arise from personal or financial relationships, academic competition, and intellectual passion are not uncommon in science. In biomedical publication, a conflict of interest may exist when an author (or the author’s institution, employer, or funder) has financial or other relationships that could influence (or bias) the author’s decisions, work, or manuscript.2,3,4,5,6,7,8 However, much concern has been directed toward the financial interests of researchers and authors, perhaps because such interests often are the easiest to measure or identify, and because of the complex relationships between them and the funders of their work.9,10,11,12,13,14,15,16,17,18 In addition, concerns have increased about author biases associated with financial ties to industry and pressures from commercial funders that result in incomplete, delayed, or suppressed publication.8,9,12,18,19,20,21

Journal editors strive to ensure that information published in their journals is as balanced, objective, and evidence based as possible. Because of the difficulty in distinguishing the difference between an actual conflict of interest and a perceived conflict,22 many biomedical journals require authors to disclose all relevant potential conflicts of interest.2,6,7 Financial interests may include but are not limited to employment, consultancies, stock ownership, honoraria, paid expert testimony, royalties, patents (filed, pending, or registered), grants, and material or financial support from industry, government, or private agencies. Nonfinancial interests include personal or professional relationships, affiliations, knowledge, or beliefs that might affect objectivity.

Many potential biases may be detected during the editorial assessment and peer review of a manuscript (eg, problems with a study’s methods and analysis, inappropriate interpretation of results, unbalanced selection or citation of the literature, unjustified emphasis or overly enthusiastic language, and conclusions that go beyond a study’s results) or are apparent from the author’s affiliation or area of expertise. However, financially motivated biases are less easily detected. Therefore, in the 1980s biomedical journals began to require authors to disclose any financial interests in the subject of their manuscript.23,24 During the next 20 years, authors typically included information about financial support from grant and funding agencies in their submitted manuscripts, primarily because the funding agencies require them to do so, but it was less common for authors to disclose other financial interests, unless such information had been specifically requested.

Despite many high-profile scandals and studies that demonstrated bias associated with unreported conflicts of interest,8,9,10,11,12,19,20,21 many journals continued to have no conflict of interest policies. One of the first studies to assess the prevalence of journal policies was conducted in 1997. This study25 of 1396 top-ranked biomedical and science journals in terms of impact factor identified only 181 journals (13%) with conflict of interest policies; those journals with policies were overrepresented by medical journals. A subsequent study26 conducted in 2005 of the 7 highest-impact peer-reviewed journals in 12 different scientific disciplines found a higher prevalence of journals that reported having conflict of interest policies (80%), although only 33% made these policies publicly available (eg, in their instructions for authors). All the top-ranked general medical and multidisciplinary science journals had such policies, but journals in other scientific disciplines were less likely to have such policies and/or to publish them in their instructions for authors.26 In more recent years, studies27,28,29,30,31 have found continued increases in journals adopting conflict of interest disclosure policies. However, individual policies and compliance with them continue to vary among journals and disciplines.27,28,32 Recognizing this problem, in 2009 the International Committee of Medical Journal Editors (ICMJE) created a universal author disclosure form that can be used for all authors and any journal.2,33 With the goal of improving usability and reporting, the ICMJE form has been modified a few times and a version is available for downloading at Some journals have begun to consider encouraging authors to disclose interests in centralized repositories.

Most biomedical journals, including the JAMA Network journals, require disclosure of conflicts of interest from everyone involved in the editorial process, including authors, reviewers, editorial board members, and editors, and for all types of articles.7 The JAMA Network journals also have policies for recusal of peer reviewers and editors with conflicts of interest (see 5.5.6, Ethical and Legal Considerations, Conflicts of Interest, Requirements for Peer Reviewers, and 5.5.7, Ethical and Legal Considerations, Conflicts of Interest, Requirements for Editors and Editorial Board Members). The ICMJE,2 the Council of Science Editors (CSE),34 the Committee on Publication Ethics (COPE),35 and the World Association of Medical Editors (WAME)36 support similar policies of disclosure and transparency or recusal, depending on the circumstances. Many journals also require individuals (such as editorial and publishing employees and full-time and part-time editors) who have access to material during the review and publication processes to comply with policies on conflicts of interest.

