Physicians and patients rely on medical journals as trusted sources of medical information. Unfortunately, conflicts of interest may undermine the credibility of the medical literature. Improved policies and practices at journals should address the conflicts of interest of authors, reviewers, editors, and journals. Medical journals should manage and eliminate conflicts, not just improve the disclosure of financial relationships.

Physicians and patients rely on medical journals as trusted sources of medical information. Unfortunately, in multiple instances conflicts of interest have undermined the credibility of the medical literature.The primary sources of conflict of interest at medical journals are authors, reviewers, editors, and journals. Consider these examples.

A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of “informed consent/refusal.” So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.