John P. A. Ioannidis
Ensuring transparency of financial conflicts of interest related to psychosocial interventions starts with boosting awareness to researchers, editors, peer reviewers and readers that these conflicts are relevant, widespread and more diverse than those in the general biomedical field, researchers wrote in a viewpoint.
“The discussion of financial [conflicts of interest] associated with psychosocial interventions has remained underdeveloped,” Ioana-Alina Cristea, PhD, Meta-Research Innovation Center at Stanford, Stanford University, and John P. A. Ioannidis, MD, DSc, department of medicine, Stanford University School of Medicine, wrote in JAMA Psychiatry. “The strength of the evidence for these practices may vary widely because they are largely unregulated and without major oversight. This huge market is unlikely to be immune from the biasing influences of financial gain.”
Improving disclosure of financial conflicts of interest related to psychosocial interventions is often hindered by an inability to identify the manufacturer because these interventions do not usually come from an established corporate research program and most are not patented by single groups, according to the authors. Furthermore, guidelines created for conflicts of interest related to pharmaceuticals or medical products with a recognizable sponsor are difficult to interpret. Absence of guidelines relating specifically to psychosocial interventions may be due to the limited knowledge of possible biasing effects, Cristea and Ioannidis wrote. Specific information for disclosing interests associated with psychosocial interventions are often lacking as well.
“One way forward is an initial framework clarifying what should be disclosed and with regards to whom. The most obvious instance involves commercial ventures associated with disseminating or testing psychosocial interventions,” the authors wrote. “However, less straightforward cases, such as companies that are spinoffs from academic institutions, exist.”
It is vital that grants, honoraria, speaker’s fees and paid advisory positions relating to for-profit commercial entities be disclosed, according to Cristea and Ioannidis. Disclosures should also try to make circumstances relating to spinoffs as clear as possible.
The authors also point out that support activities such as professional training, books, manuals, demonstrations and courses are important factors of psychosocial interventions that are usually marketed through free-standing for-profit entities created by the developer. However, evidence is lacking on whether these ventures are susceptible to misrepresentation. Disclosure of financial conflicts of interest would help determine who stands to gain from these activities and therefore increase transparency, Cristea and Ioannidis explained.
“A more transparent landscape may help understand who in this large market is doing what, how, and why,” the authors wrote. “Disclosure guidelines could include explicit examples tailored on these interventions. This article could be a basis for a taxonomy of [conflicts of interest] relevant to psychosocial interventions that may be endorsed by dedicated reporting guidelines (eg, the Consolidated Standards of Reporting Trials extension for social and psychological interventions).” – by Savannah Demko
Disclosures: Ioannidis reports an unrestricted gift from Sue and Bob O’Donnell and support from the Laura and John Arnold Foundation.