Protesting Conflicts of Interest in Psychiatry

An interesting letter to the editor in Psychiatric News regarding Conflicts of Interest, by Alan Stone, M.D. - Cambridge, Mass.

At our APA annual meeting in San Diego in May, I attended a symposium that continues to trouble me. It was unlike any other APA symposium I have attended over the past 40 years.

Various speakers presented different kinds of evidence about the ways large pharmaceutical houses distort the results of clinical trials and mislead psychiatrists about the relative merits of their products. One shocked clinician finally asked the question that I imagined was on everyone's mind—I paraphrase her words, "How am I to sort my way through all this misinformation so I can do what is best for my patients?" One of the speakers suggested that she subscribe to his independent newsletter. But the reality is that most ordinary practitioners continue to be awash in misinformation.

Perhaps the most troubling moment for me came when the discussant for the symposium, one of the most distinguished psychiatrists in the world, put the various presentations in perspective. What it boiled down to was that huge sums of money are at stake, it is a high-risk industry, and the pharmaceutical companies are not entirely evil. Most experts who know anything and whose opinions are worth having will be retained by drug companies, so the legalistic approach of focusing on conflicts of interest will eliminate only the knowledgeable experts from decision-making panels.

All this I had heard before, but then he confirmed a shocking and fraudulent practice of misinformation that one of the presenters had described.

Drug companies control their own clinical research, have it written up by science-writing firms created for that purpose, and then shop it around to find an academic with the right credentials to be the first author. The academic's resume grows, the career prospers, more captive experts are created, and the drug company plants more misinformation in our journals.

Other psychiatrists at the symposium seemed well aware of this fraudulent collaboration; I was not. But when the symposium discussant acknowledged that he had himself been asked to participate in this kind of obvious deception, I was compelled to believe it exists. The discussant then said, "We all know who is doing it, and the solution is to shame them." I am not one of the "we" who knows who the academics are who have done this or who are doing it, but surely it is an offense equal to plagiarism.

Unfortunately the discussant did not identify any of the offenders who have done or are doing this, so to my knowledge the shaming did not begin at that May symposium in San Diego. I would therefore like to remind the "we who all know" that section 2 of APA's principles of ethics require us to "strive to report physicians. . .engaging in fraud or deception to appropriate entities."

Someone once said about the medical profession that medical etiquette is more important than medical ethics. Unless the shaming begins, that damning judgment will once again be proven correct.