Conflict of Interest and Plastic Surgery Journal Editors: The Problem and the Solution

Journals insist that authors disclose their financial conflicts. However, the same standard is rarely imposed on journal editors. Surprisingly, most high-impact medical journals (about 88%) do not publish editor conflicts of interest (COIs). The Sunshine Act makes it possible to query physician payments from industry. Importantly, some companies are exempted. The leading 5 US-based plastic surgery journals were investigated. Only chief editors and coeditors were included, for a total of 10 editors. The range of payments was US $0 to US $297,000 between 2015 and 2021. The mean payment was $90,890, or $12,984 per year. This amount may be compared with the average industry payments to all plastic surgeons, which is approximately $5000 annually. Examples of editor COIs are considered. In one case, an article detailing important factual deficiencies in an article defending Allergan macrotextured breast implants was rejected by coeditors that included a coeditor who received payments from Allergan. An article promoting radiofrequency treatments containing previously reported data was accepted by a chief editor with a COI, who was also a coauthor. Articles claiming improved scarring for a wound adhesive device and numerous benefits for an Allergan implant insertion funnel also found acceptance by conflicted chief editors, despite serious deficiencies. Editor COIs should be published. Attempts to manage editor COI have not been successful. No data support a dollar limit or expiry date for COIs. Relevance and breadth of COIs are unsolved problems. The ethics of industry payments to physicians are questionable at best. An alternative option is recommended—elimination of COI for journal editors. This remedy would restore editorial integrity and avoid the need for recusals. There is precedence. About half of high-impact medical journal editors have no COIs. Industry subsidies in general should be reconsidered. Abandoning them would be in the best interest of our patients and our specialty.