Undisclosed conflicts of interest, whether intentionally concealed or unintentionally unreported because of denial or confusing policies, are harmful to researchers and authors, journals, and the public trust in science. In a regulatory attempt to improve transparency of industry-physician relationships and to manage the bias associated with undisclosed financial interests on medical knowledge, the US Centers for Medicare & Medicaid Services released a public website in September 2014 under the Sunshine Act.37 This website, called Open Payments, provides information on a wide range of types of payments, including research funding and general payments for consulting, honoraria, gifts, travel, education, royalties or licenses, investment, compensation for serving as faculty or speaker, and research funding and grants, made to US physicians and teaching hospitals by industry and manufacturers of drugs, devices, biologicals, or medical supplies. For the year 2017, Open Payments reported more than $8.4 billion in payments from 1525 companies to 628 000 physicians and 1158 institutions, including $2.82 billion in general payments and $4.66 billion in research payments.38 Such regulatory efforts may result in an increase in conflict of interest disclosures on the part of US physician authors to biomedical journals.

The following discussion addresses conflict of interest policies in general as recommended by the ICMJE,2 CSE,34 COPE,35 and WAME36 and provides specific examples of policies, procedures, and terms as used by the JAMA Network journals.7,39

5.5.2 Requirements for Authors.

Authors should disclose all conflicts of interest related to the subject in the manuscript at the time of manuscript submission (if so required by the journal), in a cover letter to the editor, or on the journal’s disclosure form (if the journal uses one). Journals should define conflicts of interest and the types of disclosures required (eg, all types of conflicts of interest or only financial interests) in their instructions for authors and in any disclosure forms. For example, the JAMA Network journals require authors to include all relevant financial interests, activities, relationships, and affiliations (other than those affiliations listed on the title page of the manuscript) in the Acknowledgment section of the manuscript so that all involved in reviewing manuscripts (editors and peer reviewers) can see the disclosure.4,7,39 The journals describe these policies in their instructions for authors and in the online manuscript submission forms.

In an attempt to remove stigma associated with the word “conflict,” some journals use the term declaration of interests. Journals commonly require authors to provide disclosure (or declaration) statements in a cover letter or disclosure form and do not share these disclosures with peer reviewers, unless the journal routinely shares author correspondence and submission forms with peer reviewers. Whether a journal requires complete disclosure of all potential conflicts of interest or only those related to the specific manuscript and whether the disclosures are to be nonconfidential and included in the manuscript or confidential and listed only in documents and communications not shared with peer reviewers, these policies should be made clear to all prospective authors and be publicly available in easily accessible instructions for authors. However, if a manuscript is accepted, whether the journal’s disclosure policy is nonconfidential or confidential during the review process, the author’s disclosures should be published.

For example, at the time a revision is requested, and before acceptance, the JAMA Network journals require authors to complete an Authorship Form with a section for disclosure of potential conflict of interest that is based on the questions included in the ICMJE universal disclosure form. To help authors avoid incomplete, inaccurate, or inconsistent disclosures, each time an author answers “no” to the questions about potential conflicts of interest, a pop-up message appears asking if the author is certain that “no” is the correct answer and if the author’s answer is consistent with disclosures in recently published articles.7 The JAMA Network journals do not publish these Authorship Forms. Instead, for accepted manuscripts, each author’s disclosure statement is extracted from the Authorship Form and added to the manuscript during the editing process and then published in a conflict of interest disclosure statement in the Article Information section at the end of the article. If there is inconsistency between the disclosures included in the submitted manuscript and what each individual author has declared in the Authorship Forms, a manuscript editor will query the corresponding author to confirm that the disclosures in the edited manuscript are accurate (see, Publishing Authors’ Disclosure Statements).

Some journals that require the ICMJE disclosure form publish these as online supplements to articles and may or may not include the disclosures in the actual articles. Such practice makes it challenging for readers to efficiently read or access the disclosure statements when reading a specific article.

The JAMA Network journals also require all authors to report detailed information regarding all financial and material support for the research and work, including but not limited to grant support, funding sources, and provision of equipment and supplies (see 5.5.3, Reporting Funding, Sponsorship, and Other Support). Definitions and Terms of Conflict of Interest Disclosures.

