Vagus Nerve Stimulation and Depression: Conflict of Interest's "Perfect Storm"?

By Daniel J. Carlat, MD | December 1, 2006

Adequate disclosure is a good way to minimize the negative effects of conflict of interest, but—as we have seen in this review—there is much disagreement about what constitutes adequate disclosure. My own perspective is informed by my responsibilities as editor of a newsletter that eschews pharmaceutical funding, and thus my opinions are oriented to more, rather than less, disclosure. A proposal of what I feel editors should request from authors can be found in the Table.


TABLE Recommended author disclosures

*1. Authors should be required to disclose all* financial relationships with any commercial health care entity. Journal editors should decide which relationships are relevant to the content of the article; they can publish whichever disclosures they believe are most likely to present relevant conflicts of interest. 2. Detailed authorship disclosures should be required. The author responsible for the first draft should ordinarily be the first author listed, since the first draft forms the backbone of the finished article and the writer of the first draft generally does most of the hard work of literature review and synthesis. Therefore, each author's specific contribution should be disclosed; it will be up to the editor to decide whether all of this information is relevant enough to merit printing. 3. Compensation disclosures should be required.** This can take the form of broad ranges rather than specific dollar amounts, but an indication of the scale of financial compensation is crucial in judging the likelihood of bias.

Clearly, psychiatry is in crisis. Many of our top academic leaders appear willing to sell themselves to the highest corporate bidder. However, since this is a crisis of ethics, it will not be resolved easily. A good start is to require meaningful disclosures so that readers can begin to regain their trust in the integrity of psychiatric opinions.

This is part 2 of a 2-part article on conflict of interest in psychiatry. Part 1, "Conflict of Interest in Psychiatry: How Much Disclosure is Necessary?" was published in the November issue of Psychiatric Times.
Dr Carlat is assistant clinical professor of psychiatry at Tufts University School of Medicine in Boston and is editor-in-chief of The Carlat Psychiatry Report. He reports no conflicts of interest concerning the subject matter of this article.

Pages: 1 2 3 4

References
1. Our conflicted medical journals. Editorial. The New York Times. July 23, 2006; sect 4:11.
2. US Senate Committee on Finance. Review of the FDA's approval process for the vagus nerve stimulation therapy system for treatment resistant depression. February 2006. Available at: http://finance.senate.gov/press/Gpress/02_2006 report.pdf. Accessed October 12, 2006.
3. Nemeroff CB, Mayberg HS, Krahl SE, et al. VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiologic mechanisms. Neuropsychopharmacology. 2006;31:1345-1355.
4. Armstrong D. Medical reviews face criticism over lapses. Wall Street Journal. July 19, 2006;B1.
5. Waters R. Medical journal to correct Cyberonics device article. Bloomberg News. July 18, 2006.
6. Is this the perfect storm of corruption? ACNP journal. Alliance for Human Research Protection Web site. Available at: http://www.ahrp.org/cms/content/view/295/55/. Accessed October 13, 2006.
7. Leading research institutions initiate mechanism of action studies on vagus nerve stimulation (VNS) therapy for treatment-resistant depression. Cyberonics press release. May 23, 2006. Available at: http://www.cyberonics.com/PressRelease_detail.asp?
ID=32A90EDE-A8C6-4AAB-A709-C0C432DFF3CA. Accessed October 13, 2006.
8. Armstrong D. Medical journal editor Nemeroff steps down over undisclosed ties. Wall Street Journal. August 28, 2006;B7.
9. Mathews AW. At medical journals, writers paid by industry play big role. Wall Street Journal. December 13, 2005;A1.
10. Healy D, Cattell D. Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatry 2003;183:22-27.
11. Bass A. Drug companies enrich Brown professor. Boston Globe; October 4, 1999:A1.

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Vagus Nerve Stimulation and Depression: Conflict of Interest's "Perfect Storm"?

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