At American Family Physician, we believe that readers should be able to clearly distinguish educational content from the advertisements we publish. However, we are hardly alone among medical journals in being vulnerable to biased or even promotional content that may be introduced by those with financial or other conflicts of interest. We take the responsibility of providing unbiased clinical information very seriously and have several mechanisms in place to ensure editorial independence and scientific credibility.

For example, AFP's policy is to not interrupt the pages of clinical review articles with advertisements. Wherever possible, we also keep advertisements for drugs, devices, and medical tests away from articles that may happen to discuss these products, lest such placement be interpreted as an implicit endorsement. Our medical editors and their immediate family members are prohibited from having financial interests in or other affiliations with pharmaceutical companies. Finally, authors of clinical review articles are required to submit detailed disclosures of professional activities, which are reviewed for potential conflicts of interest at the time of submission.

What Is a Conflict of Interest?

A conflict of interest is any financial or proprietary interest or arrangement that may cause an author to write more or less favorably about a subject than they otherwise would. These include, but are not limited to, financial support, assistance with manuscript preparation, honoraria, consulting services agreements, grants, research support, directly purchased stock holdings, speaker's bureau listings, employment, and other material support. Some conflicts may require only a simple published acknowledgement, while others may be serious enough to warrant rejection of the manuscript. We require that authors submit all relevant information and allow our editors to decide what is important.

Until recently, our Letters to the Editor department operated on the honor system regarding conflict of interest disclosures. Because we receive hundreds of letters each year and publish only a small portion, we have previously requested, but have not required, that authors disclose any potential conflicts. It had been our assumption that authors who did not submit disclosure forms did not have any conflicts to disclose. Unfortunately, this has not always been the case. As we and other journals have discovered,¹ authors may not only intentionally fail to disclose obvious conflicts of interest, but in some cases have not even written the manuscript they're submitting. Even for the most vigilant editors, detecting these “corporate coauthors” can be challenging.

New Letters Policy

Therefore, for consistency's sake, and to encourage full disclosure of all conflicts of interest, we have changed our Letters policy and will now publish a disclosure statement after every letter. If authors state that they have no conflicts of interest, that disclosure will be noted. By making conflicts of interest more transparent, we hope to further encourage intellectual honesty in publication. This “trust, but verify” approach offers additional assurance that you will be able to tell the difference between education and advertising in AFP.

Submitting a Letter or Comment

Letters to the editor are published in each issue of AFP, and we welcome submissions from readers. You may comment on a previously published article or present a freestanding letter on an important clinical topic. Letters should be fewer than 500 words in length, with a limit of one table or figure, and six or fewer references. Some letters may be published online only; online letters will be listed in the table of contents of the print version. For more information on submitting a letter, see page 470 of this issue.

To submit other comments or suggestions about how to improve AFP, please feel free to mail the comment card published in this issue or send an e-mail to afpedit@aafp.org.