Reviewer Conflict of Interest

September 2002 
The following case was submitted anonymously by an editor and discussed at the Fourth International Congress on Peer Review in Barcelona in September 2001. The case was presented to the audience by Michael Callaham of the WAME Ethics Committee and was discussed by an expert panel, consisting of Richard Smith (BMJ), Richard Horton (Lancet), and Frank Davidoff (Annals of Internal Medicine). There was much commentary from a very informed audience. A very brief summary of the topics and key discussion points follows below. 

The Case

We rejected a manuscript after peer review. Although we had received two reports that were quite positive, asking for minor corrections before publication, the third report was very negative, arguing that the authors hadn't provided enough documentation of scientific results to demonstrate their point. None of the three reviewers declared to have competing interests. 
A few days after he was informed of our decision to reject the paper, the corresponding author wrote back to us that the referee who had written the negative report had in fact failed to mention an important conflict of interest. The rejected paper presented a new method to pre-select the sex of offspring, and the referee was the holder of a patent on the method that is commonly used. Of course, one can see the economic impact publication of this paper might have had on the referee's royalties, etc. We didn't contact the referee, but told the author that we would be willing to consider a resubmission of the manuscript. 
Questions and discussion on case #1: 
The role of open (signed) review — the point was made by an editor whose journal uses open (unmasked) review that the only reason this conflict came to light was that the name of the reviewer was publicly revealed, thus allowing the conflict to be recognized. In the more traditional blinded review, the author would never have known of this conflict and the paper might well have been rejected for (undetected) reasons of bias. 
The language of the “declaration of competing interests” — The case information is very vague about this declaration. Was there indeed a specific declaration, or was silence taken to be a negative declaration? How specific is the conflict of interest statement the reviewer has to sign regarding competing interests? Does it require an explicit yes or no answer? Is the reviewer in fact required to sign any statement? The description given above is vague and does not specify. Many journals do not require reviewers to make any declarations about conflict of interest; others require them to state if they have a conflict but leave it up to them to volunteer that information. Not asking reviewers explicitly may result in them saying nothing, and such a non-response is too ambiguous. The most unequivocal way of dealing with this is to require reviewers to declare, over signature, that they either do or do not have a conflict. There can be no confusion about this statement if it later turns out they did have a conflict. 
How should the reviewer be dealt with? Should other authorities be notified? The dean or university? — Discussion pointed out that the journal has an obligation to maintain the integrity of the scientific record, and thus cannot simply do nothing about a reviewer who either did not recognize or declare this serious conflict of interest. Remedies could range from a phone call educating the reviewer to the ethical principles involved and the journal’s policies on them, to a formal letter to the reviewer. It is not clear from the case how well the journal explained its expectations to the reviewer either for that specific review, or when the reviewer first began working for the journal. If the journal never specifically explained its expectations, that is a failing on their part and they should do so for all reviewers. Notifying a dean or the university has very serious consequences in many instances and is most appropriate for a case where clear scientific misconduct has occurred. In this case, one would have to try to determine the intent, the background, and the previous reputation of this reviewer before deciding on such an action. 
Note that the journal says they “didn’t contact the referee.” This suggests a “hands-off” approach that may have contributed to this problem in the first place. Deliberately recommending rejection of a competitor’s paper for one’s own financial advantage would clearly be scientific misconduct and would certainly distort the scientific record (if successful); a journal has a responsibility to make sure this does not happen. The journal cannot conduct a formal investigation or issue any definitive judgment, but if the circumstances support this interpretation, they should relay the details of the case to an institution with appropriate authority to do these things. Whether the institution proceeds to appropriate action is a separate matter that is not under the control of journals or editors; it is well known that some institutions prefer to sweep such matters under the carpet, particularly if the involved person is famous, powerful, or brings a large amount of money to the institution. However, that is not a reason for editors to shirk their responsibility to report when necessary. 
What about "blacklists" of a reviewer who clearly lied about their conflict of interest? — Several editors recounted having used the blacklist method (refusing to consider or publish subsequent submissions of the offending reviewer) and recommended it. In some cases, the blacklisting was internal and only applied to that one journal; in another, the blacklist was shared with several journals in one specialty area. There are several problems with this approach. The most trivial problem is that reviewers might still have valuable expertise to offer in areas in which they did not have a conflict of interest, but you would then be relying on the judgment of a person who had already proven that his or her ethical judgment was poor. Additionally, with a blacklist you are arriving at a judgment without a formal investigation that could stand up under legal scrutiny, and applying a remedy that might be considered a form of defamation of character. No cases were mentioned in which this became a legal issue, but it could be. Furthermore, if there truly was a conflict that was scientific misconduct, this solution would be unknown to the world and would only apply to one journal, or a few journals. The offender could continue the same practice elsewhere. A referral to an institution, on the other hand, could if appropriate lead to a formal, defensible legal investigation. 
How much proof (if any) is an author who accuses a reviewer of such a conflict required to submit? Would they need to provide evidence of stock ownership? Or is their accusation alone enough to warrant referring it for investigation? — The answer, obviously, is that their accusation is sufficient for the journal to have to consider the issue. A journal cannot conduct a formal investigation (see above), but it can collect facts and responses from the involved parties and consider the issues. If the statements of the involved parties and the supporting evidence (if any) would lead a reasonable person to believe that some ethical breach occurred, then the journal has to decide what next step to take, as discussed above. The author may indeed provide supporting materials and that would be helpful, but requiring them to provide evidence such as stock ownership (which they may have no access to) is an unfair requirement that would simply ensure that very few reviewers who conducted themselves this way would ever experience any consequences. Again, the journal cannot and should not conduct a formal inquiry that is implied to have legal significance, but is in the same position as an executive in a company who discovers what appears to be embezzlement or some other serious misconduct. If there is enough evidence for a reasonable person to be concerned about whether the allegation occurred or not, the matter must be resolved to someone with the authority to appropriately follow it up and investigate it. In scientific publication, that is usually the university or funding agency.

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