Physician-authors publishing in the American Journal of Psychiatry and JAMA Psychiatry left undisclosed $645,135 in industry payments—14.2% of the $4.54 million they received over 3 years, according to a cross-sectional study.
In the analysis, investigators examined original research articles published between January 1, 2020, and December 31, 2022, in the two journals. Among 2,872 publications screened, 74 articles authored by 27 eligible US-based physician-authors met the inclusion criteria. The investigators compared author self-disclosures against mandatory reports in the Open Payments database.
Research payments constituted 82% of all undisclosed payments. American Journal of Psychiatry (AJP) authors received $205,943 in undisclosed payments (8% of their total payments), whereas JAMA Psychiatry authors received $439,192 (25%). These top 10 authors accounted for 95% of all undisclosed payments across both journals—85% in AJP and more than 99% in JAMA Psychiatry—highlighting the concentration of undisclosed conflicts among a small subset of highly compensated researchers.
Among all eligible physician-authors, just 8.6% of those in JAMA Psychiatry and 13.6% in AJP had Open Payments profiles, indicating they received industry payments during the study period. The remaining eligible physician-authors (91% in JAMA Psychiatry, 86% in AJP) had no Open Payments profiles, indicating they received no reportable industry payments during the 3-year period.
Additionally, 68% (n = 15/22) of men received payments totaling $4.34 million—96% of all 3-year payments. Among undisclosed payments, 5.9% (n = 13) of men received $527,963 (82% of undisclosed totals), while 60% (n = 3/5) of women received $117,173 (18%).
Authors of randomized controlled trials (RCT) accounted for 99% of all payments ($4.5 million) and 96% ($620,473) of undisclosed payments. Nearly all undisclosed payments (96%) went to authors conducting RCTs.
The median total payment to AJP authors was $44,548, while JAMA Psychiatry authors received a median of $49,036. For general payments, the AJP median was $8,140 and the JAMA Psychiatry median was $2,395. Research payments showed higher medians: $144,204 for AJP and $108,353 for JAMA Psychiatry.
Across all authors, the median undisclosed total payment was $8,231. When stratified by payment type, the median undisclosed general payment was $2,340 and the median undisclosed research payment was $37,110.
Among the top 10 authors with undisclosed payments, leading payers were Janssen Research & Development ($115,888; 18% of their undisclosed total), Genentech ($106,522; 17%), and Neurocrine Biosciences ($83,834; 13%). Device manufacturers contributed to two studies but represented a smaller share.
Among the 12 RCTs conducted by the top 10 earners, 11 (92%) involved pharmaceutical interventions. Seven studies (58%) focused on depression, examining antidepressants, anticonvulsants, antipsychotics, and N-methyl-D-aspartate receptor channel blockers. Other topics included vasopressin 1a receptor antagonists for autism spectrum disorder (two studies), antidepressant medication for anxiety (one study), cognitive behavioral therapy for emotional and behavioral problems (one study), and genetic analysis of completed suicide (one study).
Disclosure practices varied among the 27 authors who received payments. Twelve of them made disclosures summing to at least half their total payment amounts. Five achieved 100% disclosure rates—two published in AJP and three in JAMA Psychiatry. Eight authors disclosed between 50% and more than 99% of their payments. Seven authors disclosed less than half, ranging from 8% to 39%. Six authors who received payments disclosed 0%.
Total undisclosed payments by year across both journals were: $79,100 in 2017 (12% of total undisclosed), $70,629 in 2018 (11%), $228,370 in 2019 (34%), $78,341 in 2020 (12%), $89,856 in 2021 (13%), and $123,540 in 2022 (18%). These years reflect the 3-year look-back period from each article's publication date.
Both journals require a 3-year disclosure of financial relationships, but their policies differ. For instance, JAMA Psychiatry, following the standards of the International Committee of Medical Journal Editors, requires disclosure of relevant financial relationships outside submitted work, while AJP mandates disclosure of all financial relationships with industry regardless of perceived relevance to the study topic.
The study's limitations included its focus on only two US journals and the use of an inclusive definition that classified any financial payment in Open Payments not disclosed to the journal as undisclosed, without independently determining relevance to article topics. The analysis excluded nonphysician authors because complete 3-year payment data were unavailable for these groups during the study period. Further, research payments may have been underestimated because manufacturers can delay reporting for up to 4 years, meaning some 2020 to 2022 payments may not yet be public.
The investigators noted that while some authors may have disclosed only conflicts deemed directly relevant, both journals require broad reporting. The study applied an inclusive definition of undisclosed conflicts of interest, defining any financial payment in Open Payments not disclosed to the journal as undisclosed, without independently adjudicating relevance to article topics.
The study was supported by Geisinger Commonwealth School of Medicine Summer Research Immersion Program.
Source: BMJ Open
