24 Mar Behind the Paywall: Undisclosed Conflicts of Interest in Leading Psychiatry Journals

Francis J. Gesel

MedicalResearch.com Interview with:
Francis J. Gesel
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania

MedicalResearch.com: What is the background for this study?

Response: Conflicts of interest (COIs) in psychiatric research represent a longstanding ethical challenge, given the close relationship between the pharmaceutical industry and psychiatry. Journals require authors to disclose these relationships, while the U.S. Open Payments database, created under the Sunshine Act, provides a record of payments from manufacturers to physicians. However, whether physician-authors in psychiatry’s most influential journals consistently disclose these relationships had not been systematically assessed. We focused on the American Journal of Psychiatry (AJP) and JAMA Psychiatry (JAMA-PSY), two of the highest-impact journals in the field, to evaluate the prevalence and magnitude of undisclosed financial COIs.

MedicalResearch.com: What are the main findings?

Response: Of 2,872 publications between 2020 and 2022 that were screened, we identified 74 eligible articles authored by 27 U.S.-based physician-authors. These authors received a combined total of US$4.54 million in payments from industry. Of this, US$645,135 (14.2%) were not disclosed to the journals. The extent of undisclosed payments varied by journal. AJP authors had US$205,943 (7.5% of their total) undisclosed. JAMA-PSY authors had US$439,192 (24.8%) undisclosed. Research payments comprised the majority (82.3%) of all undisclosed funds. Notably, nearly all undisclosed payments (96.2%) were linked to randomized controlled trials, and the top 10 highest-paid authors accounted for 95% of all undisclosed payments. The distribution was highly skewed. A small number of authors accounted for the vast majority of undisclosed industry ties.

MedicalResearch.com: What should readers take away from your report?

Response: Substantial undisclosed financial conflicts of interest exist among physician-authors publishing in psychiatry’s most influential journals. These undisclosed relationships were concentrated among a subset of highly compensated authors conducting randomized controlled trials, the very studies most likely to influence clinical guidelines and prescribing practices. Our findings suggest that current disclosure policies, which rely on self-reporting, are insufficient to ensure transparency. Readers, clinicians, and policymakers should interpret psychiatric research with awareness of these gaps.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our study highlights that undisclosed COIs are not isolated incidents but part of a systemic pattern, particularly in industry-sponsored research. Importantly, we did not attempt to judge whether undisclosed payments were “relevant” to the published study—journals’ policies already require comprehensive disclosure regardless of perceived relevance. Future policies may benefit from independent verification mechanisms, such as requiring direct links to Open Payments profiles during manuscript submission. Addressing these issues is not about discouraging collaboration between industry and academia but ensuring transparency so that patients, providers, and policymakers can evaluate psychiatric research with full context.

Citation

Gesel F, et al. Undisclosed financial conflicts of interest among physician-authors in leading US psychiatry journals: a cross-sectional study. BMJ Open 2026; 15(11):e104955.

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Last Updated on March 24, 2026 by Marie Benz MD FAAD