NYT Editorial: Our Conflicted Medical Journals

"Leading medical journals seem to be having a difficult time disentangling themselves from the pharmaceutical and medical device industries. If they cannot stop printing articles by scientists with close ties to these businesses, they should at least force the authors to disclose their conflicts of interest publicly so that doctors and patients are forewarned that the interpretations may be biased."
 
However, an unfortunate coyness prevents readers from gaining clarity about who is corrupting medical information sources. Why leave readers to wonder who the culprits are whose conduct the editorial rightfully criticizes? The editorial refers to: "13 authors"— without citing that study. [1]  The unnamed authors are prominent faculty members at Harvard, UCLA and Emory.
Times reporters generally refer to them in news reports as "authorities"–also without disclosing to readers their financial ties to drug manufacturers.

The editorial refers to Neuropsychopharmacology as an "obscure journal published by the leading professional society in the field…"

Given that only a small inner circle of drug makers and departments of psychiatry at academic centers know the cast of characters,  99.9% of Times readers are likely left bewildered.

Readers would have gained insight had they been informed that the publisher, the powerful American College of Neuropsychopharmacology (ACNP), has used its prestige and substantial resources–provided mostly by pharmaceutical companies–to promote expanded use of costly and controversial psychoactive drugs. ACNP promotes controversial uses of drugs in children–despite their hazardous effects; ACNP promotes controversial invasive interventions whose safety and value is unproven; ACNP used its muscle to try to prevent the FDA from issuing warnings about  the risks of drug-induced suicidal behavior in children prescribed SSRI antidepressants; [2]  and ACNP continues to issue reports denying those risks–even after the drugs’ manufacturers added warnings acknowledging on the drugs’ labels multiple lethal risks. http://www.ahrp.org/cms/content/view/71/28/

Finally, the editorial is justifiably outraged by the ACNP journal editor’s involvement, calling it "particularly incestuous."
"the lead author of the study is the journal’s editor and a consultant to the company. He has been accused in the past of promoting therapies in which he had a financial stake."

Shouldn’t readers be told who the editor / consultant is?  Shouldn’t they be informed that he is also an influential chairman of a university department of psychiatry?

If the editorial’s lack of clarity was an effort to shield the culprits out of deference to academia, it is a sign of misplaced elitism.
If, on the other hand, the unclear allusions were meant to convey that the entire field is corrupted by conflicts of interest, then readers should at least be informed about a series of major recent exposes documenting widespread institutional conflicts of interest. [4] [5]
.
The Times editorial board should consider stepping up to the plate by adopting al strict disclosure policy for its own science, news, and business reporters who report about medicine.

REFERENCES:

1. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.  JAMA. 2006 Feb 1;295(5):499-507.

2. ACNP has issued several reports exonerating SSRI antidepressants–even as the manufacturers acknowledge multiple lethal risks:  "Executive Summary" of a "Task Force" Report issued by PR agency GYMR (January 2004 two weeks before FDA hearings). the ACNP claimed "SSRI Antidepressants Do Not Increase Suicidal Behavior in Youth with Depression." ACNP Presents Findings As FDA Opens Hearings;    Report issued by the American College of Neuropsychopharmacology (ACNP) Task Force, “SSRIs and Suicidal Behavior in Youth,” (January 2006).
http://www.nature.com/npp/journal/vaop/ncurrent/full/1300958a.html.  

See: ACNP Task Force ties to drug companies: http://www.ahrp.org/cms/content/view/26/55/

3. Charles B Nemeroff, Helen S Mayberg, Scott E Krahl, James McNamara, Alan Frazer, Thomas R Henry, Mark S George, Dennis S Charney and Stephen K Brannan.  VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms  Neuropsychopharmacology (July, 2006) 31, 1345–1355. published online 19 April 2006. http://www.nature.com/npp/journal/v31/n7/full/1301082a.html

4. Full disclosure of the issues–including documents and identitification of the key players in academia–is accessible on the AHRP website.  

