To the Editor,
We congratulate JAMA on committing to deal publicly with conflict of interest (COI)[1] However your editorial implies that preventing trouble from future whistle-blowers trumps the integrity of JAMA’s disclosure practices. We do not understand why the prompt exposure of unreported COI in any appropriate forum should be discouraged. An academic response to the BMJ's series on Doctors, Patients, and the Drug Industry[2] struck us as appropriate, when JAMA failed to correct its own record expeditiously.
Obfuscation of COI should be corrected urgently because it may contribute to scientific “disinformation”. Simultaneous with publication of the research report in JAMA, [3] Dr. Robinson recommended in the popular media that ‘every stroke patient who can tolerate an antidepressant should be given one to prevent depression’ [4] – even though his study showed no advantage of medication over talk therapy. The JAMA study may have influenced prescribers’ and stroke patients’ subsequent decisions in favour of antidepressants, while they remained ignorant about Dr. Robinson’s ties to Forest Laboratories. The advantage of COI disclosure is to allow journal readers and media to use their own informed judgment to assess how such bias may affect the study authors’ objectivity in interpretation of experimental data.
It is also unclear why JAMA could not have responded within days of being informed of Dr. Leo’s concerns. JAMA could have confirmed or refuted any allegations by asking Dr. Robinson for urgent clarification about information readily available on the internet. JAMA’s lag time to resolve a simple issue of intellectual integrity greatly exceeds the typical delay for de novo review of complex manuscripts.
Finally, we are concerned that JAMA editors took the potentially intimidating step of contacting Dr. Leo's academic superior simply because Dr. Leo had alerted the scientific community to a violation of JAMA’s policy. In contrast, your editorial did not indicate any contact with Dr. Robinson's superiors or grantors to apprise them of his lapse in proper disclosure. JAMA’s apparent scepticism about Dr Leo’s motivation contrasts with seemingly uncritical acceptance that Dr Robinson’s failure to disclose a primary conflict of interest reflected a “memory lapse”.
We propose a more constructive approach to dealing with conflict of interest. JAMA and other leading journals should give priority to complete transparency and timely correction of any incomplete reporting. After all, the reputation of journals is not as important as the integrity of medical research and scientific inquiry.
Dr Jon Jureidini, MBBS, FRANZCP, PhD
Head, Department of Psychological Medicine,Women's & Children's Hospital, 72 King William Street
Adelaide
South Australia 5006 Telephone: +61 8 8161 7227
Facsimile: +61 8 8161 7032
jon.jureidini@health.sa.gov.au
Thomas L. Perry, BSc, MD, FRCPC
Clinical Assistant Professor,
Dept. of Anesthesiology, Pharmacology & Therapeutics
University of British Columbia
Vancouver
Dr Agnes Vitry, PharmD, PhD
Senior Research Fellow,
Quality Use of Medicines and Pharmacy Research Centre
Sansom Institute, School of Pharmacy and Medical Sciences
University of South Australia
Adelaide
Acknowledgement: The authors are members of Healthy Skepticism Inc. Jeffrey Lacasse is a member of Healthy Skepticism’s international management group and provided information that assisted in the preparation of this letter.
1. DeAngelis CD, Fontanarosa PB. Conflicts over conflicts of interest. JAMA, published online March 20, 2009 (doi:10.1001/jama.2009.480).
2. Leo J, Lacasse J. Clinical trials of therapy versus medication: even in a tie, medication wins. BMJ Rapid responses. March 5, 2009.
3. Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, Fonzetti P, Hegel M, Arndt S. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA 2008; 299(20):2391-400.
4. Elias, M. Study: Antidepressants help stroke victims. USA Today, May 28, 2008.