Drs. Mathew and Charney Reply

To the Editor: We thank Dr. Steingard for her letter, which expresses concerns regarding the validity of pharmaceutical-sponsored research performed at academic medical centers and, more broadly, the pernicious effect of financial conflicts of interest on the integrity of the medical profession. Undoubtedly, conflicts of interest at our academic medical centers (and our professional societies) must be closely scrutinized and judiciously managed, as recently discussed in the Journal (1) . This is a view we strongly support, since the public trust is at stake. However, we also contend that carefully crafted and transparent partnerships are essential to invigorate drug discovery for our most debilitating psychiatric disorders.

Academic investigators discover novel molecular targets and develop new technologies but generally lack the infrastructure support and drug development expertise to translate neuroscientific discoveries into clinically applicable therapies. At the same time, the pharmaceutical industry—facing mounting regulatory, fiscal, and competitive pressures—may increasingly opt to “play it safe” and focus its resources on developing new formulations of existing molecular entities with marginal benefit over existing options. The unfortunate consequence of this dynamic is that despite the explosion in the neuroscience knowledge base over the past two decades, innovation in psychiatric therapeutics has suffered. In the end, our patients continue to suffer.

To reverse this tendency, we believe that academic institutions should continue to partner with industry to maximally leverage the unique strengths of both. Disease-focused research collaborations have the potential to harness resources and intellectual capital that simply cannot be matched by academic centers or pharmaceutical companies working alone. In our commentary, we noted the transformation of HIV infection from an inevitable death sentence to a chronic manageable illness as a cogent example of what can be achieved when highly focused, multi-disciplinary, academic-industrial partnerships (also including governmental and philanthropic organizations) work toward a common goal. Collaborations between academic medical centers and multiple stakeholders were integral to that success story, which we hope can be replicated for psychiatric disorders.