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Authors' reply

Published online by Cambridge University Press:  02 January 2018

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Abstract

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Copyright © 2002 The Royal College of Psychiatrists 

Dr Wright correctly notes that the potential impact of ties with the pharmaceutical industry may extend to editorial decisions about whether or not a manuscript is published. This topic was addressed in a recent article in theJournal of the American Medical Association (Wilkes et al, 2001) and the authors, a group of editors of general medical journals, recommended periodic publication of the editors' relationships with various companies. Should the Editor of the British Journal of Psychiatry choose to accept this suggestion, it would appear to address at least some of Dr Wright's concerns.

Most of us in academic medicine have some consulting, teaching, or research relationship with the corporations that manufacture medications. I do not know Professor Wilkinson, but I assume that, like me and most others, he works with more than one company.

It is neither reasonable nor necessary to assume that any fiscal relationship with a pharmaceutical company should necessitate that the editor exclude himself or herself from the decision-making process. I do not favour the use of a specific level of income to determine whether or not there is a conflict. Frankly, some of the most blatantly biased decisions (about the scientific merit of a manuscript) that I have observed over the past 25 years have involved no money whatsoever. A monetary threshold cannot replace personal integrity or judicious feedback when one's peers seem to be close to the edge of propriety.

With respect to our paper (Thase et al, 2001), we submitted to the British Journal of Psychiatry because of the journal's clear commitment to evidence-based medicine. No aspect of the submission, review, revision, resubmission or acceptance process seemed to be out of the ordinary. The manuscript received very positive ‘blind’ reviews and was praised for being even-handed. The studies incorporated in our pooled analysis were randomised, double-blind trials, the data sets were ‘closed’ (i.e. they had already been subjected to external regulatory review), and the studies were not selected or excluded because of the pattern of findings. In fact, two of the studies in the pooled analysis were ‘rescued’ from the file drawer of unpublishable results. The results were robust: the findings were consistent across multiple outcome definitions and various study characteristics. The findings also were reinforced by a sensitivity analysis, which indicated that the effect was not dependent on the results of any single study.

There are now a number of other studies comparing venlafaxine and selective serotonin reuptake inhibitors (SSRIs), and we tabulated the grouped data of nine such trials in our paper. Additional pooled analyses are underway. Working with an over-lapping data set, Freemantle et al (2000) observed a similar magnitude of advantage favouring venlafaxine (v. SSRIs) using a meta-regression approach to meta-analysis. If venlafaxine is indeed a more effective antidepressant than the SSRI class, there will be ample documentation of this effect. Although the funding source of a research finding should be considered when reviewing and interpreting the results of a study, hopefully our field has not become so jaded or cynical that all such work is rejected out of hand.

Footnotes

EDITED BY MATTHEW HOTOPF

Declaration of interest M. E. T. is a paid consultant to Wyeth—Ayerst Laboratories.

References

Freemantle, N. Anderson, I. M. & Young, P. (2000) Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs. Metaregression analysis. British Journal of Psychiatry, 177, 292302.CrossRefGoogle Scholar
Thase, M. E. Entsuah, A. R. & Rudolph, R. L. (2001) Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. British Journal of Psychiatry, 178, 234241.CrossRefGoogle ScholarPubMed
Wilkes, M. S. Davidoff, F. DeAngelis, C. D. et al (2001) Sponsorship, authorship, and accountability. Journal of the American Medical Association, 286, 12321234.Google Scholar
M. E. Thase University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 38 O'Hara Street, Pittsburgh, PA 15213-2593, USA.Google Scholar
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