Diane H. Schetky, M.D.

The names and some of the facts of this scenario have been altered but the issues raised are based upon an actual case. Dr. Green, a young career child and adolescent psychiatrist, was delighted to learn that his scholarly review article on the diagnosis of attention deficit/hyperactivity disorder in young children had been accepted for publication by a prestigious journal. Soon after publication, he received requests for media interviews regarding his conclusion that this diagnosis was being erroneously applied to many children. As is usual in these interviews, he was asked about his affiliations and, although now in private practice, he mentioned that he also had an academic appointment. He was then surprised to get a call from his department chair informing him that he could no longer use his hospital or academic affiliations when speaking to the press, and that only hospital approved media trained spokespersons could so do. Dr. Green had been a trainee on one of the hospital units at the time he wrote the article, but had never been informed of such a policy. He surmised that the wish to silence him had to do with the fact that the facilities with which he was affiliated receive major funding from pharmaceutical companies for their research in attention deficit/hyperactivity disorder. He reacted with dismay and anger; feeling he was being silenced. He began to wonder if the business model of controlling brand name image was conflicting with academic freedom. He noted that academic departments are increasingly dependent upon funding from the pharmaceutical industry to survive and support their research, as other sources of funding are harder to come by. At the same time, he felt as if he were being intimidated, but did not wish to jeopardize his future career in academia. He decided to ask for an ethics consultation. The consultant suggested to Dr. Green that he re-familiarize himself with the AACAP Code of Ethics, particularly the following principles:

Principle I of the AACAP Code of Ethics reminds us that “the primary concerns of child and adolescent psychiatrists are the welfare and the optimum development of the individual child or adolescent patient or of the population of children and adolescents being served.” It goes on to say that optimally children are assessed in the context of family and community life and that “judgments and behaviors should be based on scientific knowledge and collective personal experience.” Principle III admonishes child and adolescent psychiatrists to avoid exercising influence primarily for their own gain or aggrandizement. Principle IV recognizes the child and adolescent psychiatrist’s larger responsibility to children and their families and, when possible, the need to reduce the deleterious influence of the actions of other individuals or of society at large on the well being of children and their families. Principle XVII states that “the source of compensation should not influence professional judgments and behaviors.”

The AACAP Code of Ethics reinforced his belief that the institutions’ vested interests in retaining grant money from the pharmaceutical industry were in conflict with freedom of speech and could possibly have a deleterious effect on children being medicated for attention deficit/hyperactivity disorder. The fact that his article had been peer-reviewed gave credence to the critical articles he had cited in his review. He felt that the public had a right to know about his findings. He remained concerned as to what sort of example of ethical behavior his institutions were setting for trainees. As for feeling silenced, there was nothing in the contracts he signed with these facilities limiting his freedom of speech. Dr. Green continued to talk with the press — feeling he had a need to advocate for what he believed to be the truth, based on data reviewed, and that it was his job to do so as an advocate for children. While he did not volunteer his academic affiliations, which needless to say were cited in his publication, the media in some cases insisted on including them in their reports. He recognized that differences of opinion are often healthy and promote further discussion and research, yet he was left feeling there was no room for dissent in the eyes of the institutions to which he was affiliated.

Commentary

The press and the public have a right to know the academic affiliations of authors of scientific articles. Such ties often lend credence to what the authors have to say. In fact, reporters who fail to include such information are likely to be called to task by their editors. If hospitals or training institutions have policies regarding press releases, trainees and staff should be so informed and given the rationale for the policies. Many organizations, including the American Academy of Child and Adolescent Psychiatry, have provided media training, which is intended to improve skills for handling media interviews. Media spokespersons also learn to protect patient privacy and to use these media contacts to educate the public and promote the field of child and adolescent psychiatry. This should not be confused with offering self-serving information designed to promote the financial well being of the spokesperson or a particular institution. Nor should media spokespersons try to suppress valid information that might not be in the best interests of the institution.