Financial conflicts of interest in psychiatry FORUM: FINANCIAL CONFLICTS OF INTEREST IN PSYCHIATRY

The proliferating connections between physicians and the pharmaceutical industry have brought the credibility of clinical medicine to an unprecedented crisis (1). The public seems to be increasingly skeptical of clinical medicine, since corporate actions that have placed profit over public health have become regular news in the media (2). Medical journals have been defined by a former editor as “an extension of the marketing arm of pharmaceutical companies” (3). The dangers of medicine’s complicity with big business have been disclosed to the lay public in several books (4-7). In one of these books, John Abramson admirably unveils how propaganda has substituted research evidence in the medical field (7). More and more voices from academic medicine are questioning the relationship between the pharmaceutical industry and the physicians (8). Conflicts of interest have thus become a major issue of concern in medicine, including psychiatry, and are getting more and more important for medical journals (9). They undermine the credibility of papers which are submitted, their review process, and even the editorial decisions about acceptance or rejection. The notion of conflict of interest is widely used but may entail different meanings. Margolis (10) distinguishes between conflicting interests and conflicts of interest. The former occur in any situation where competing considerations are presumed to be legitimate. Conflicts of interest, on the other hand, are characterized by individual occupying dual roles which should not be performed simultaneously. Because of the potential for abuse, performing both roles at the same time is considered to be inappropriate. Which roles? For instance, being a researcher and holding a financial interest in an area related to the research one is involved in. Table 1 lists the main sources of conflicts of interest. I will describe some of the insights that research on conflicts of interest has generated in medicine and psychiatry, and some strategies which may counteract this phenomenon.