Research Ethics Blog

A recent story in the Milwaukee-Wisconsin Journal Sentinel points to what seems like a new kind of potential conflict of interest in medicine. We’ve published various stories on conflicts of interest in medicine and research before more than once — stories about ghostwriting, <a href="
http://www.researchethics.ca/blog/2008/12/publishing-and-subtleties-of-conflict.html&#8221; target=”_blank”>asking authors to declare potential conflicts of interest, about med schools tightening up their conflict of interest policies, a story on how personal relationships between drug reps and physicians and most recently, a story the appointment of a Pfizer VP to CIHR’s Governing Council. But this time, the story focuses on someone in a different role with a clear conflict of interest — a journal editor.

Thomas Zdeblick, a University of Wisconsin orthopedic surgeon, took over as editor-in-chief of The Journal of Spinal Disorders and Techniques in 2002 while he was working with Medtronic (which he continued to do) in developing, researching and patenting spinal implants. And making millions of dollars in royalties for the patented spinal implants that he then wrote about and published in a number of articles over the last seven years, all published in his own journal.

Here’s a link to the story, in the Milwaukee Sentinel: Journal editor gets royalties as articles favor devices

It would be the beginning of a beautiful friendship.

In the years to come, Zdeblick would receive more than $20 million in patent royalties from Medtronic for spinal implants sold by the company. And the medical journal he edited would become a conduit for positive research articles involving Medtronic spinal products, a Journal Sentinel analysis found.

Dozens of studies that mentioned Medtronic products have been published while Zdeblick has been editor. But in issue after issue, readers of the journal were not told that he was receiving millions of dollars in royalty payments from Medtronic at the same time.

Most of the time the articles, including some co-authored by Zdeblick himself about devices for which he gets royalties, had good things to say about the Medtronic products. Only on a small number of occasions did the articles find major problems with Medtronic devices.

It’s clear that Zdeblick had a conflict of interest and that he was not forthright with readers about this conflict, both in his role as author and his role as editor — according to the article, his relationship with Medtronic was not disclosed in any articles or editorials. Certainly, journals do and should ask authors to declare any potential conflict of interest. And it’s obvious that having a vested financial interest in the success of a device should put up a red flag for anyone assessing the author’s ability to be objective about such a device. But that role — assessing the author’s objectivity and asking questions about relationships — is really the role of an editor along with an editorial board and assigned reviewers. But according to the Sentinel, Zdeblick never declared his relationship with Medtronic and it seems, until now, no one asked.

While there has been plenty of discussion over potential conflicts of interest for authors and researchers, little attention has been paid to editors of journals who have a great deal of control over what research gets published. The representative for Wolters Kluwer (who publishes the journal) and the rep for Medtronic, both cited in the article, feel that there is no need for concern though. Their reassurance, however, is based on the claim that the journal is “independent and peer reviewed” through “strict processes”. Processes which are controlled by the editor-in-chief, who also happens to have co-authored a number of the articles, etc. etc.

Unfortunately, it seems like it’s hardly news anymore when a conflict like this is revealed. In this case, while it seems unique as we’re highlighting a journal editor instead of say, a researcher or an author, it’s the same theme time and time again. Lack of transparency and accountability. No one asking the obvious questions. In this case, one is left wondering about the roles of the editorial board and the reviewers who would have encountered and reviewed article after article, co-authored by the editor-in-chief, about Medtronic spinal implants. It seems like no one had any backbone, until now, to ask questions about this.

As of today, Zdeblick is still listed as editor-in-chief of the journal. We’ll keep you updated on this story as it develops.

~ by Nancy Walton on January 9, 2010.

Posted in by Nancy Walton