Regular readers of Psychiatric Times know that we have been engaged in a comprehensive review of our “conflict of interest” (COI) and disclosure policies, which now include posted disclosure statements from all our editorial board members. So far as we are aware, Psychiatric Times is the only major psychiatric journal to require this of its editorial board, as well as of our regular writers.
But our readers are also sophisticated enough to know that such disclosures do not guarantee scientific or journalistic objectivity and accuracy. Indeed, there is an important sense in which arguments over COI policies miss the scientific point. The critical questions readers ought to be asking of scientific journals about a given article are:
• Was the article based on well-designed and appropriately analyzed studies?
• Did the authors have access to unpublished and perhaps “negative” studies bearing on the drug or drugs in question?
• Do the claims in the article comport with the best available data, or are they “spun” in a way that reflects bias?
I believe these are actually more important questions than those relating to the researcher’s or author’s “ties” to the pharmaceutical industry, although readers should be made aware of relevant commercial affiliations that could bear on the author’s objectivity.
In an important and provocative commentary, Drs Donald F. Klein and Ira D. Glick argue that “the complex COI issue cannot be dealt with by an editorial fix”1(p3026) and that editors must make more concerted efforts to evaluate the raw data on which a study’s claims are based. In principle, I agree. But as Klein and Glick acknowledge, “many current articles far exceed the statistical capabilities of so-called peer reviewers (and the readers) . . . [and] how to meet the expenses of engaging expert statistical and scientific reviewers is certainly a problem.”1(p3025) It is safe to say that no Editor-in-Chief, even one assisted by a full-time staff of biostatisticians, could possibly review and evaluate all the data behind every article that appears in the journal and still meet publication deadlines. We do not live in the “best of all possible worlds,” but in this all-too-imperfect one. And yet—as Klein and Glick correctly argue—scientific journals must do more to restore the public’s trust in medical science than merely publish COI disclosure statements.
To help address this responsibility, Psychiatric Times will be launching a new occasional column titled “Pharmonitor.” This will be reader-driven commentary of about 700 words, focusing on articles and reports in Psychiatric Times that the reader considers biased. This means that, in the reader’s opinion, the article either under-emphasized or over-emphasized the positive or negative effects of a pharmaceutical agent or medical device. To be published or posted on www.PsychiatricTimes.com, the Pharmonitor submission will need to show, scientifically, how the article in question slanted the data or failed to consider certain elements of experimental design (such as lack of a control group, poor statistical analysis, or biased sample) in reaching its conclusions. Submissions will not be accepted on the basis of personal attacks on investigators or their putative “motives”—or simply on the strength of a supposed financial COI. However, a substantial and relevant COI could be noted in the broader critique.
On occasion, we may permit the author of the criticized article the opportunity for rebuttal, or offer editorial comment on the submission. We may even invite pharmaceutical industry representatives to comment on submissions, when appropriate. We believe that nobody should be “banned” from the marketplace of ideas, even when we find the ideas objectionable. In a recent and very important book, Dubovsky and Dubovsky wisely note, “The same [scientific] principles apply to industry-sponsored and non-industry–sponsored studies.”2(p87) There is, of course, no monopoly on exaggerated claims, and “Big Pharma” should not be singled out in this respect. Sometimes, inaccurate claims regarding the efficacy of psychosocial treatments may also appear in published studies, and this journal is also open to critiques of such claims.
Dubovsky and Dubovsky argue that protecting the public from exaggerated pharmaceutical company claims “by attempting to legislate away industry marketing” is not likely to succeed. Rather, it is more important that physicians learn how to “think critically about all of the information to which they are exposed.”2(pp10-11) That, indeed, is the goal of our Pharmonitor column, ably augmented by Dr Nassir Ghaemi’s series of columns on statistics in psychiatry, the first of which appears in this issue on page 31.
We at Psychiatric Times will not be able to evaluate the raw data or statistics on every study that comes our way. Our Editorial Board and outside peer reviewers continue to provide an important “check” on the objectivity and accuracy of our articles. But we can also enlist the aid of an alert readership to help us maintain our scientific and ethical compass. We owe nothing less to our readers and our patients.