The JAMA Network journals require authors to provide detailed information about all relevant financial interests, activities, relationships, and affiliations (other than those affiliations listed on the title page of the manuscript), including but not limited to employment, affiliation, funding and grants received or pending, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, paid expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Following the 2018 guidelines of the ICMJE,2 the definitions and terms of such disclosures include the following:

1.Any potential conflicts of interest “involving the work under consideration for publication” (during the time involving the work, from initial conception and planning to present),

2.Any “relevant financial activities outside the submitted work” (during the 3 years before submission), and

3.Any “other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing” what is written in the submitted work (based on all relationships that were present during the 3 years before submission).

Authors without conflicts of interest, including relevant financial interests, activities, relationships, and affiliations, should include a statement of no such interests in the Acknowledgment section of the manuscript and in the disclosure forms. The Instructions for Authors for the JAMA Network journals note that “failure to include this information in the manuscript may delay evaluation and review of the manuscript” and that “authors should err on the side of full disclosure and should contact the editorial office if they have questions or concerns.”7,39

Although many universities and other institutions and organizations have established thresholds for reporting financial interests (eg, $5000, $10 000), the JAMA Network journals require complete disclosure of all relevant financial relationships and potential financial conflicts of interest, regardless of amount or value.

Decisions about whether conflict of interest information provided by authors should be published, and thereby disclosed to readers, are usually straightforward. For example, authors of a manuscript about hypertension should report all financial relationships they have with all manufacturers and owners of products, devices, tests, and services used in the management of hypertension, not only those relationships with companies whose specific products, devices, tests, and services are mentioned in the manuscript. Authors should also consider reporting affiliations with organizations, societies, or other entities that may be related to the subject of their manuscripts, such as nonpaying volunteer leadership positions in professional societies or advocacy organizations. If authors are uncertain about what constitutes a relevant conflict of interest or relationship and whether the journal would deem a specific conflict of interest relevant, they should contact the editorial office. Application of Policies to Different Types of Articles.

A journal’s conflict of interest policies should apply to all manuscript submissions and types of articles, including reports of research, reviews, opinion pieces (eg, editorials), educational articles, reviews of books and other media, letters to the editor, and online-only comments.4,5

Some journals might not accept manuscripts from authors with financial interest in the subject of the manuscript. For example, editors of some journals prefer that authors of some types of articles, such as editorials and other opinion pieces and reviews, not have relevant financial interests in the subject matter.40,41 Unlike scientific reports, editorials and nonsystematic reviews contain no primary data and offer an evaluation of a topic from a selection and interpretation of the literature; hence, they are more susceptible to bias,8 which accompanying financial disclosures do not obviate. Authors of opinion pieces and review articles are expected to provide an expert and authoritative perspective that is not unduly biased, which they may not be able to do if they have financial ties to products or services mentioned in the manuscript or are otherwise related (eg, within the same area, category, or topic).

However, such policies may be overly restrictive and may limit the journal’s ability to publish articles from some qualified authors. Journals with concerns about the financial interests of authors of opinion pieces and review articles must balance the risk of publishing potentially biased discussion and comment against excluding potentially valuable contributions to the literature, which in some fields may be the only expert contribution available. The key is for the editor to ensure that the editorial or review is as balanced, objective, and evidence based as possible. If, after review and careful consideration, the editor believes the work is biased and that the author is unable or unwilling to revise the manuscript to eliminate such bias and prospective readers would be misled, the editor should not accept the manuscript for publication. The policy of the JAMA Network journals recognizes that conflicts of interest are common and in some cases perhaps even helpful (eg, from a knowledgeable and critical reviewer with an opposing viewpoint). This policy favors complete disclosure from all authors over a ban of authors with conflicts of interest. However, when inviting an author to write an editorial to comment on a paper to be published, the editors will ask the prospective author to disclose any relevant conflicts of interest before writing and submitting the manuscript and consider this information carefully, in light of the potential for risk from bias vs benefit from expertise, before confirming that the author is the best available person to write the editorial. Publishing Authors’ Disclosure Statements.