July 12:  Harvard –Psychiatry’s Opinion Leaders Financial Ties to Industry:
Drug Interactions: Financial Ties to Industry Cloud Major Depression Study –Wall Street Journal  http://www.ahrp.org/cms/content/view/286/55/

July 19: Is this the perfect storm of corruption?
ACNP journal: Medical Reviews Face Criticism Over Lapses–Wall Street Journal  http://www.ahrp.org/cms/content/blogsection/1/55/

July 20: AQ Matter of Disclosure:  FDA Adds SSRIWarnings:  http://www.ahrp.org/cms/content/view/296/55/  

5. Of note,  The Wall Street Journal and other newspapers have uncovered evidence demonstrating  the corrupting influence of pharmaceutical and medical device industries.
Among these

 The Los Angeles Times: July 17:  LAT Investigation: NIH Scientist Ties to Pharma http://www.ahrp.org/cms/content/view/292/55/

Mercury News: July 9: Conflicts of Interest: Stanford University http://www.ahrp.org/cms/content/view/283/55/ ;
    July 10: Science critics make issue of financial ties  http://www.ahrp.org/cms/content/view/286/55/

Bloomberg News: July 18: Medical Journal to Correct Cyberonics Device Article http://www.ahrp.org/cms/content/view/295/55/

The Associated Press: July 19: JAMA Misled Again Over Industry Ties: http://www.ahrp.org/cms/content/view/296/55/

Also of note, an article by a scientist in the U.K. who blew the whistle on scientific fraud and the collusion of academia with pharmaceutical companies.
July 18. While Rome Burns by Dr. Aubrey Blumsohn:  http://www.healthyskepticism.org/library/ref.php?id=6059

Contact: Vera Hassner Sharav
veracare@ahrp.org
 

http://www.nytimes.com/2006/07/23/opinion/23sun2.html?_r=1&oref=slogin
THE NEW YORK TIMES
July 23, 2006
Editorial
Our Conflicted Medical Journals

Leading medical journals seem to be having a difficult time disentangling themselves from the pharmaceutical and medical device industries. If they cannot stop printing articles by scientists with close ties to these businesses, they should at least force the authors to disclose their conflicts of interest publicly so that doctors and patients are forewarned that the interpretations may be biased.

Two disturbing cases were described in detail by The Wall Street Journal in recent weeks. One involved The Journal of the American Medical Association, or JAMA; the other an obscure journal known as Neuropsychopharmacology, which is published by a leading professional society in the field.

The article in JAMA must surely have pleased all makers of antidepressant drugs. It warned pregnant women that if they stopped taking antidepressant medication they would increase their risk of falling back into depression. Hidden from view was the fact that most of the 13 authors had been paid as consultants or lecturers by the makers of antidepressants. Their financial ties were not disclosed to JAMA on the preposterous grounds that the authors did not deem them relevant.

An even more egregious set of events occurred at Neuropsychopharmacology, which recently published a favorable assessment of a controversial new treatment for depression resistant to conventional therapies. Left unmentioned was that eight of the nine authors serve as consultants to the company that makes the device used in the therapy. The ninth works directly for the company. Just to make things particularly incestuous, the lead author of the study is the journal’s editor and a consultant to the company. He has been accused in the past of promoting therapies in which he had a financial stake.

It is hard to know whether to be more upset at the journal’s failure to disclose these ties or at its decision to let such interested parties serve as authors in the first place. Early drafts of the article were prepared by a professional writer hired by the company. With all those ingredients coalescing, it is no wonder that the new therapy was judged “a promising and well-tolerated intervention” for treatment-resistant depression.

Many journals have been tightening their disclosure and publication policies in recent years, and both JAMA and Neuropsychopharmacology plan further tightening. But the reforms are not likely to go far enough. It seems imperative that more muscle be put into forcing disclosure and publication of conflicts of interest. If all leading journals agreed to punish authors who fail to reveal their conflicts by refusing to accept further manuscripts from them, a lot more authors would be inclined to fess up. Better yet, journals should try much harder to find authors free of conflicts. That is the best hope for retaining credibility with doctors and the public.

Copyright 2006 The New York Times Company

FAIR USE NOTICE: This may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a ‘fair use’ of any such copyrighted material as provided for in Title 17 U.S.C. section 107 of the US Copyright Law. This material is distributed without profit.