Our Conflicted Medical Journals
New York Times
Published: July 23, 2006

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.

http://www.nytimes.com/2006/07/23/op...in&oref=slogin