Setting the Record Straight

Perhaps you read the editorial commentary in the August issue of Psychiatric Times in which our editor-in-chief, Ronald Pies, MD, wrote about ongoing congressional hearings into potential conflicts of interest (COIs) among prominent psychiatrists? Dr Pies wrote of the need for Psychiatric Times to ensure that “our own house is in order” and that “this begins with our own editorial board-which includes some of the most respected names in the field of psychiatry.” Dr Pies reported then that PT editorial board members would be asked to submit a detailed disclosure form in hopes that editorial transparency would help to “ensure fair and accurate reporting, as well as balanced and scientifically grounded opinion and commentary.”

The financial statements of our editorial board members can now be viewed on www.PsychiatricTimes.com: the link is http://www.psychiatrictimes. com/editorial-board.

We find it surprising and paradoxical that these efforts were met with the following online report, which was recently posted to the Web site of an organization called Integrity in Science (http://www.cspinet.org/integrity/watch/200809021.html).

The director of that organization declined to post Dr Pies’s responses to that report on its Web site. We believe, however, that Dr Pies’s response (which follows) needs to be heard. We hope that you will find his retort to the following online report illuminating and compelling.

Editorial board of Psychiatric Times to disclose COIs

"The ongoing congressional investigation into conflicts of interest in medicine has prompted Psychiatric Times to begin disclosing its editorial board’s conflicts of interest to readers. In an editorial, Ronald Pies, editor-in-chief of Psychiatric Times, said 'it is the editor-in-chief’s job to know of potential conflicts and to make executive decisions accordingly.' However, the move only raises further questions about who is calling the shots at leading psychiatric journals. The International Committee of Medical Journal Editors’ 'Uniform Requirements for Manuscripts Submitted to Biomedical Journals' says 'editors who make final decisions about manuscripts should have no personal financial involvement in any of the issues they might judge.' Top editors of psychiatric journals, though, frequently have such ties and include Pies [and 3 colleagues*] all of whom receive education grants or consulting fees from pharmaceutical companies that sell psychiatric medicines."

In response to that item, Dr Pies wrote to advise the director that “your information about my association with pharmaceutical companies is outdated and inaccurate.” He noted that “since I became editor-in-chief of Psychiatric Times in January 2007, I have not (to the best of my knowledge and recollection) received any speakers’ honoraria or stipends from any pharmaceutical companies, nor do I accept any such honoraria any longer.” Dr Pies asked “I hope you will correct the erroneous impression created by your article about my activities.”

The director responded: “. . . We use a 5-year-look-back period for conflicts of interest. This is the same look-back period used by the Journal of the American Medical Association. . . .”

In regard to the financial disclosures, the director offered “thanks for elevating your publication’s standards. I am certain it will pay dividends in the form of increased credibility in the years ahead.”

Dr Pies responds

I am sure both of [our organizations] strongly support the ideals of full disclosure of conflict of interest and “transparency” in scientific journals. This, indeed, was the intention behind our recent disclosure policy at Psychiatric Times.

It is one thing for a journal like JAMA to “cast a wide net” and require disclosure information from authors extending back 5 years. It is quite another for an organization such as yours to single out specific editors-in-chief and their publications for what amounts to the not-very-subtle implication that we are somehow involved in undisclosed or inappropriate conflicts of interest that might bias the scientific content of our publications-and all this, without seeing fit to contact or distinguish the particular editors, with respect to their specific disclosures or potential conflicts of interest, if any.

Section II D of the International Committee of Medical Journal Editors (ICMJE) “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” includes a statement on conflict of interest (COI): “Conflict of interest exists when an author (or the author’s institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions (such relationships are also known as dual commitments, competing interests, or competing loyalties). These relationships vary from those with negligible potential to those with great potential to influence judgment, and not all relationships represent true conflict of interest.”

Section II D 3 notes that “editors should publish regular disclosure statements about potential conflicts of interests related to the commitments of journal staff. . . .”

Knowing from our August 2008 Editorial (which you cited) that Psychiatric Times was in the process of posting updated disclosure information about its editorial board, the responsible action-rather than publishing innuendoes-would have been to check with me, and with the identified psychiatrists individually, to see if we were at present reporting potential or actual conflicts of interest; and then, making a professional determination as to whether any such conflicts represented ones with “negligible potential” or “greater potential” to influence our editorial judgment, consistent with ICMJE standards.

Otherwise, you are essentially arguing that there is no substantive difference, with respect to safeguarding the public interest, between, say, a physician who accepted two or three $500 speaking honoraria 3 years ago and none since; and a physician who, to this day, belongs to a drug company’s speakers bureau, receives regular stipends from that company, and holds substantial stock in it.

This sort of broad-brush approach to disclosure only tars reputations and does not serve the public interest, in my view. Furthermore, in my opinion, your failure to investigate these particulars does not reflect well on the “integrity” of your organization. Indeed, the conclusion reached in your article re: Psychiatric Times’ new disclosure policy strikes me as both misleading and cynical; ie, “the move only raises further questions about who is calling the shots at leading psychiatric journals.”

Surely, our policy does not “only” raise further questions-it also answers some, as regards our Board members and writers. Indeed, I would argue that our policy represents a significant step in the direction of “transparency,” and stands as an example of responsible practice for other professional journals. I would have thought that your conclusion that PT’s new disclosure policy “[elevates] your own publication’s standards . . .” and that “. . . it will pay dividends in the form of increased credibility in the years ahead” might have been reflected in the original announcement you ran. It puzzles and disturbs me that it was not.

I hope you will see fit to contact the other psychiatrists whose reputations you have impugned-esteemed colleagues and thoroughly decent professionals, all-to see if they wish to respond to your organization’s article. . . .

We support Dr Pies’s view that it is not appropriate to make statements about conflicts of interest based on incomplete and out-of-date information. One well-respected medical ethicist who reflected on the matter commented, “It is misleading to speak in the present tense about events that happened in the past, especially without a footnote explaining their process of attributing conflicts of interest.” As Dr Pies puts it, “misuse of the ‘look-back’ period is blatantly misleading to the general public-a curious position to be in an organization that casts itself in the role of guardian of the public interest and a paragon of ‘integrity.’”

Please e-mail us your comments at PTEdit@cmpmedica.com.

[*The link to one of the named editors (R.F.) brings up information about another person with a similar name.]