Background: Clinical practice guidelines (CPG) are developed, endorsed, and disseminated through professional medical organizations such as the American Psychiatric Association (APA) as the standard of care for health care providers. Because of their influence, it is critical that CPG are based on objective data, unprejudiced by stakeholder groups, and that any financial associations between authors of CPG and the pharmaceutical industry are made transparent. The present study examined the degree and type of financial ties to the pharmaceutical industry held by authors of 3 major CPG. Methods: By using multimodal screening techniques, we investigated the financial relationships to the pharmaceutical companies of 20 work group members who authored the guidelines for the treatment of schizophrenia, bipolar disorder, and major depressive disorder. Results: Eighteen CPG authors (90%) had at least 1 financial tie to the pharmaceutical industry. All of the CPG authors who had industry relationships had financial relationships with companies whose products were specifically considered or included in the guideline they authored. The leading categories of financial interest held by CPG authors were research funding (77.7%), consultancies (72.2%), members of corporate boards (44.4%), and collaborators in industry-funded studies (44.4%). Conclusions: Ninety percent of the authors of 3 major CPG in psychiatry had financial ties to companies that manufacture drugs which were explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses. None of the financial associations of the authors were disclosed in the CPG.

Keywords:
Clinical practice guidelines, Conflict of interest, Financial associations
1.
Choudhry NK, Stelfox HT, Detsky AS: Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002;287:612–617.
2.
Genuis S: The proliferation of clinical practice guidelines: professional development or medicine-by-numbers? J Am Board Fam Prac 2005;18:419–425.
3.
Grilli R, Magrini N, Penna A, Giorgio M, Liberati A: Practice guidelines developed by specialty societies: the need for critical appraisal. Lancet 2000;355:103–106.
4.
Als-Nielsen B, Chen W, Gluud C, Kjaergard LL: Association of funding and conclusions in randomized drug trials. JAMA 2003;290:921–928.
5.
Fava GA: Financial conflicts of interest in psychiatry. World Psychiatry 2007;6:19–24.
6.
Carey B, Harris G: Psychiatric association faces Senate scrutiny over drug industry ties. New York Times, July 12, 2008, p A13.
7.
Bass A: Side Effects. Chapel Hill, Algonquin Books, 2008.
8.
www.forensic-psych.com (accessed August 21, 2008).
9.
Herelin A: What is the impact of financial conflicts of interest on the development of psychiatry? World Psychiatry 2007;6:36–37.
10.
Fava GA: The intellectual crisis of psychiatric research. Psychother Psychosom 2006;75:202–208.
11.
Starcvic V: Opportunistic ‘rediscovery’ of mental disorders by the pharmaceutical industry. Psychother Psychosom 2001;71:305–310.
12.
Vieta E: Psychiatry: from interest in conflicts to conflicts of interest. World Psychiatry 2007;6:27–29.
13.
Bursztajn HJ, Feinbloom RI, Hamm RM, Brodsky A: Medical Choices, Medical Chances: How Patients, Families, and Physicians Can Cope with Uncertainty. New York, Delacorte Press/Seymour Lawrence, 1981;New York, Routledge, 1990.
14.
Cosgrove L, Krimsky S, Vijayraghavan M, Schneider L: Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychother Psychosom 2006;75:154–160.
15.
American Psychiatric Association: APA names DSM-V task force members: leading experts to revise handbook for diagnosing mental disorders (press release). Washington, APA, July 23 2007.
16.
APA: Meet the work groups. www.psych.org/MainMenu/Research/DSMIV/DSMV/WorkGroups.aspx (accessed June 20, 2008).
17.
National Institute of Mental Health: The numbers count: mental disorders in America. http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml (accessed August 20, 2008).
18.
Moreno C, Laje G, Blanco C, Jiang H, Schmidt A, Olfson M: National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatr 2007;64:1032–1039.
19.
IMS: 2007 top therapeutic classes of drugs by US sales. www.imshealth.com (accessed August 21, 2008).
20.
Cosgrove L, Bursztajn HJ: Towards credible conflict of interest policies in psychiatry. Psychiatr Times 2009;26:40–41.
21.
Stelfox HT, Chua G, O’Rourke K, Detsky AS: Conflict of interest in the debate over calcium channel antagonists. N Engl J Med 1998;338:101–106.
22.
Krimsky S: Science in the Private Interest. Lanham, Rowman & Littlefield, 2003.
23.
Angell M: The Truth about Drug Companies: How They Deceive Us and What to Do about It. New York, Random House, 2004.
24.
Avorn J: Dangerous deception – hiding the evidence of adverse drug effects. N Engl J Med 2006;355:2169–2171.
25.
Chan AW, Hróbjartsson A, Haahr MT, Gotzsche PC, Altman DG: Empirical evidence for selective reporting of outcomes in randomized trials. JAMA 2004;291:2457–2465.
26.
Balon R: By whom and how is the quality of research data collection assured and checked? Psychother Psychosom 2005;74:331–335.
27.
Cialdini RB: Influence: The Psychology of Persuasion. New York, Quill William Morrow, 1993.
28.
Katz D, Mertz J, Caplan A: All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift giving. Am J Bioethics 2003;3:39–46.
29.
Wazanza A: Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373–380.
30.
Bitton A, Neuman MD, Barnoya J, Glantz SA: The p53 tumour suppressor gene and the tobacco industry: research debate, and conflict of interest. Lancet 2005;365:531–340.
31.
Cosgrove L, Bursztajn HJ: Undoing undue industry influence: lessons from psychiatry as psychopharmacology. J Org Ethics 2006;3:131–133.
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2009
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