Undisclosed Industry Payments Found in Top Psychiatry Journals

Research has shown that financial conflicts of interest (COIs) are a common issue in medicine and psychiatry, with a 2020 paper finding that 55.7% of US psychiatrists accepted some form of industry payment. Studies have found that the pharmaceutical industry spends billions of dollars per year making payments to clinical trial authors, DSM panel members, and FDA committee members, creating COIs at every level of the drug approval process. A 2021 Mad in America investigation revealed that industry paid psychiatrists alone $340 million between 2014 to 2020. The same investigation also reported that financial COIs were present in the testing of every new psychotropic drug approved by the FDA between 2013 to 2017.

A new study published in BMJ Open examines undisclosed financial COIs for physician-authors in two major US academic journals, the American Journal of Psychiatry (AJP) and the Journal of the American Medical Association Psychiatry (JAMA-PSY). The current work finds that 14.2% of industry payments ($645,135) made to authors published in these two journals between 2020 and 2022 were undisclosed. This research, led by Francis Gesel of the Geisinger Commonwealth School of Medicine, additionally finds that nearly all undisclosed payments (96.2%) were made to authors conducting randomized controlled trials (RCTs).

The authors write:

Harm and Bias Linked to Financial Conflicts of Interest

Research has found that industry money biases clinical trial results. Studies have demonstrated bias in trials for antidepressants, antipsychotics, psychotherapy, and digital therapy related to financial COIs. Experts have also argued that these kinds of industry payments, both to clinical trial authors and experts writing commentaries on those trials, undermine the credibility of major journals.

In 2015, JAMA published an editorial downplaying problems with COIs. The authors, themselves the recipients of industry payments, took issue with the term “conflict,” arguing that it was “confrontational and presumptive of inappropriate behavior.” However, research has shown that industry payments directly to physicians are linked to “irrational prescribing of the company’s drug,” inappropriately increased prescribing rates, lower prescribing quality, increased prescriptions of lower-value drugs, increased Medicare expenditures, more patient complaints, and costlier prescribing practices.

Study Details

The goal of the current work was to examine the prevalence and magnitude of financial COIs in the AJP and JAMA-PSY as well as author and study characteristics linked to financial COIs. The authors also wanted to identify the companies making undisclosed payments and their association with the drugs under investigation by authors they had paid.

The authors chose to examine AJP and JAMA-PSY for their high impact, influence over clinical practice, and explicit COI disclosure policies. They searched each journal for US based physician-authors in issues published between 2020 and 2022. To be included in the current research, authors had to hold either an MD or DO degree. Non-original research articles were excluded..

The researchers located each relevant author’s records at OpenPayments.CMS.GOV, a database where pharmaceutical companies are legally required to report payments to US physicians. They collected payment data for the 36 months preceding each article’s publication date, and compared it to COI disclosures made by the authors in the AJP and JAMA-PSY.

Journals typically require authors to disclose only the companies from which they have received industry payments, not the amounts paid. To estimate the value of undisclosed conflicts of interest, the researchers compared authors’ disclosures with records at OpenPayments.CMS.GOV. Any payments reported in the Open Payments database from companies not listed in the authors’ disclosures were counted as undisclosed.

Twelve of 139 eligible JAMA-PSY authors (8.6%) and 15 of 110 AJP authors (13.6%) had industry payments listed in the OpenPayments database. In total, these authors accepted $4,539,207 in the 36 months preceding the publication of their research in the AJP of JAMA-PSY. This included $895,000 (20%) in general payments and $3,644,100 (80%) in research payments. AJP authors received $2,766,147 compared to JAMA-PSY author’s $1,773,060.

Undisclosed payments accounted for 14.2% ($645,136) of all industry payments received by eligible authors in both journals. Twenty-five percent ($439,192) of all payments made to JAMA-PSY authors were undisclosed compared to 8% ($205,943) for AJP authors.

Of the 27 authors with profiles on OpenPayments, only five had a 100% disclosure rate. Six authors that had received payments had a 0% disclosure rate. Twelve of these authors disclosed at least 50% of their total payments.

The 10 authors receiving the highest amount of undisclosed payments contributed to 12 RCTs, 11 of which were for new psychotropic drugs. Industry sponsorship of research accounted for all the undisclosed payments among these authors. The pharmaceutical industry sponsored 92% of these studies and accounted for 95% of undisclosed payments. Device manufacturers accounted for the remaining payments.

In total, 99.4% of all payments ($4,513,574) and 96.2% of undisclosed payments were made to authors of (RCTs). In the AJP, RCT authors received 88.8% of all undisclosed payments compared to 99.6% in JAMA-PSY. Ten companies accounted for 90% of all undisclosed payments:

• Janssen Research & Development (US$115 888; 18%)
• Genentech (US$106 522; 17%)
• Neurocrine Biosciences (US$83 834; 13%)
• Medtronic USA (US$67 370; 11%)
• Biohaven Pharmaceuticals (US$58 511; 9%)
• Pfizer (US$35 595; 6%)
• Sunovion Pharmaceuticals (US$27 683; 4%)
• Vanda Pharmaceuticals (US$26 917; 4%)
• Lundbeck (US$26 847; 4%)
• H. Lundbeck A/S (US$26 595; 4%)

The authors conclude:

Limitations

The authors acknowledge several limitations with the current work. As the research was conducted entirely within two journals, the results may not be generalizable to other publications. Due to discrepancies in reporting which authors were US physicians, the researchers may be slightly over- or under-representing the percentage of authors that are not in the OpenPayments database. Due to OpenPayments only requiring companies to report payments to non-physicians starting in 2021, non-physicians were excluded from the current analysis. As companies have four years to report payments to physicians in the OpenPayments database, some payments received by authors included in this research may not have been published when this study was completed.

Industry Influence Over Research

Past research has identified other instances of undisclosed payments to authors of clinical trials, as well as 60% of DSM-5 authors. Studies have shown that pharmaceutical company funding of clinical trials biases the research towards positive results for the industry. Industry also makes payments to editorialists, peer reviewers, and psychopharmacology textbook authors. These kinds of payments, along with other tactics employed by industry to control research and influence clinical guidelines, have lead some experts to argue that evidence based medicine is an illusion. Research has also found that transparency about these kinds of payments has not been enough to reduce them, or stem the corruption of research.

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Gesel, F., Baraldi, J., Goldhirsh, J., & Piper, B. J. (2025). Undisclosed financial conflicts of interest among physician-authors in leading US Psychiatry Journals: A cross-sectional study. BMJ Open, 15(11). (Link)