Unpacking the black box - a questionnaire study of how medical journals identify and manage conflicts of interest of editors and peer reviewers

Objectives: To describe how medical journals identify and manage conflicts of interest of editors and peer reviewers, how policies are enforced, and whether practices are concordant with policies.Study design and setting: Between April and September 2024, we contacted 250 medical journals, randomly sampled from Clarivate Journal Citation Reports. We sent a questionnaire related to the peer review process, practices for identifying and managing conflicts of interest of editors and peer reviewers, and enforcement of journal policies. We analysed open-ended responses using content analysis. In a subset of journals with conflict of interest policies, we assessed concordance between actual practice and policy content.Results: Of the 250 invited medical journals, 80 (32%) responded to the questionnaire (median completion of questions 94%). Seventy percent of respondents were editors, and 18% publisher representatives. Sixty-six percent of journals identified financial and non-financial interests of editors, 54% did not allow financial interests, and 46% did not allow non-financial interests. Peer reviewers with conflicts of interest were not invited by 66% of journals. Disclosures were required in peer review reports by 41% of journals, 22% verified all or some disclosure information, and 57% informed reviewers on how to handle conflicts of interest. If reviewers had conflicts of interest, 36% of journals would not use the review report. In cases where undisclosed conflicts of interest were identified before or after publication, more than one-third of journals either did not have procedures in place or respondents were unaware of their journal’s practices. For a subset of journals with public policies (N = 55 for editors and N = 54 for peer reviewers), some of the reported practices were discordant with the policy for editors in 45% and for peer reviewers in 50% of journals.Conclusion: The majority of medical journals identify both financial and non-financial interests of editors, but not those of peer reviewers. Conflicts of interest are usually managed by disqualification, but journals often lack procedures, staff are unaware of practices, and practices are not aligned with policies, creating room for inconsistent management of conflicts of interest. These findings highlight the need for comprehensive policies and staff education to promote transparency and integrity in the editorial processes.