Information about relevant conflicts of interest can be published in the Acknowledgment or Article Information section at the end of the article (after the list of author contributions and before information about grants and financial or material support) or on the title page of the article near the author’s affiliation (see 2.10.7, Conflict of Interest Disclosures, and 5.2, Acknowledgments). The following example shows placement in the Acknowledgment (or Article Information) section:

Author Contributions: Dr Jones had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jones, Jacques, Smith, Brown.

Acquisition of data: Jones, Smith, Brown.

Analysis and interpretation of data: Jones, Jacques, Smith, Brown.

Drafting of the manuscript: Jones.

Critical revision of the manuscript for important intellectual content: Jacques, Smith, Brown.

Statistical analysis: Jacques.

Obtained funding: Jones.

Supervision: Brown.

Conflict of Interest Disclosures: Dr Jones reported serving as a paid consultant to Wyler Laboratories. Dr Jacques owns stock in Wyler Laboratories. No other disclosures were reported.

[Or: Conflict of Interest Disclosures: None reported.]

Funding/Support: This study was funded in part by Wyler Laboratories.

The following example shows placement in the author affiliation footnote on the title page/screen:

Author Affiliations: Department of Cardiology, Ambrose University Hospital, Boston, Massachusetts (Jones, Smith), and Wyler Laboratories, Geneva, Switzerland (Jacques, Brown).

Conflict of Interest Disclosures: Dr Jones reported serving as a paid consultant to Wyler Laboratories. Dr Jacques owns stock in Wyler Laboratories. No other disclosures were reported.

Corresponding Author: John J. Jones, MD, Department of Cardiology, Ambrose University Hospital, 444 N State St, Boston, MA 01022 (

5.5.3 Reporting Funding, Sponsorship, and Other Support.

In addition to individual financial conflicts of interest, authors should report all financial and material support for the work reported in the manuscript. This support includes, but is not limited to, grant support and funding, provision of equipment and supplies, and other paid contributions.2,4 All financial and material support for the work should be indicated in the Acknowledgment section of the manuscript, along with detailed information on the roles of each funding source or sponsor (see 5.2.6, Funding and Role of Funders and Sponsors). Some journals also request that this information be included in a funding field in electronic manuscript submission systems, either in free text or with a defined taxonomy. For example, FundRef uses a standard taxonomy of funder names.42 Journals using FundRef may also deposit the standardized names of funders for published articles in a publicly searchable registry managed by CrossRef along with grant numbers and DOIs and other metadata about the published article.

In addition, all individuals who provided other important paid contributions should be identified, with their names and affiliations listed in the Acknowledgment section of the manuscript or as authors if they meet the full criteria for authorship. These contributions include the work of employed or compensated writers, editors, statisticians, epidemiologists, and others involved with manuscript preparation, data collection or management, and analyses. Acknowledgment of such contributions should be specific and may include information on funding. For example, the JAMA Network journals require authors to include information about each nonauthor contributor’s role/contribution, academic degree(s), affiliation, and indication if compensation was received for each person named in the Acknowledgment section (see 5.2.1, Acknowledging Support, Assistance, and Contributions of Those Who Are Not Authors).

5.5.4 Reporting the Role of the Funder/Sponsor.

In the interest of full disclosure, the ICMJE recommends that authors report how funders and sponsors have participated in the work reported in a specific manuscript.2,43 Journals should require authors to indicate the role of the sponsor/funding organization in each of the following: “design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.”39 If the sponsor or funder had no such roles, this should be stated. This information may be included in the Acknowledgment or Methods section of the manuscript2 (see 5.2.6, Funding and Role of Funders and Sponsors). Authors should not agree to allow sponsors with a proprietary or financial interest in the outcome of a study or review article to control the author’s rights to publication, although review of manuscripts by sponsors or funders is typically permitted as long as such review does not impose an unacceptable delay or suppression.2,8,12,43 According to the ICMJE, “authors should avoid entering into agreements with study sponsors, both for-profit and non-profit, that interfere with the authors’ access to all of a study’s data or that interfere with their ability to analyze and interpret the data and to prepare and publish manuscripts independently when and where they choose.”2

