The Hidden Costs of Financial Conflicts of Interest in Medicine

Fava, Giovanni A.

doi:10.1159/000442694

Cited by 21 publications

(16 citation statements)

References 36 publications

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“…This could explain the paucity of trials on the comparison between BZD and newer AD, since the financial interests in the latter may have led to a selective publication of results about their efficacy [57,58].…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benasi¹,

Guidi²,

Offidani³

et al. 2018

Psychother Psychosom

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Background: The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus placebo, antidepressant drugs (AD), or both. Methods: Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. Results: A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. Conclusions: BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.

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Section: Discussionmentioning

confidence: 99%

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benasi¹,

Guidi²,

Offidani³

et al. 2018

Psychother Psychosom

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“…At a time when the progress of psychopharmacology is hindered by major financial conflicts of interest that cast doubts on its credibility [79,80], fascinating vistas for the independent features of clinical pharmacopsychology are opening up. They should be welcome to all those who are disillusioned with the disappointing practical results of recent research in psychopharmacology and should become a channel of funding and attention.…”

Section: Discussionmentioning

confidence: 99%

Clinical Pharmacopsychology: Conceptual Foundations and Emerging Tasks

Fava

Tomba

Bech

2017

Psychother Psychosom

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The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology is outlined, with discussion of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with (a) wanted and expected treatment effects, (b) treatment-induced unwanted side effects, and (c) the patient's own personal experience of a change in terms of well-being and/or quality of life. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Research in this area deserves high priority.

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“…Further, detection of adverse events requires sensitive clinimetric indices that depart from conventional assessment strategies geared to demonstrating efficacy against placebo [Fava and Bech, 2016;Bech, 2016;Piolanti et al, 2016]. Finally, the role of financial conflicts of interest in shaping the literature appraisal is an increasing source of concern [Fava, 2016]. While the dependence potential of benzodiazepines is widely acknowledged, the clinician is less likely to be aware that the same, if not worse, phenomenon may occur with ADs [Chouinard and Chouinard, 2015;Fava et al, 2015b;Starcevic et al, 2015].…”

Section: Reinterpreting Psychotherapy/pharmacotherapy Detrimental Effmentioning

confidence: 99%

The Potential Role of Iatrogenic Comorbidity in the Interaction between Pharmacotherapy and Psychotherapy in Anxiety Disorders

2017

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The combination of pharmacotherapy and psychotherapy in the setting of anxiety disorders is often viewed as a potential source of augmentation of clinical effects, with little attention paid to the potential occurrence of negative events. In most of the studies, however, if benefits ensued, they were modest and likely to fade. Further, 4 high-quality and well-designed individual studies suggest that the addition of a benzodiazepine or an antidepressant to cognitive behavioral treatment of anxiety disorders could be detrimental compared to placebo at follow-up. The aim of this review was to outline a novel hypothesis, which needs to be adequately tested but may shed some new light on this interaction. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug or of modifying responsiveness to subsequent treatments. The changes are persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects. The term ‘iatrogenic comorbidity' refers to unfavorable modifications in the course, characteristics, and responsiveness of an illness that may be related to treatments that were administered previously. The likelihood of iatrogenic comorbidity needs to be considered in clinical practice: The concurrent use of pharmacotherapy and psychotherapy may yield advantages in the short term, but its costs at some later point in time may largely outweigh such benefits.

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The Hidden Costs of Financial Conflicts of Interest in Medicine

Cited by 21 publications

References 36 publications

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Clinical Pharmacopsychology: Conceptual Foundations and Emerging Tasks

The Potential Role of Iatrogenic Comorbidity in the Interaction between Pharmacotherapy and Psychotherapy in Anxiety Disorders

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