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

Ronald W. Pies, MD


November 11, 2013

In This Article

Full Disclosure: The Ethical Standard?

Nonetheless, full disclosure is now considered the ethical standard in research, articles, and lectures. Typically, this disclosure is proffered with respect to the material presented in the study, article, or lecture.

Under this standard, owning stock in a pharmaceutical company on the part of the author would not be relevant to an article on, for example, the spiritual dimensions of psychotherapy. However, Daniel Carlat, MD,[8] advocates a more sweeping kind of disclosure, one that:

...require[s] authors to disclose all financial ties to any healthcare-related company, whether seemingly relevant or irrelevant to the topic of the article. It would then be up to the readers to decide whether these ties represented true conflicts.

So far, this more stringent standard does not seem to have been adopted by most journals, but it is arguably more transparent and informative than the typical subject-specific disclosure. In contrast, in a recent study of COI disclosures in psychiatric review articles, Kopelman and colleagues[9] concluded that:

Disclosures seemed to be of limited utility in helping readers assess possible biases because the nature and the extent of the relationships being disclosed were often unclear. Efforts to screen out authors with significant financial relationships pertaining to the topic under review may be more effective than are disclosures, in protecting the integrity of the medical literature.

This proposal, of course, places a substantial "screening burden" on journal editors.

Of interest, Kopelman and colleagues[9] found that reviews in the psychiatric journals were significantly less likely to include industry-related disclosures than were reviews in general medical journals. This led to the conclusion that "...psychiatry does not have a particular problem"[9] with COI, at least with respect to review articles. This, of course, assumes that COI was accurately and honestly reported by the authors of the reviews.


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