Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds School of Medicine, 15 Hyde Terrace, Leeds LS2 9LT, UK
In a recent editorial, Thompson (2001) argues strongly against the findings of a systematic review in the same issue of the Journal (Barbui & Hotopf, 2001). The Journal requires authors of original papers, but not of editorials, to declare financial interests. In this case your editorial writer did not record his consultancies (past or present) to companies that manufacture selective serotonin reuptake inhibitors. Neither did he indicate that the recent study he cited to support his case (Thompson et al, 2000) was, in fact, carried out by a pharmaceutical company. The company (Eli Lilly) manufactures one of the antidepressants, the benefits of which are questioned by Barbui & Hotopf's systematic review.
The Journal began to publish Declarations of Interest in 1999, but only for original papers not editorials. We urge extension of the Declarations to include editorials. We would support more stringent criteria for editorials and similarly for reviews than for original papers in line with the New England Journal of Medicine which for 10 years has "had a policy that prohibits editorialists and authors of review articles from having any financial connection with a company that benefits from a drug or device discussed in the editorial or review article" (Angell & Kassirer, 1996).
REFERENCES
Angell, M. & Kassirer, J. P. (1996)
Editorials and conflicts of interest. New England Journal of
Medicine, 335,
1055-1056.
Barbui, C. & Hotopf, M. (2001)
Amitriptyline v. the rest: still the leading antidepressant after 40
years of randomised controlled trials. British Journal of
Psychiatry, 178,
129-144.
Thompson, C. (2001) Amitriptyline: still
efficacious, but at what cost? British Journal of
Psychiatry, 178,
99-100.
Thompson, C., Peveler, R. C., Stephenson, D., et al
(2000) Compliance with antidepressant medication in the
treatment of major depressive disorder in primary care: a randomised
comparison of fluoxetine and a tricyclic antidepressant. American
Journal of Psychiatry, 157,
338-343.
Department of Mental Health, 1st Floor Department of Psychiatry, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, UK
I am pleased to be able to respond to the letter from Drs Owens & House with which I am in partial agreement. I am happy to confirm that the cited study (Thompson et al, 2000) was designed by me, carried out by Eli Lilly in a UK primary care context, and was analysed and written up by my colleagues and I. These facts are acknowledged in the primary research publication in the American Journal of Psychiatry.
I am also happy to confirm that, along with occasional paid lectures, I currently hold a consultancy with Organon UK and have recently held a similar consultancy with Janssen and with Philips, but not with Eli Lilly. Readers of the Journal might also wish to know that these interests have been declared to the Royal College of Psychiatrists and are known to my employing University.
I completely agree that conflicts of interest should be declared. However, I wonder whether the editors of the New England Journal of Medicine would include in their censorship policy the authors of editorials in which the objective is solely to comment on the methodological adequacy of an original article. If so, that appears to me to be more a prohibition on freedom of speech than anything related to evidence-based medicine, and would have precluded my criticisms of the Barbui & Hotopf article. If that is the objective of Drs Owens & House, then I cannot agree with them on that point.
Finally, I have not been able to find any scientific points in Owens & House's letter to which I can respond and I therefore assume that they are in full agreement with my criticisms. Otherwise, I am sure that they would have presented rational arguments against my analysis instead of taking their argument ad hominem.