International Committee
of Medical Journal Editors

2.Issues to consider before
submitting a manuscript

3.Requirements for
submission of manuscripts

- Definition of a
peer-reviewed journal
- Editorial freedom
and integrity

- Conflict of interest
- Authors
- Reviewers
- Editors and staff
- Confidentiality
- Medical journals and
the popular media

- Advertising
- Supplements
- The role of the
correspondence column

- Competing manuscripts
based on the same study:

- Differences in analysis
or interpretation

- Differences in reported methods or results


Separate statements: Definition of a peer-reviewed journal

A peer-reviewed journal is one that has submitted most of its published; articles for review by experts who are not part of the editorial staff. The number and kind of manuscripts sent for review, the number of reviewers, the reviewing procedures, and the use made of the reviewers' opinions may vary, and therefore each journal should publicly disclose; its policies in its instructions to authors for the benefit of readers and potential authors.

Editorial freedom and integrity

Owners and editors of medical journals have a common endeavor-the publication of a reliable and readable journal, produced with due respect for the stated aims of the journal and for costs. The functions of owners and editors, however, are different. Owners have the right to appoint and dismiss editors and to make important business decisions in which editors should be involved to the fullest extent possible. Editors must have full authority for determining the editorial content of the; journal. This concept of editorial freedom should be resolutely defended by editors even to the extent of their placing their positions at stake. To secure this freedom in practice, the editor should have direct access to the highest level of ownership, not only to a delegated manager.

Editors of medical journals should have a contract that clearly states the editor's rights and duties in addition to the general terms of the appointment and that defines mechanisms for resolving conflict.

An independent editorial advisory board may be useful in helping the editor establish and maintain editorial policy.

All editors and editors' organizations have the obligation to support; the concept of editorial freedom and to draw major transgressions of such freedom to the attention of the international medical community.

Conflict of interest

Conflict of interest for a given manuscript exists when a participant in the peer review and publication process-author, reviewer, and editor-has ties to activities that could inappropriately influence his or her judgment, whether or not judgment is in fact affected. Financial relationships with industry (for example, through employment, consultancies, stock ownership, honoraria, expert testimony), either directly or through immediate family, are usually considered to be the most important conflicts of interest. However, conflicts can occur for other reasons, such as personal relationships, academic competition, and intellectual passion.

Public trust in the peer review process and the credibility of published articles depend in part on how well conflict of interest is handled during writing, peer review, and editorial decision making. Bias can often be identified and eliminated by careful attention to the scientific methods and conclusions of the work. Financial relationships and their effects are less easily detected than other conflicts of interest. Participants in peer review and publication should disclose; their conflicting interests, and the information should be made available so that others can judge their effects for themselves. Because readers may be less able to detect bias in review articles and editorials than in reports of original research, some journals do not accept reviews and editorials from authors with a conflict of interest.


When they submit a manuscript, whether an article or a letter, authors are responsible for recognizing and disclosing financial and other conflicts of interest that might bias the ir work. They should acknowledge in the manuscript all financial support for the work and other financial or personal connections to the work.


External peer reviewers should disclose to editors any conflicts of interest that could bias their opinions of the manuscript, and they should disqualify themselves from reviewing specific manuscripts if they believe it to be appropriate. The editors must be made aware of reviewers' conflicts of interest to interpret the reviews and judge for themselves whether the reviewer should be disqualified. Reviewers should not use knowledge of the work, before its publication, to further their own interests.

Editors and staff

Editors who make final decisions about manuscripts should have no personal financial involvement in any of the issues they might judge. Other members of the editorial staff, if they participate in editorial decisions, should provide editors with a current description of their financial interests (as they might relate to editorial judgments) and disqualify themselves from any decisions where they have a conflict of interest. Published articles and letters should include a description of all financial support and any conflict of interest that, in the editors' judgment, readers should know about. Editorial staff should not use the information gained through working with manuscripts for private gain. Corrections, retractions, and "expressions of concern" about research findings

Editors must assume initially that authors are reporting work based on honest observations. Nevertheless, two types of difficulty may arise.

First, errors may be noted in published articles that require the publication of a correction or erratum of part of the work. It is conceivable that an error could be so serious as to vitiate the entire body of the work, but this is unlikely and should be handled by editors and authors on an individual basis. Such an error should not be confused with inadequacies exposed by the emergence of new scientific information in the normal course of research. The latter require no corrections or withdrawals.

