Monday, January 28, 2008

Conflict of Interest in High Places: the American Journal of Psychiatry

It's tough being the editor of a major medical journal these days. You are under constant pressure to fill your pages with high quality research, and much of this is funded by drug companies. Company-funded research is fine, and often leads to important drug discoveries. The problem is that the editors in charge of accepting articles often have their own drug industry ties, making it hard to trust the integrity of the journal content.

The New England Journal of Medicine has been embroiled in these issues for years. The current editor, Dr. Jeffrey Drazen, initially had ties to about 20 drug companies when he took over from Marcia Angell, but he has since severed those ties, and has become an important watchdog of excessive industry influence in medicine.

Unfortunately, our major psychiatric journal, the American Journal of Psychiatry, has decided to take the low road, heading back into the land of conflict of interest. Each January, the journal publishes the financial disclosures of its main editors. You can read the latest disclosures here.
The editor in chief, Robert Freedman, M.D., who disclosed no competing interests last year, now discloses that he serves as an "unpaid co-investigator ... for investigations sponsored by pharmaceutical companies that are developing new drugs for patients based on his research findings."

I nearly jumped out of my seat when I read that, because this is the same editor who took the unusual step of writing an editorial criticizing an accepted article in December 2006 issue. Freedman critiqued an article by Rosenheck that presented data showing that the old antipsychotic Trilafon was more cost-effective than newer atypicals. At the end of that editorial, Freedman said he had no competing interests. Maybe that's true--perhaps he did not begin his "unpaid" investigations with companies until after he wrote the editorial. However, it seems likely that he knew at that time that he might be entering into those relationships, because he has been conducting the research on antipsychotics for many years.

What about the "unpaid" nature of his work with companies? Does this mitigate the nature of his competing interests? Of course not; Freedman co-owns a patent for a promising molecular target of new antipsychotic drugs (see this article for background), and stands to benefit hugely, either financially, or in terms of career advancement, if this target pans out as an effective treatment for schizophrenia.

Don't get me wrong: I think it's great that Dr. Freedman is doing important research and I hope it leads to effective new treatments. But is he the right man to be at the helm of the major American psychiatric journal? Certainly not. We need an editor with no competing interests, whether those interests are related to financial incentives or career incentives.

By the way, I e-mailed Dr. Freedman about my concerns and he responded with the following explanation which I found perplexing:

"My research concerns the development of new treatments for schizophrenia, for which I am funded by NIH and VA research grants. NIH and the VA funded the development of the molecule that I currently am working on. However, in the course of developing new drugs, I may need to interact with a pharmaceutical company if it has discovered a more promising molecule for the targets that my research group has identified. Although that has not happened, I want our readers to be aware that it could possibly happen. It is a disclosure in advance of any transaction that might subsequently require disclosure, so that readers can assess the issue in prospect."

That's a mind-bender! In this month's issue of his journal, he states that he "serves" as an investigator for studies sponsored by drug companies. But in his response to my question, he retracts that disclosure, saying that, in fact, he has not worked with drug companies, and does not now, but that he might in the future.

I, for one, am confused. I look forward to what Dr. Freedman has to say in his 2009 disclosures!


Anonymous said...

We are doomed as a profession when this kind of rationalization comes from alleged leaders in psychiatry.

To me, it gives rougue organizations like Scientology and followers of Szasz ammunition to demean us further. The decade of the brain is turning out to be the decade of the drain; respectability of the field of psychiatry is being sucked into the septic tank of greed and opportunism of selfish interests.

One reasone why I do not belong to the APA or read their journal.

soulful sepulcher said...

typo in title

Anonymous said...

Biographical and disclosure statements are rigidly "styled" from journal to journal. It is a reasonable assumption that the editor of the journal would be loathe to break with the standard journal style for his own disclosure, by providing copy such as "... in the course of developing new drugs, I may need to interact with a pharmaceutical company if ..." That would make for quite the wishy-washy editorial disclosure statement, no?!

Is it possible that in copping to the disclosure in the journal as having pharma affiliations, Dr. Freedman, in fact, took the high road? Since he had the opportunity to provide a longer (and perhaps more accurate) explanation to you, should he be criticized for making a "preemptive admission" in the journal? What about readers referring to Freedman's work in years to come?

As a publisher, I'd naturally give the editor the benefit of the doubt. Though it may very well be warranted in this case. Who would expose such a contradiction in such a haphazard way except for someone striving for a more complete disclosure than he may have been afforded to begin with? Am I making sense, Danny? Regards.

James M. La Rossa Jr.
MedWorks Media Global
Los Angeles, CA

Anonymous said...

Maybe he's waiting for the highest bidder before he declares who he's going to get payment from.

Anonymous said...

I think attacking Freedman is dangerous to the credibility of the Carlat blog.
That is because, for the many who know Freedman, he is the wrong man to be subjected to this kind of scrutiny.
It does make the blog master come across as a paranoiac.