Scandalous conflicts of interest revealed in psychiatry guidelines

Quick, answer this question: Who writes the guidelines for physicians on how to treat mental illnesses, such as schizophrenia, bipolar disorder or major depression? 

A) Psychiatrists interested in the welfare of patients with these terrible and debilitating diseases?
B) Academic researchers who are willing to lend their expert opinion to help fellow doctors?
C) People financed by drug companies who can be counted on to write the guidelines in a way that serves the company's interests?
D.) All of the above.

If you answered D, you're on the money.

In fact, being "on the money" is the operative phrase here, because a recent report on the conflicts of interest in psychiatric guidelines committees reveal some shocking facts about the financial entanglements of the people putting those guidelines together. 

The study published last month found that 90% of the authors of three American Psychiatric Association (APA) clinical practice guidelines in psychiatry had financial ties to drug companies mentioned in those guidelines. Worse yet, the authors had financial associations including owning equity in the companies that made the recommended medications, being a consultant or corporate board member, or receiving honoraria. And these conflicts were not disclosed in the guideline.

The picture becomes even darker when you narrow in on the conflicts of interest of the authors of the guidelines for just bipolar disorder and schizophrenia: Here, 100% of the authors had such conflicts.

Most people would consider this a worrying state of affairs, including Tufts professor Sheldon Krimsky, one of the co-authors of this report.  In an interview from his office in Boston, he told me that we should be worried about conflicts of interest because they can lead to a "distortion of the scientific record" and that drug companies who fund such activities may lead to an "interpretation of the science in a direction that may not be defensible."

Authors who disclose their conflicts of interest are only an intermediate step, says Krimsky, and more effort should be made to separate the researchers and the clinicians from the drug manufacturers' influence.

No doubt, guideline committees such as ones sponsored by the APA need to come clean on their financial conflicts. But they must avoid or minimize them in the first place.

John Santa, director of the Consumer Reports Heath Ratings Center, underscores the point by noting, "It is especially concerning that organizations like the American Psychiatric Association have financial relationships with drug companies and have been slow to appreciate the influence these relationships have created. We rely on professional and consumer organizations to protect patients and doctors from industry, not facilitate their influence."

Here's a simple skill-testing question I think the APA's guidelines gurus could use for prospective committee members:  "Do you have financial ties to drug companies which make psychiatric medications?"  

It doesn't take a brainiac to figure out where to go from there…

—Alan Cassels, guest blogger

Alan is a pharmaceutical policy researcher at the University of Victoria, British Columbia and co-author of "Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients."