Journals require authors to disclose any possible financial conflicts of interest (COIs) because research has shown links between industry funding and study outcomes. Funding from pharmaceutical or medical device companies is relatively straightforward to track, but financial COIs in psychosocial research can be more complex and underreported. Nonetheless, they are no less important to disclose, argue Ioana-Alina Cristea, Ph.D., and John P. A. Ioannidis, M.D., DSc, in a JAMA Psychiatry commentary earlier this year.
Psychosocial interventions include types of therapy, such as cognitive behavior therapy or dialectical behavior therapy, and programs for parenting, behavior change, wellbeing, mindfulness and similar topics.
“This huge market is unlikely to be immune from the biasing influences of financial gain,” Cristea and Ioannidis write.
Cristea and Ioannidis (who is well known for his critiques of research methodology) point out that disclosure reporting in psychosocial research is inconsistent and difficult to parse, just as the interventions themselves can vary greatly regarding practice, oversight and regulation. In one study they cite, the developers of four commercially distributed parenting interventions only disclosed their connection to that intervention 11 percent to 73 percent of the time in papers they authored.
The writers also acknowledge the difficulty of determining what constitutes a COI and where financial gain might occur (or not). For example, psychosocial interventions usually do not come only from a single person or research program. In cases where they do, that person or entity may not necessarily reap financial gain from others using that intervention. Some interventions come from for-profit companies, some from foundations or other nonprofits, some from individuals, and some from research programs.
Then there is the challenge of ideological bias: “Psychotherapy research has long grappled with the potential bias of investigators who believe in the superiority of one treatment over another, a phenomenon called researcher allegiance,” Cristea and Ioannidis write. Though the rationale for a researcher’s allegiance may be multi-faceted, financial COIs may play a role for some.
But we don’t know for sure, because research is scant into the biasing influence of financial COIs in psychosocial research. Moreover, in a vicious circle, “patchy and inconsistent disclosure hinders reliable research on the potential consequences of COIs, particularly because there are also no searchable databases of financial contributions to researchers in this field (as with Open Payments),” they wrote.
So the first step is figuring out “what should be disclosed and with regards to whom,” they say. As health journalists, we cannot necessarily wait for journals and associations to come up with guidelines, so we may need to do detective work on our own, as well as directly ask sources whether they have any links to a particular therapy or program. If we are writing about a specific type of therapy and we aren’t aware that a source earns speaking fees for promoting that therapy, we risk neglecting an important financial conflict that should be disclosed in our story.
It’s worth reading Cristea and Ioannidis’s full commentary because they provide multiple examples of COIs that can exist, the challenges of tracking them and the interplay between public and private entities (such as research institutions and partnerships with both nonprofit and for-profit institutes). Their examples can help journalists who write about psychosocial research determine what to ask to ferret out potential COIs.
The need to keep track is becoming even more important as digital and telehealth industries expand.
“Transparent disclosure is particularly critical for digital and technology-aided treatments, where fast-moving advances have spawned a wide range of commercial ventures (e.g., Empower Interactive, Actualize Therapy), often with rapid ownership and participation turnover,” Cristea and Ioannidis write. “This typically makes information about who stands to gain from a venture impossible to track down without insider knowledge and thus exposes the field to bias.”
The authors conclude acknowledging that no single answer or framework will ensure transparency of COIs in psychosocial research across the board. But it’s important to be aware that they exist, are widespread yet underreported, the effects are less understood and can be more diverse than the usual COIs seen in biomedical research. All of this makes it all the more important that journalists consider them.