The second type of difficulty is scientific fraud. If substantial doubts arise about the honesty of work, either submitted or published, it is the editor's responsibility to ensure that the question is appropriately pursued (including possible consultation with the authors). However, it is not the task of editors to conduct a full investigation or to make a determination that responsibility lies with the institution where the work was done or with the funding agency. The editor should be promptly informed of the final decision, and if a fraudulent paper has been published, the journal must print a retraction. If this method of investigation does not result in a satisfactory conclusion, the editor may choose to publish an expression of concern with an explanation.

The validity of previous work by the author of a fraudulent paper cannot be assumed. Editors may ask the author's institution to assure them of the validity of earlier work published in their journals or to retract it. If this is not done they may choose to publish an announcement to the effect that the validity of previously published work is not assured.


Manuscripts should be reviewed with due confidentiality. In submitting their manuscripts for review, authors entrust editors with the results of their scientific work and creative effort, on which their reputation and career may depend. Authors' rights may be violated by disclosure of the confidential details of the review of their manuscript. Reviewers also have rights to confidentiality, which must be respected by the editor. Confidentiality may have to be breached if dishonesty or fraud is alleged but otherwise must be honored.

Editors should not disclose information about manuscripts (including their receipt, their content, their status in the reviewing process, their criticism by reviewers, or their ultimate fate) to anyone other than the authors themselves and reviewers.

Editors should make clear to their reviewers that manuscripts sent for review are privileged communications and are the private property of the authors. Therefore, reviewers and members of the editorial staff should respect the authors' rights by not publicly discussing the authors' work or appropriating their ideas before the manuscript is published. Reviewers should not be allowed to make copies of the manuscript for their files and should be prohibited from sharing it with others, except with the permission of the editor. Editors should not keep copies of rejected manuscripts.

Opinions differ on whether reviewers should remain anonymous. Some editors require their reviewers to sign the comments returned to authors, but most either request that reviewers' comments not be signed or leave the choice to the reviewer. When comments are not signed the reviewers' identity must not be revealed to the author or anyone else. Some journals publish reviewers' comments with the manuscript. No such procedure should be adopted without the consent of the authors and reviewers. However, reviewers' comments may be sent to other reviewers of the same manuscript, and reviewers may be notified of the editor's decision.

Medical journals and the popular media

The public is entitled to important medical information without unreasonable delay, and editors have a responsibility to play their part in this process. Doctors, however, need to have reports available in full detail before they can advise their patients about the reports' conclusions. In addition, media reports of scientific research before the work has been peer reviewed and fully published may lead to the dissemination of inaccurate or premature conclusions.

Editors may find the following recommendations useful as they seek to establish policies on these issues.

1. Editors can foster the orderly transmission of medical information from researchers, through peer-reviewed journals, to the public. This can be accomplished by an agreement with authors that they will not publicize their work while their manuscript is under consideration or awaiting publication and an agreement with the media that they will not release stories before publication in the journal, in return for which the journal will cooperate with them in preparing accurate stories (see below).

2. Very little medical research has such clear and urgently important clinical implications for the public's health that the news must be released before full publication in a journal. In such exceptional circumstances, however, appropriate authorities responsible for public health should make the decision and should be responsible for the advance dissemination of information to physicians and the media. If the author and the appropriate authorities wish to have a manuscript considered by a particular journal, the editor should be consulted before any public release. If editors accept the need for immediate release, they should waive their policies limiting prepublication publicity.

3. Policies designed to limit prepublication publicity should not apply to accounts in the media of presentations at scientific meetings or to the abstracts from these meetings (see Redundant or Duplicate Publication). Researchers who present their work at a scientific meeting should feel free to discuss their presentations with reporters, but they should be discouraged from offering more detail about their study than was presented in their talk.

4. When an article is soon to be published, editors may wish to help the media prepare accurate reports by providing news releases, answering questions, supplying advance copies of the journal, or referring reporters to the appropriate experts. This assistance should be contingent on the media's cooperation in timing their release of stories to coincide with the publication of the article.


Most medical journals carry advertising, which generates income for their publishers, but advertising must not be allowed to influence editorial decisions. Editors must have full responsibility for advertising policy. Readers should be able to distinguish readily between advertising and editorial material. The juxtaposition of editorial and advertising material on the same products or subjects should be avoided, and advertising should not be sold on the condition that it will appear in the same issue as a particular article.

Journals should not be dominated by advertising, but editors should be careful about publishing advertisements from only one or two advertisers as readers may perceive that the editor has been influenced by these advertisers.

Journals should not carry advertisements for products that have proved to be seriously harmful to health-for example, tobacco. Editors should ensure that existing standards for advertisements are enforced or develop their own standards. Finally, editors should consider all criticisms of advertisements for publication.


