Most medical journals (as well as TCPR) require authors to disclose their affiliations with pharmaceutical companies or other for-profit entities, to help readers assess for any evidence of bias. In a letter of apology published in the January 2014 issue of JAMA Psychiatry (Gibbons RD et al, JAMA Psychiatry 2014;71(1):95), five prominent researchers admit that they failed to reveal a key industry relationship in a November 2012 article (Gibbons RD et al, Arch Gen Psychiatry 2012;69(11):1104–1112).
The article in question was about the development and evaluation of a computerized test for the diagnosis of depression. In their 2014 letter, the authors reveal that at the time of the article’s publication, they all had a financial stake in a for-profit company called Psychiatric Assessments, Inc., or PAI, incorporated in 2011.
In fact, the lead author of the paper, Robert Gibbons, is founder and president of PAI, yet the paper failed to mention this key conflict of interest. Importantly, the primary business of PAI is the development of computerized tests for psychiatric diagnosis.
The conflict of interest has raised additional eyebrows. Another of the paper’s authors is David Kupfer, who—along with each of the other authors, according to the letter—received “founder’s shares” in PAI. Readers may also know Kupfer as the Task Force Chair for the DSM-5, published in 2013. It is concerning, to some, that the individual in charge of drafting new diagnostic criteria for mental illness (ie, the DSM-5) had a simultaneous financial interest in a company that develops materials for potential use in office-based diagnostic testing. Also, the research in question was funded by a NIMH grant (ie, public money) that the researchers apparently plan to translate into a private enterprise.”
It is unlikely that all potential conflicts of interest in psychiatric research can be avoided, but some are more egregious than others. Journal editors should demand disclosure of conflict when researchers have a clear financial interest in the outcome of a study, as in this case. But the present situation reveals an even deeper issue.
For years, the authors of DSM-5—the most visible emblem of organized psychiatry—received intense scrutiny from within and outside of the psychiatric community, much of it pertaining to conflicts of interest, actual and perceived, among its authors. Kupfer and others disclosed their conflicts and swore their impartiality, but we now know that even with these reassurances, not all commercial alliances were revealed. This leads one to wonder: is conflict of interest unavoidable in psychiatry? Are some conflicts more worthy of disclosure than others? And perhaps most important, are certain factions of psychiatrists beyond reproach?