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The doors of perception

What's the difference between real and perceived conflicts of interests?

A few weeks ago, a reader of our blog, Spoonful of Medicine, wondered what we meant by 'perceived' conflicts of interest: “This term crops up frequently in the editorials of Nature journals, and I would be extremely grateful if [...] you would like to explain the difference between a perceived and an actual conflict of interest.”

This is a frequently asked—and very interesting—question that perhaps only an ethicist could answer in a rigorous way. Editorially, though, let's start by saying that our chief concern relates to conflicts of financial interests (CFIs) and that we have a clear policy about their declaration by authors, referees and editors, which can be found on our website.

In the case of perceived CFIs, we think about them as instances in which no conflict exists, but the potential for financial gain as a result of what we publish is strong enough to give our readers the impression of an actual conflict.

A typical example, from the perspective of our own potential conflicts, is the publication of sponsored content. Producing, say, a supplement to Nature Medicine requires financial resources that may not be part of our budget. If we want to publish this content for the benefit of our readers, we must find the money elsewhere. A sponsor may be interested in the topic of the supplement and agree to underwrite the costs.

To the casual reader, this may look like a CFI—either the sponsor directly paid for the content, or the journal published on this topic to get money from the sponsor. There is, however, no conflict, because our sponsors never have a say on the editorial content of anything we publish. In fact, all of the editorial content for supplements is often already commissioned before we approach potential sponsors.

Our reader, however, is not persuaded: “Even with an absolute division of labor between financial and editorial activity, to be truly unconflicted, an editor would have to be totally unaware of the magazine's readership and advertisers [...]. Conflicts are therefore an inseparable part of editorship, and the important question is whether an editor understands and recognizes conflicts adequately and deals with them satisfactorily.”

We agree. In the example above, we would definitely recognize the potential for conflict. Whether we deal with them satisfactorily, though, depends on who you ask, as journals vary a lot in their handling of these issues—there are journals that, as a matter of policy, don't carry sponsored content or even advertising, and there are journals that experience no such inhibition and publish content directly paid for by a sponsor.

In our case, some readers will always construe sponsored content as a CFI, even though we have always striven to be as transparent as possible regarding the role of sponsorship. We are certainly sensitive to these concerns and welcome your views on this matter.

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The doors of perception. Nat Med 14, 106 (2008).

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