Supplements are collections of papers that deal with related issues or topics, are published as a separate issue of the journal or as a second part of a regular issue, and are usually funded by sources other than the journal's publisher. Supplements can serve useful purposes: education, exchange of research information, ease of access to focused content, and improved cooperation between academic and corporate entities. Because of the funding sources, the content of supplements can reflect biases in choice of topics and viewpoints. Editors should therefore consider the following principles.

1. The journal editor must take full responsibility for the policies, practices, and content of supplements. The journal editor must approve the appointment of any editor of the supplement and retain the authority to reject papers.

2. The sources of funding for the research, meeting, and publication should be clearly stated and prominently located in the supplement, preferably on each page. Whenever possible, funding should come from more than one sponsor.

3. Advertising in supplements should follow the same policies as those of the rest of the journal.

4. Editors should enable readers to distinguish readily between ordinary editorial pages and supplement pages.

5. Editing by the funding organization should not be permitted.

6. Journal editors and supplement editors should not accept personal favors or excessive compensation from sponsors of supplements.

7. Secondary publication in supplements should be clearly identified by the citation of the original paper. Redundant publication should be avoided.

The role of the correspondence column

All biomedical journals should have a section carrying comments, questions, or criticisms about articles they have published and where the original authors can respond. Usually, but not necessarily, this may take the form of a correspondence column. The lack of such a section denies readers the possibility of responding to articles in the same journal that published the original work.

Competing manuscripts based on the same study

Editors may receive manuscripts from different authors offering competing interpretations of the same study. They have to decide whether to review competing manuscripts submitted to them more or less simultaneously by different groups or authors, or they may be asked to consider one such manuscript while a competing manuscript has been or will be submitted to another journal. Setting aside the unresolved question of ownership of data, we discuss here what editors ought to do when confronted with the submission of competing manuscripts based on the same study.

Two kinds of multiple submissions are considered: submissions by coworkers who disagree on the analysis and interpretation of their study, and submissions by coworkers who disagree on what the facts are and which data should be reported.

The following general observations may help editors and others dealing with this problem.

Differences in analysis or interpretation

Journals would not normally wish to publish separate articles by contending members of a research team who have differing analyses and interpretations of the data, and submission of such manuscripts should be discouraged. If coworkers cannot resolve their differences in interpretation before submitting a manuscript, they should consider submitting one manuscript containing multiple interpretations and calling their dispute to the attention of the editor so that reviewers can focus on the problem. One of the important functions of peer review is to evaluate the authors' analysis and interpretation and to suggest appropriate changes to the conclusions before publication. Alternatively, after the disputed version is published, editors may wish to consider a letter to the editor or a second manuscript from the dissenting authors. Multiple submissions present editors with a dilemma. Publication of contending manuscripts to air authors' disputes may waste journal space and confuse readers. On the other hand, if editors knowingly publish a manuscript written by only some of the collaborating team, they could be denying the rest of the team their legitimate coauthorship rights.

Differences in reported methods or results

Workers sometimes differ in their opinions about what was actually done or observed and which data ought to be reported. Peer review cannot be expected to resolve this problem. Editors should decline further consideration of such multiple submissions until the problem is settled. Furthermore, if there are allegations of dishonesty or fraud, editors should inform the appropriate authorities.

Two kinds of multiple submissions are considered: submissions by coworkers who disagree on the analysis and interpretation of their study, and submissions by coworkers who disagree on what the facts are and which data should be reported.

The cases described above should be distinguished from instances in which independent, non-collaborating authors submit separate manuscripts based on different analyses of data that are publicly available. In this circumstance, editorial consideration of multiple submissions may be justified, and there may even be a good reason f or publishing more than one manuscript because different analytical approaches may be complementary and equally valid.

Members of the International Committee of Medical Journal Editors: Linda Hawes Clever, Western Journal of Medicine; Lois Ann Colaianni, US National Library of Medicine; Frank Davidoff, Annals of Internal Medicine; Richard Glass, JAMA; Richard Horton, The Lancet; George Lundberg, JAMA; Magne Nylenna, Tidsskrift for Den Norske legeforening; Richard G Robinson, New Zealand Medical Journal; Richard Smith, BMJ; Bruce P Squires, Canadian Medical Association Journal; Robert Utiger, The New England Journal of Medicine; Martin VanDer Weyden, The Medical Journal of Australia; and Patricia Woolf, Princeton University.

This document may be copied and distributed without charge for not-for-profit, educational purposes.

The uniform Requirements has been published in several journals. Please cite a version that appeared in the primary journal literature on or after 1 January 1997.

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