COMMENTARY

Conflicts of Interest: Concepts, Conundrums, and Course of Action

Ronald W. Pies, MD

Disclosures

November 11, 2013

In This Article

A Psychiatrist on Potential Conflicts of Interest

Consider these potential conflict of interest scenarios:

The slide set. Dr. A is an academic psychiatrist and well-regarded lecturer. She receives an invitation to speak on the topic of antidepressant use during pregnancy at a major medical school. The talk is sponsored by a pharmaceutical company that makes a popular antidepressant, and the stipend for Dr. A's participation is very generous. The pharmaceutical company representative contacts Dr. A and tells her, "We have a set of slides that our lecturers have found very helpful. There is no obligation, but we would be happy to send them to you."

To what extent does this scenario present Dr. A with a conflict of interest (COI)? What are her ethical obligations in this situation?

The pharmacy committee. Dr. B agrees to join a speaker's bureau for a large pharmaceutical company, in exchange for a regular monthly stipend. Dr. B then accepts a position at a large community mental health center, where he is appointed to the center's Pharmacy & Therapeutics Committee. It is the committee's job to decide which psychiatric medications to include in the center's formulary. The list of candidate medications includes several drugs produced by the company from which Dr. B receives a stipend.

What COI, if any, does this pose for Dr. B, and what are his ethical obligations?

The dependent patient. Dr. C is a psychiatrist in private practice providing individual psychotherapy to a 38-year-old unmarried woman, Ms. Y, who has been diagnosed with generalized anxiety disorder and "dependent personality traits." Ms. Y originally sought help for her generalized anxiety disorder and had no particular complaints with respect to interpersonal relationships or dependency issues. She has been in treatment with Dr. C for nearly 1 year, twice weekly, and regularly pays out-of-pocket, preferring not to involve any third-party payers.

Dr. C has used a combination of cognitive-behavioral and psychodynamically oriented approaches and has concluded that Ms. Y's anxiety disorder is now in full remission. He wonders whether it is appropriate to continue the therapy, even though Ms. Y has expressed the clear wish to continue seeing him.

We will return to consider these vignettes and the ethical issues they raise later in this article.

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