Thursday, April 16, 2009

Where's the conflict of interest here, Mr. Robinson?

Remember the flap a few weeks ago between researcher Jonathan Leo and the Journal of the American Medical Association, whereby JAMA's editors got egg all over their face after trying to intimidate Leo? Leo, a professor of neuroanatomy at Lincoln Memorial University in Harrogate, Tenn., had written a letter to the British Medical Journal, pointing out that the author of a study published in JAMA failed to disclose he had a financial relationship with the drug company whose product he was reporting on. As it turned out, Leo had first brought the undisclosed conflict of interest to the attention of JAMA, but when he didn't hear back from them for five months, he published it online in BMJ. JAMA editors then insisted they were about to issue the correction themselves (which they did here) and blasted Leo for acting precipitously (is waiting five months precipitous?). According to an article by David Armstrong in the Wall Street Journal, Catherine D'Angelis, editor in chief of JAMA, went so far as to call Leo "a nobody and a nothing."

Now there's a new twist to this saga: Robert Robinson, the researcher who originally failed to disclose his conflict of interest, published a letter yesterday in BMJ where he accuses Leo of having a conflict of his own. Leo, he said, was a board member of the International Center for the Study of Psychiatry and Psychology (ICSPP), a group "that is strongly opposed to the blanket use of psychopharmacological treatments." Neither accusation happens to be true: Leo is no longer a board member of ICSPP, and the ICSPP is not opposed to the use of drugs. Indeed, the group's website says, "we are not against the use of psychoactive drugs by competent adults who have been thoroughly informed of their value, potential side effects, and alternatives."

What Robinson seems not to understand is what a conflict of interest really consists of. According to Tufts University's Sheldon Krimsky and other experts, conflicts of interest are widely understood to be financial interests or ties to companies whose products you are studying. As Krimsky told me when I was researching my book, Side Effects, "The integrity of the scientific endeavor is tarnished by the quantity of the money [a particular researcher] is getting as well as the lack of disclosure." Research done by Krimsky and others shows that financial conflicts of interest do bias the recipients of such largesse and their work. And that's why JAMA and other leading medical journals require researchers to disclose financial conflicts of interest, which Robinson failed to do. (Robinson now acknowledges that he was getting personal payments from Forest Labs, the maker of Lexapro, which he should have disclosed in the JAMA study finding that Lexapro was effective in helping treat depression in stroke victims).

But where is financial conflict of interest with regard to Leo? Yes, he was once a board member of ICSSP, an unpaid position, but while that may shed light on where he stands about the indiscriminate use of powerful psychoactive drugs, it is not a conflict of interest. Get real, Robinson.

Full disclosure: I have been asked to speak at the ICSPP's annual meeting next fall (Oct. 9) in Syracuse. And while I am being reimbursed for my travel expenses, I am not being paid a speaker's fee. Would that I were!


Dan said...

This ordeal only became precipitious due to exposure of wrongdoing. Had this not occured, neither would any precipite.

Conflicts of interests corrupt or alter the duties of others they are obligated to perform.

The conflict can either be actual or potential. In this particular case, the corruption from the conflict of interest atrophies the reliability of clinical researchers, and perhaps IRBs, annotators, and so forth.

This happens because there are no clear guidelines between the pharma industry and elements of clinical research.

Other professions are different regarding conflicts of interests.

With lawyers, if a conflict of interest exists or is discovered, the lawyer involved with performing duties related to their profession withdrawls and new counsel is engaged as a result.

This is due to the Model Rules Of Professional Conduct. Perhaps the pharma industry needs a similiar Model Rules maxim.

Fid said...


Where DO they drags these words from?

The book of Stonewalling perhaps?

A fav of the British drugs regulator seems to be 'vexatious'

Basically, they label the person enquiring vexatious because they are not satisfied with the answer the MHRA give them.

Spin that merry-go-round now.