Conflicts of interest.

The issue of conflict of interest has brought clinical medicine to an unprecedented crisis of credibility. Corporate actions that have placed profit over public health have become regular news in the media. The public seems to be increasingly sceptical of the integrity of medical practice, including psychiatry. Clinicians are more and more disoriented because of the discrepancy between the campaigns to shape a favourable climate of opinion for new drugs and the disappointing results in practice. Attempts to control conflict of interests by simple disclosure have yielded very limited results. A radical proposal for addressing the issue of conflict of interest in psychiatry and regaining credibility is advanced. It is based on the definition of “substantial” conflict of interest: being an employee of a private company; being a regular consultant or in the board of directors of a company; being a stockholder of a company related to the field of research; owning a patent directly related to the published work. Occasional consultancies, grants for performing investigations, or receiving honoraria or refunds in specific occasions would not be a source of substantial conflict of interest. Psychiatric investigators who hold positions in scientific societies, medical journals (editorship), groups for guidelines and clinical matters, should be devoid of substantial conflict of interest. Disclosure is no longer sufficient for the independence of the psychiatric field.