COMMENTARY

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

Ronald W. Pies, MD

Disclosures

November 11, 2013

In This Article

Psychiatric Medication, Big Pharma, and Publication Bias

In recent years, concern has been increasing that psychiatric research has been unduly biased by its ties to the pharmaceutical industry, and that this bias is often unrecognized in published research articles. In a frequently cited study of publication bias, Perlis and colleagues[6] found that among 397 clinical trials of psychiatric drugs, 239 (60%) reported receiving funding from a pharmaceutical company or other interested party. In 187 studies (47%), at least 1 author reported a financial COI.

Among the 162 examined randomized, double-blind, placebo-controlled studies, those that reported a COI were nearly 5 times more likely to report positive results -- and this association was significant only among the subset of pharmaceutical industry-funded studies. Perlis and colleagues concluded that "author conflict of interest appears to be prevalent among psychiatric clinical trials and to be associated with a greater likelihood of reporting a drug to be superior to placebo."

These findings are often cited by critics of psychiatry as evidence that industry-supported studies of psychotropic medications can't be trusted or are inherently corrupt. Yet this was not the conclusion of the study authors, who provided alternative interpretations of their data. For example:

Industry sponsorship may allow larger and better-designed studies, with greater statistical power to identify significant differences if such differences exist. Indeed, the median number of subjects was larger among studies in which conflict of interest was present. Industry-funded trials would naturally examine drugs already suggested to have efficacy in earlier-stage trials. [6]

In short, at least some industry-funded trials may produce more positive outcomes because they are based on better preliminary information about the drug in question. More fundamentally, Klein and Glick[7] have argued that the best defense against an inaccurate and misleading scientific paper lies in the accurate, scientific scrutiny of the article's methods, design, statistical analysis, and conclusions.As these authors observe, "...the important issue is whether the presentation truthfully reflects the known scientific facts and draws justifiable conclusions..."[7]

According to Klein and Glick,[7] if a study or article meets this test, the issue of financial underwriting is not of great public health importance. If the study fails this test, the research is not redeemed by its independent funding source. Indeed, in principle, a researcher utterly without COI may still produce an atrocious and misleading piece of research. Conversely, a researcher or writer who has a COI may produce an article or study that is accurate, meticulously designed, and scrupulously analyzed.

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