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Effect of different financial competing interest statements on readers’ perceptions of clinical educational articles: a randomised controlled trial
  1. Sara Schroter1,
  2. Julia Pakpoor2,
  3. Julie Morris3,
  4. Mabel Chew1,
  5. Fiona Godlee1
  1. 1 The BMJ, London, UK
  2. 2 Academic Clinical Fellow in Public Health, Oxford University Clinical Academic Graduate School, Oxford, UK
  3. 3 Education & Research Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Manchester, UK
  1. Correspondence to Dr Sara Schroter; sschroter{at}


Objectives To investigate how different competing interest (COI) statements affect clinical readers’ perceptions of education articles.

Design Randomised controlled trial.

Setting and participants Random sample of UK doctors.

Interventions We created four permutations of each of two clinical reviews (on gout or dyspepsia), which varied only in terms of the COI statement. Volunteers were blinded and randomised to receive one review and asked to complete a questionnaire after reading it. Blinded factorial analyses of variance and analyses of covariance were carried out to assess the influence of each review and type of COI on outcomes.

Primary and secondary outcomes Confidence in the article’s conclusions (primary outcome), its importance, their level of interest in the article and their likelihood to change practice after reading it.

Results Of 10 889 doctors invited to participate, 1065 (10%) volunteered. Of these, 749 (70%) completed the survey. Analysis of covariance (adjusting for age, sex, job type, years since qualification) showed no significant difference between the groups in participants’ confidence in the article (gout: p=0.32, dyspepsia: p=0.78) or their rating of its importance (gout: p=0.09, dyspepsia: p=0.79). For the gout review, participants rated articles with advisory board and consultancies COI as significantly less interesting than those with no COI (p=0.028 with Bonferroni correction). Among participants indicating that they treat the condition and that the article’s recommendations differed from their own practice, there was no significant difference in likelihood to change practice between groups (gout: p=0.59, n=59; dyspepsia: p=0.56, n=80).

Conclusions Doctors’ confidence in educational articles was not influenced by the COI statements. Further work is required to determine if doctors do not perceive these COIs as important in educational articles or if they do not pay attention to these statements. More meaningful COI disclosure practices may be needed, which highlight context-specific potential sources of bias to readers.

Trial registration number NCT02548312; Results.

  • general medicine (see internal medicine)
  • medical journalism

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  • Patient consent for publication Not required.

  • Contributors FG initiated the study. SS, JP, JM, MC, FG contributed to the study design, including the wording of the competing interest statements, outcome measures and sampling strategy. JM estimated the required sample size and carried out the statistical analysis. SS was responsible for running the trial and wrote the first draft of the manuscript with help from JP. SS, JP, JM, MC, FG contributed to the interpretation of the results and the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SS and FG are employed full time by The BMJ; MC was formerly employed by The BMJ; JP was a Clegg Scholar at The BMJ and JM is a statistics editor for The BMJ. None of the authors work directly for BMJ Open or are involved in the decision-making process for articles submitted to BMJ Open.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The anonymised individual participant data will be shared on reasonable request.

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