Every member of the panel that wrote APA’s depression guideline had ties to drugmakers
STUDY: Cosgrove L et al, Journal of Evaluation in Clinical Practice 2013;19(4):674-681
STUDY TYPE: Audit of a clinical practice guideline
FUNDING: Independent
Background
This study audits the American Psychiatric Association’s last guidelines (from 2010) for major depressive disorder.
The Study
- Reviewed the guideline’s development committee, an independent panel meant to screen for bias, and the 130 references behind its 12 core recommendations
- Tallied financial ties to industry and checked how many cited studies met basic quality standards
Results
Every member of the guideline committee disclosed financial ties to pharmaceutical companies, averaging 20.5 relationships each, and most sat on drug company speakers’ bureaus. Even the independent panel meant to catch bias wasn’t clean: one member had undisclosed financial ties to antidepressant makers.
Of the 130 references, only 34% met all the criteria for high-quality evidence. A third studied the wrong population entirely, inpatients or people with dysthymia rather than outpatients with major depression, and 17% didn’t measure a clinically meaningful outcome.
The guideline told doctors that antidepressants show good response rates across the board. But the two meta-analyses it leaned on found the opposite: drug-placebo differences were negligible in mild to moderate depression and only became meaningful in more severe cases.
Other Examples
In Japan, a similar pattern was found: 93.3% of authors of bipolar disorder and major depressive disorder guidelines received industry payments totaling over $4 million, with large payments concentrated among a small number of authors including the guideline chairperson.
Guidelines with strong industry influence are 26% more likely to favor industry products, according to a Cochrane analysis. Conversely, those with more comprehensive conflict-of-interest policies are 32% more likely to have negative recommendations about industry products.
Practice Implications
- With so much pharmaceutical influence, it’s unlikely these guideline authors are biased toward a single medication, but they are biased toward medications in general.
- This may explain why UK guidelines, which don’t allow any conflicts, recommend against antidepressants for mild depression, while the US guidelines do not.
