Financial conflict of interest is a near inevitability in today's medical
world, and if it cannot realistically be eliminated, then it must be managed
to preserve the profession's credibility, Catherine DeAngelis, M.D., M.P.H.,
said at the annual meeting of the American Academy of Child and Adolescent
Psychiatry (AACAP) in Chicago in October.
DeAngelis, a pediatrician and editor of the Journal of the American
Medical Association, spoke to the group the day before it debated a
review of its own policies on conflict of interest.
AACAP gave DeAngelis its Catcher in the Rye Humanitarian of the Year Award
for her leadership on the increasingly important issue.
"Dr. DeAngelis has demanded that the medical community reexamine and
reflect on conflicts of interest to assure transparency," said AACAP
President Robert Hendren, D.O., in a statement. "She continues to raise
the bar on behalf of quality research being delivered to families."
Everybody faces some conflict of interest—physicians, researchers,
medical organizations, even journal editors who want to increase their
publication's impact, subscriptions, and profits, said DeAngelis.
"Conflicts arise when there are differences between a physician's
personal interests and the patient's interests," she said.
Medicine is also under increased scrutiny from a skeptical citzenry and
lawmakers, as recent high-profile incidents involving apparent conflicts of
interest by physicians have shown. Responsibility may be widely distributed,
but DeAngelis has no trouble spotting the elephant in the room.
Pharmaceutical and device manufacturers decided 15 years ago to shift
dollars from science to marketing, "and that has too often led to
increased dependence by researchers on industry funding, manipulation of
clinical trials, suppression of results, delay of publication, and even
deliberate lying," she said. "Those outcomes arouse public concern
and threaten the credibility of biomedical research."
Nevertheless, the pharmaceutical companies have an essential place in
medicine, she said, "and we must work with them."
Doing so means starting with full disclosure by physicians of their
financial ties to industry, although "disclosure is not enough,"
she said. JAMA and 11 other major medical journals have also said
that all clinical trials whose results they publish must have been formally
entered in advance in a central clinical-trials registry. In cases where she
suspects major violations of ethical boundaries or attempts to hide them,
DeAngelis emphasized her willingness to call up officials at a researcher's
university and suggest an inquiry (Psychiatric News, September 15,
At the same meeting, AACAP members discussed the second of their
organization's three guidelines covering conflicts of interest in patient care and
research settings, as well as for AACAP as an institution.
The first guideline, governing members' work with their patients, was
approved in June, said AACAP President-elect Laurence Greenhill, M.D., in an
interview with Psychiatric News.
The guidelines take the form of recommendations to members, alerting them
to potential conflicts in their practices and asking them to evaluate those
conflicts and disclose and discuss them with patients. Child and adolescent
psychiatrists should "consider" not accepting gifts from
pharmaceutical companies or distributing patient-information literature
sponsored by them, according to the guidelines.
DeAngelis served on the panel that put together that statement, said
"She really educated us," he said. "It took me a while to
understand the issues, but I have already changed how I do things." As
an example, he said that he would no longer accept travel stipends from a drug
manufacturer in the same year that he received a research grant from the
The second set of guidelines, on conflicts arising in research and
academia, is not yet released publicly but is under review and due for
approval in spring 2009, said Greenhill. A third statement will cover whether
and how AACAP can accept industry funding.
"It is possible to work with private sources of funding, but disclose
those sources and where the money goes," Greenhill stated.