5.5.5 Access to Data Requirement.

For all reports, regardless of funding source, that contain original data (research and systematic reviews), at least 1 named author should indicate that she or he “had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis”2,3,39 (see 5.1.1, Authorship: Definition, Criteria, Contributions, and Requirements). This responsibility can vest with the principal investigator, the corresponding author, or both. Although in some research groups, particularly small ones, all authors may have access to all the data, it is usually not meaningful to state generically that all authors had such access. In such cases, the JAMA Network journals prefer that no more than 2 authors are indicated as being so responsible and prefer that at least 1 author is not employed by or affiliated with the study sponsor.39

5.5.6 Requirements for Peer Reviewers.

Following the recommendations of the ICMJE, CSE, and WAME, reviewers should disclose conflicts of interest in reviewing specific manuscripts and disqualify themselves from a specific review if necessary.2,34,36 Reviewers should never use information obtained from an unpublished manuscript to further their own interests. Following the same rationale applied to authors, reviewers should state explicitly if they have no relevant conflicts of interest to disclose.2

The JAMA Network journals include the following instructions regarding conflicts of interest in the letter sent requesting an individual to review a manuscript:

While most conflicts of interest are not disqualifying, if you perceive that you have a disqualifying interest, either financial or otherwise, please contact the reviewing editor immediately (if possible, with the names of alternative reviewers). This will not affect your reviewer status.

Not all conflicts of interest are necessarily disqualifying, and in some cases the reviewer with the most expertise may also have conflicts of interest. For example, if a potential conflict of interest exists (financial or otherwise) but the editor and reviewer agree that the reviewer can provide an objective assessment, the JAMA Network journals may request that the reviewer disclose the specific conflict and provide the review. Other journals may choose to exclude any reviewer with a conflict of interest from participating in the review process. A journal’s policy on conflicts of interest for peer reviewers should be communicated to the reviewer when the review is requested.

The online review system used by the JAMA Network journals also contains a field in the reviewer recommendation form that requires reviewers to disclose conflicts of interest or state that they have no relevant conflicts of interest before submitting their reviews. This information is kept confidential and is not revealed to authors or other reviewers.

Many journals will accept reviewer recommendations from authors, but editors should carefully vet any such recommendations and should avoid automatically routing papers to author-recommended reviewers. There have been cases of authors gaming electronic submission systems by recommending fictitious reviewers and then reviewing their own papers under the guise of these sham reviewers.44

Journals may also consider authors’ requests not to send papers to specific reviewers. Authors who wish to exclude specific reviewers should explain the reasons for such requests at the time of manuscript submission. As with author-recommended reviewers, editors should carefully consider author requests to exclude specific reviewers (see, Selection of Reviewers, and 5.11, Editorial Responsibilities, Roles, Procedures, and Policies).

5.5.7 Requirements for Editors and Editorial Board Members.

Editors may also have their objectivity influenced or biased by conflicts of interest.45,46,47,48,49,50 As a result, the ICMJE, CSE, and WAME recommend that editors follow policies on conflicts of interest that require disclosure of all relevant conflicts of interest (financial and nonfinancial) and that they not participate in the review of or decisions on any manuscripts in which they may have a conflict of interest.2,34,36 Editors and journal editorial board members are prohibited from using information obtained during the review process for personal or professional gain and should refrain from making any decisions or recommendations about manuscripts in which they have a personal, professional, or financial interest. According to the ICMJE, “Editors who make final decisions about manuscripts should recuse themselves from editorial decisions if they have conflicts of interest or relationships that pose potential conflicts related to articles under consideration.”2 This recommendation applies to all editors, other editorial staff, and any editorial board members who make decisions to consider, accept, revise, or reject manuscripts. All decision-making editors and editorial board members should provide the editor in chief with conflict of interest disclosure statements at least annually, with updates for any major changes.

Editors should also consider how to handle manuscripts from an author who is from the same institution as the editor or in a field in which the editor has research funding and how to handle their own research and review articles.6 In the event that an editor works alone and has a conflict of interest with a particular manuscript, he or she should assign that manuscript to a guest editor or a member of the editorial board and should not take part in the review and editorial decision of such manuscripts. The JAMA Network journals publish disclaimers with any research or reviews articles that have an author who is also a decision-making editor for the journal to inform readers that the author-editor was not involved in the review or editorial decision.

