Conflicts of Interest: Policies of Psychiatric Times

October 7, 2009

What safeguards does Psychiatric Times build into its review policies to avoid conflicts of interest (COIs)? Do these policies apply to the “supplements” sometimes mailed out with the regular publication?

What safeguards does Psychiatric Times build into its review policies to avoid conflicts of interest (COIs)? Do these policies apply to the “supplements” sometimes mailed out with the regular publication?

As Editor in Chief and Group Editorial Director of Psychiatric Times, we recognize that COIs in medical education are a serious and growing concern. While we appreciate that many definitions of COI have been promulgated, we believe the most useful and coherent definition of COI is the one offered by Harvard ethicist Dennis Thompson:

. . . a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain).1

Psychiatric Times has several levels of protection against COIs. Nonetheless, its heavy reliance on advertising revenues from pharmaceutical companies (rather than on subscription fees) does pose at least a potential COI for its editors and regular writers. One can debate whether the conflict is “actual” or “potential,” depending on one’s definition of COI. In our judgment, a number of factors combine to reduce the risk of undue influence-and hence, the risk of actual COI, using Thompson’s definition.

First, the Editor in Chief is essentially “insulated” from any monitoring, feedback, or even regular discussions, with the corporate and executive officers of the parent company, CMPMedica. No content published in Psychiatric Times is subject to “preapproval” or authorization by the corporate or executive officers of CMPMedica. The entire editorial board of Psychiatric Times has been chosen and approved by the Editor in Chief (in consultation with the Group Editorial Director) and does not answer to any corporate authority.

The board members provide their services without remuneration, and all are required to complete COI disclosure forms every year. These are publicly available on the Web site www.psychiatrictimes.com. To our knowledge, Psychiatric Times is the only major psychiatric publication in this country that requires this of its editorial board members. Furthermore, all regular columnists for Psychiatric Times are required to post and update the same disclosure forms annually. Invited contributions from freelance authors are also subject to a brief COI disclosure query.

Second, most full-length clinical articles-and all online and print Category 1 CME articles-undergo peer review. Normally, this is done with “blinding” of both author and reviewer. In a few instances, the Editor in Chief may decide to accept an article of unusual merit without the usual blind review procedure; and, in some instances, an article deemed unworthy of publication is rejected before full peer review. Many peer-reviewed articles go out to 2 or more reviewers-especially when there is substantial disagreement about the article’s merits.

Also, Pharmonitor, a new feature in Psychiatric Times, invites critical feedback from readers who believe that an article or supplement appearing in the publication shows a positive or negative bias.

From time to time, supplements may be mailed with Psychiatric Times. Typically, their CME content is provided by CME LLC. CME supplements are generally supported through educational grants from pharmaceutical companies and are clearly labeled as having industry support. Historically, CME supplements from CME LLC have undergone review under the auspices of CME LLC, which is certified by the Accreditation Council for Continuing Medical Education (ACCME) to provide physicians with continuing education. In addition, CME LLC has been approved by the AMA to provide physicians with AMA PRA Category 1 Credits (see http://www.cmellc.com/accreditation.html for details). Notwithstanding these credentials, CME LLC supplements have generally bypassed review by the editors and editorial board of Psychiatric Times. On occasion, this has also been true of some content provided by outside sources not affiliated with CME LLC, including pharmaceutical companies.

Psychiatric Times is in the process of establishing tighter “quality control” protocols for all supplements. Specifically, supplements that originate with CME LLC will undergo physician-level review by the CME LLC medical director and accreditation team. In addition, all supplements, including those originating with pharmaceutical companies, will undergo:

• Review by the Editorial Director of Psychiatric Times

• Further review by Psychiatric Times’ editorial board if questions arise as to the article’s objectivity

Final publication and mailing of a supplement will not occur until concerns regarding the article’s objectivity have been adequately addressed. Furthermore, Psychiatric Times will not accept supplements that focus on a single drug, and all discussions of treatment must include a balanced assessment of options.

All print and online supplements will carry a prominent disclaimer notifying readers that the content is supported by a pharmaceutical company, if applicable. Readers will also be able to click on a link or URL to read details of our editorial guidelines. All supplements are also considered “fair game” for reader feedback and critiques in our Pharmonitor column.

We believe that with these multiple layers of protection the risk of substantial COIs is low, and that our readers will receive the most objective and balanced scientific information available. We welcome our readers’ responses to this editorial and look forward to further refinement of our review procedures.

References:

Reference1. Thompson DF. Understanding financial conflicts of interest. N Engl J Med. 1993;329:573-576.