Accessibility and transparency of editor conflicts of interest policy instruments in medical journals.

BACKGROUND: There has been significant discussion about the need to manage conflict of interest (COI) in medical journals. This has lead many journals to implement policies to manage COI for authors and reviewers; however, surprisingly little attention has been focused on the COI of journal editors. OBJECTIVE: The goal of this exploratory study was to determine whether the policies were accessible to the public and to researchers, and to discuss the potential impact on public transparency. DESIGN: The authors conducted an internet search of editor COI policy instruments that have been developed, implemented and communicated by the top 10 peer-reviewed medical journals (2010 ISI Web of Knowledge Impact Factor), and assessed their general accessibility by gauging the level of difficulty in navigating the journal's website (number of clicks to find the policy instruments). RESULTS: Only four of the 10 medical journals (40%) in this study have accessible COI policy directives that include editors (JIM, PLoS Medicine, AIM, CMAJ). One journal (NEJM) had an editorial on the subject, and another (The Lancet) mentioned editor COI in their general guidelines. These documents are not readily accessible; starting from the journal's main website at least four clicks are needed to access these documents. CONCLUSION: These results suggest that there is a general lack of accessible editor COI policy instruments among leading medical journals, something that may consequently have a negative impact on the trust accorded to these journals.

Ricoeur's "Petite éthique": an ethical epistemological perspective for clinician-bioethicists.

The passage from a posture of clinician to that of clinician-bioethicist poses significant challenges for health professionals, most notably with regards to theoretical or epistemological views of complex ethical impasses encountered in clinical settings. Apprehending these situations from the only clinical perspective of the nurse or the doctor, for example, can be very unproductive to help solve this kind of situation and certainly poses great limits to the role of the clinician-bioethicist. Drawing on my own experience as a former nurse who, following graduate studies in bioethics has begun providing ethics consultation services, I argue that clinicians must undergo an epistemological transformation in order to become clinician-bioethicists. A source of inspiration or framework for would-be clinician-bioethicists is, I suggest, the "Petite éthique" developed by the contemporary French philosopher Paul Ricoeur. Specifically, clinician-bioethicists should develop specific core ethical competencies (in line with the conclusions of the American Society for Bioethics and Humanities (Core competencies for health care ethics consultation, 1998); namely: savoir or knowing, savoir faire or knowing how to do, and savoir être or knowing how to be.