Disclaimer: Dr Brown, the journal’s deputy editor, was not involved in the editorial review of or decision to publish this article.

Editorials written by journal editors are exempt from such procedures, but it may be prudent for editors to ask other editors or editorial board members to review and comment on these types of manuscripts before publication (see 5.11, Editorial Responsibilities, Roles, Procedures, and Policies).

The JAMA Network journal editors complete an ICMJE conflict of interest disclosure form annually in which any financial interests and relationships (type, entity, and whether money is paid to the individual or their institution) are listed and which is kept confidential in the editorial office. The editors also agree to recuse themselves from reviewing, editing, or participating in editorial decisions about any manuscripts that deal with a matter in which they have a potential conflict of interest.

5.5.8 Handling Failure to Disclose Conflicts of Interest. For Authors of Manuscripts Not Yet Published.

In the event that an undisclosed conflict of interest on the part of an author is brought to the editor’s attention (usually during the review process), the editor should remind the author of the journal’s policy and ask the author if he or she has anything to disclose. The author’s reply may affect the editorial decision on whether to publish the manuscript. For Authors of Published Articles.

If an editor receives information (usually from a reader) alleging that an author has not disclosed a conflict of interest in the subject of an article that has been published, the editor should contact the author and ask for an explanation. If the author admits that he or she failed to disclose the existence of a conflict of interest in the subject of the article and if that author had previously submitted a signed conflict disclosure statement that did not disclose that conflict of interest, the editor should request a written explanation from the author and an updated conflict of interest disclosure and publish this information as a Letter of explanation or notice of failure to disclose conflict of interest along with a Correction notice and correct the article online.7 Depending on the circumstances and extent of the inaccurate disclosure, some editors may notify the offending author’s institution or funder.7 (See this example51 and Box 5.5-1.) COPE has a useful flowchart, “What to do if a reader suspects undisclosed conflict of interest (CoI) in a published article.”52

Box 5.5-1. Hypothetical Example of a Notice of Failure to Disclose Conflict of Interest and Listing in the Journal’s Table of Contents

Failure to Disclose Financial Interest

To the Editor.—I regret that at the time I submitted my manuscript “Effective Vaccine Strategies for Pertussis,”1 published in the March 17, 2017, issue of the Journal of Medicine, I failed to disclose that I have served as a paid expert witness in several diphtheria-pertussis-tetanus vaccine injury—related lawsuits. I had completed the journal’s conflict of interest disclosure statement, but I did not realize that expert testimony was considered a potential conflict of interest. I do not believe that my involvement in those legal proceedings biased me in any way, and I regret any confusion this may have caused. I have requested that the article be corrected to add this disclosure.2

V. W. Brazen, MD

Virginia State University



1.Brazen VW. Effective vaccine strategies for pertussis. J Med. 2017;27(5):440-441.

2.Missing conflict of interest disclosure. J Med. 2018;28(1):68.

Listing in Table of Contents Correction

Failure to Disclose Conflict of Interest.

V. W. Brazen

As in the case of other types of allegations of wrongdoing (eg, scientific misconduct), editors are not responsible for investigating unresolved allegations of conflict of interest in an article or manuscript. That responsibility lies with the author’s institution, the funding agency, or other appropriate authority. If the editor deems the author’s reply to the allegation inappropriate or incomplete, the editor may need to break confidentiality and inform the author’s supervisor (eg, dean, research integrity officer, department chair, director) or representative of the funding agency. For Reviewers, Editors, and Editorial Board Members.

The discovery of an undisclosed conflict of interest on the part of peer reviewers may result in the journal not asking that reviewer to consult again. Failure to disclose relevant conflicts of interest on the part of editors or editorial board members is grounds for dismissal.

Principal Author: Annette Flanagin, RN, MA


I thank the following for review and helpful comments: Howard Bauchner, MD, JAMA and JAMA Network; Carissa Gilman, American Cancer Society, Atlanta, Georgia; Timothy Gray, PhD, JAMA Network; Iris Y. Lo, JAMA Network; Ana Marušić, MD, PhD, Journal of Global Health and University of Split School of Medicine, Croatia; and Joseph P. Thornton, JD, JAMA Network and American Medical Association.


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