Editors of peer-reviewed journals published by APA will require full
disclosure of any industry-derived personal income and research funding from
all authors of articles they publish, according to an editorial in the
September American Journal of Psychiatry (AJP).
Beginning with the October issues, these stricter disclosures will be
published at the end of each article, to reveal any such funds received in the
12 months prior to submission, not just for the research covered in the
article. The move parallels actions by other medical journals.
"Conflict of interest diminishes the reputation of the field as a
whole," said Robert Freedman, M.D., editor of AJP, in an
"Failures in disclosure are problematic because we believe that
pharmaceutical and other industrial support—through speakers' honoraria,
consultation fees, and research contracts—may bias the conduct of
studies, the interpretation of data, and the reporting of findings,"
said the editorial, signed by Freedman, five deputy editors, and the journal's
Among those signing the editorial are the editors of Psychiatric
Services, Focus, and the Journal of Neuropsychiatry and Clinical
Neurosciences, and the chair of the task force overseeing the next
edition of the DSM (expected to be published in 2011). Jack McIntyre,
M.D., chair of the APA Steering Committee on Practice Guidelines also signed
Financial relationships, said a recent statement by the International
Committee of Medical Journal Editors, "are the most easily identifiable
conflicts of interest and the most likely to undermine the credibility of the
journal, authors, and of science itself."
A study published in the February 1 Journal of the American Medical
Association (JAMA) on the risk of relapse in pregnant women who
discontinued antidepressant medication was criticized in the lay press, for
example, for failing to disclose all relevant industry associations of its
authors. JAMA has since strengthened its rules regarding
"Change is happening but it is quite slow," said Sara Schroter,
Ph.D., senior researcher at BMJ (British Medical Journal)."
It's surprising that some journals are still not insisting on full
The AJP editors set the boundary for reportable income or support
at 12 months, not to veil any prior associations with industry but to allow
authors with earlier conflicts to create a new, conflict-free record, said
Freedman, professor and chair of the Department of Psychiatry at the
University of Colorado Health Sciences Center at Denver.
"Authors' old disclosures are available from previously published
articles," he said "We want to encourage a change in the field,
but we don't want to discourage people who have something to say."
However, an author might still show favor to an industry that provided
compensation in the past, said Schroter, a social scientist who studies
journal publishing. JAMA's policy now requires detailed financial
information covering not only the previous five years but also "for the
Journal editors have to face up to other conflict-of-interest questions as
well. Only nine of 30 medical journals surveyed by Schroter and colleagues had
policies to deal with editors' financial conflicts. Their findings are in the
August 31, 2004, Canadian Medical Association Journal.
The editor and deputy editors of AJP disclose all financial
information in the first issue of each year and do not work on manuscripts
with which they have a conflict, said a statement in the April issue.
Reviewers and associate editors must also disclose potential conflicts that
could arise in manuscripts they review. Manuscripts submitted by Freedman or
his deputy editors are reviewed independently by Howard Goldman, M.D., editor
of Psychiatric Services, to avoid any conflicts.
A complete divorce from the pharmaceutical industry is impossible and
undesirable, said the AJP statement. However, without clear
boundaries, the medical profession is open to criticism from patients about
the source of physicians' prescribing decisions.
"For psychopharmaceuticals in particular, the public's perception
that medications are prescribed free from industry influence is
critical," said the AJP statement.
If the editors of AJP decide that a conflict of interest exists,
they will not publish the submitted paper, said Freedman.
Dropping a conflicted author from the paper is not an option, since
publishing rules require that all persons involved in the study must be named.
Editors cannot investigate disclosures, given the large number of submissions
and co-authors, but if conflicts are discovered after publication,
AJP and the other APA journals can publish an "expression of
concern," which remains permanently linked to the article in Medline and
other databases. Informing the offending authors' institutions is another
possible enforcement tool, said JAMA editor Catherine DeAngelis,
M.D., M.P.H. That approach has already triggered internal investigations and
expanded conflict-of-interest education at at least three medical schools this
year, she said, in an August 23/30 editorial.