The King of Industry Supplements and I

John Shelton, PhD, may well be one of the most influential people in the field of psychiatry—though he is not a psychiatrist, and you may never have heard of him. He is the publisher of the Journal of Clinical Psychiatry, and is thus, in my mind, both Dr. Jekyll and Mr. Hyde. Jekyll-wise, he produces an excellent journal, brimming with clinically relevant articles covering topics that front-line psychiatrists care about (as opposed to, for example, Archives of General Psychiatry, which is filled with basic science articles).

But in his Mr. Hyde persona, he publishes dozens of industry-supported CME Supplements, each of which is an advertisement for a product marketed by the sponsoring company. I’ve never been shy about criticizing these supplements (here), and nor have other critics (here).

As I walked by the J Clin Psych booth at the APA meeting earlier this week, I saw Dr. Shelton in the flesh, and went up to him and introduced myself. He is a slim gregarious man with white hair and a ready smile, but when he looked at my name tag, he frowned. “The blogger!” he exclaimed. “There he is.” Surprised that he knew me right off the bat, I was a little flustered, and said, “Yep, that’s me….and I wanted to thank you for accepting my letter.” (I was referring to a soon-to-be-published letter in which I complain about bias in this recent BMS-funded supplement). “Look,” he said, “we put your letter through our review process, which is what we do for all our articles.”

The conversation was brief but cordial. I reiterated that I have no problem with the main journal but that the supplements appear to be promotional, almost without exception. He and Jane Eckstein, who is the director of their CME operation, maintained that the content is developed completely independently of drug company input. This is the standard bone of contention between those on different sides of the commercial CME divide, and both arguments are predictable, so I didn’t tarry long at the booth.

As I left, I realized that it all depends on what you define as “bias.” If you define it as inaccurate information, then Shelton and Eckstein are correct, since their supplements are carefully vetted for accuracy. But if you define it as manipulating the choice of accurate information to serve a promotional objective, then Team JCP is guilty as charged, since each supplement covers a topic of commercial benefit to the sponsor, and information is chosen to highlight advantages of the sponsor’s product.

To argue that the information is accurate and helpful to readers is not relevant. The information in drug ads is also accurate (the FDA makes certain of that) but nobody would argue that they are not also promotional.

Dr. Shelton mentioned that commercial CME covers important off-label uses, which FDA forbids companies to discuss (although recent guidelines may change this). But, in fact, doctors who don’t participate in industry CME are also free to teach about off-label uses, and they do so, frequently.

The debate will continue. And while I believe that you are doing the wrong thing, Dr. Shelton, I applaud you for being willing to engage with the “enemy”!