2. “opinion or feeling that strongly favours one side in an argument or one item in a group or series”

3. Extraordinary size of science (difficult supervision of young researchers) Professional and economic competition

4. Conflict of interest exists when a participant in the publication process (author, peer reviewer or editor) has a competing interest that could unduly influence (or be reasonably seen to do so) his or her responsibilities in the publication process (submission of manuscripts, peer review, editorial decisions, and communication between authors, reviewers and editors).

5. COI exists when an author, reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions http://www.icmje.org/ethical_4conflicts.html Financial relationship – the most easily identifiable Employment Employment Consultacies Consultacies Honoraria Honoraria...... Financial relationship – the most easily identifiable Employment Employment Consultacies Consultacies Honoraria Honoraria......

6. Possible source of bias Possible source of bias Rarely appears in COI statement Rarely appears in COI statement More subtile More subtile Lack of uniformity among journal editors Lack of uniformity among journal editors Possible source of bias Possible source of bias Rarely appears in COI statement Rarely appears in COI statement More subtile More subtile Lack of uniformity among journal editors Lack of uniformity among journal editors

7. Academic competititon/commitments Academic competititon/commitments Intellectual passion Intellectual passion Desire for fame Desire for fame Personal relationship Personal relationship Political or religious beliefs, developing country bias Political or religious beliefs, developing country bias Gender bias Gender bias Institutional affiliations Institutional affiliations Academic competititon/commitments Academic competititon/commitments Intellectual passion Intellectual passion Desire for fame Desire for fame Personal relationship Personal relationship Political or religious beliefs, developing country bias Political or religious beliefs, developing country bias Gender bias Gender bias Institutional affiliations Institutional affiliations

8. “Intellectual passion” “Intellectual passion” Hard to challenge conventional wisdom Hard to challenge conventional wisdom Needs extra effort to be published Needs extra effort to be published “Intellectual passion” “Intellectual passion” Hard to challenge conventional wisdom Hard to challenge conventional wisdom Needs extra effort to be published Needs extra effort to be published

9. Family, friends, enemies, competitors or colleagues... Family, friends, enemies, competitors or colleagues... Difficulty to be unbiased Difficulty to be unbiased Family, friends, enemies, competitors or colleagues... Family, friends, enemies, competitors or colleagues... Difficulty to be unbiased Difficulty to be unbiased

10. Commitment to political/religious views may pose COI Commitment to political/religious views may pose COI Studies coming from low and high income countries Studies coming from low and high income countries Commitment to political/religious views may pose COI Commitment to political/religious views may pose COI Studies coming from low and high income countries Studies coming from low and high income countries Yousefi-Nooraie R, et al. BMC Med Res Methodol 2006;6:37.

11. Enhancement of exclusive and biased use of critical appraisal checklists by editors of western medical journals  presuption that editors and reviewers are biased against their nationality Developing world authors selective reporting of larger studies selective reporting of larger studies with less serious limitations with less serious limitations with positive and significant results with positive and significant results Developing world authors selective reporting of larger studies selective reporting of larger studies with less serious limitations with less serious limitations with positive and significant results with positive and significant results Yousefi-Nooraie R, et al. BMC Med Res Methodol 2006;6:37.

12. A study of postdoctoral fellowship awarded by the Medical Research Council in Sweden A study of postdoctoral fellowship awarded by the Medical Research Council in Sweden Women are often disadvantaged  women needed more publications (+3 papers in Nature or Science) (+20 papers in specialty journals) Wenneras C, Wold A. Nepotism and sexism in peer-review. Nature 1997;387:341-3.

13. Not just for pharma industry Not just for pharma industry Manufactures of medical devices Manufactures of medical devices Academic institutions which has patents Academic institutions which has patents Civic organisations (patients organisations)-special interests or advocacy positions Civic organisations (patients organisations)-special interests or advocacy positions Not just for pharma industry Not just for pharma industry Manufactures of medical devices Manufactures of medical devices Academic institutions which has patents Academic institutions which has patents Civic organisations (patients organisations)-special interests or advocacy positions Civic organisations (patients organisations)-special interests or advocacy positions

14. Authors Authors Editors Editors Reviewers Reviewers Journal staff Journal staff

15. Reporting bias Reporting bias Publication bias Publication bias

16. Promotion and funding of physicians – closely linked to the number of their publications Trivial studies leading to rapid results Trivial studies leading to rapid results Reporting a study more than once Reporting a study more than once “Salami-slicing” publication “Salami-slicing” publication

17. Selective reporting Ignoring certain data (i.e., instances of drug side effects) Ignoring certain data (i.e., instances of drug side effects) Submission of positive results only Submission of positive results only Inclusion of results that agree with the reviewers or editors Inclusion of results that agree with the reviewers or editors Selective reporting Ignoring certain data (i.e., instances of drug side effects) Ignoring certain data (i.e., instances of drug side effects) Submission of positive results only Submission of positive results only Inclusion of results that agree with the reviewers or editors Inclusion of results that agree with the reviewers or editors False authorship – “ghost” authors and “honorary authors”

18. Rejecting papers that do not accord with their own beliefs Accepting papers without critical judgement that support their previous findings, or one that cites them extensively

19. Some journals reject most papers without independent review More likely to send papers to reviewers if they have met or know the authors Possibility to choose the reviewers

20. Conflict of interest – ubiquitous Can’t be eliminated – sholud be managed constructively Problem – when COI influences publication process Dangerous – not immediately apparent Suspicious COI can errode trust and journal reputation

21. Authors can suggest persons they feel should not be reviewers Reviewers must clearly disclose possible COI and refuse to review the manuscripts Reviewers must not use knowledge of the work before publication

22. Avoid reviewers with obvious COI No personal, professional or financial involvement Editorial staff must provide clear disclosure of COI Publish regular disclosure about potential COI Determine whether COI can impair an individual’s objectivity such that the article should not be published