Two essays published in separate periodicals this week raise troubling questions about the extent to which psychiatrists may be unduly influenced by the pharmaceutical industry, and how this relationship may effect public trust in psychiatry. The upshot? The concern about corruption, or at least the appearance of corruption is palpable. Sigmund Freud (see photo) would not be pleased. Interestingly, one of the authors is Tom Insel, the director of the National Institute of Mental Health (click on read more below).
For instance, Lisa Cosgrove and Harold Bursztajn write in Psychiatric Times that they looked at the two philanthropic arms of the American Psychiatric Association - the American Psychiatric Foundation and the American Psychiatric Institute for Research and Education - and found that APF’s 15-member board includes four high-level pharma execs that either make meds recommended by APA or are developing products targeted to treat mental disorders. Other board members include two more with industry ties and a senior vp at Fleishman Hillard, the public relations firm whose clients include six drugmakers.
APF’s corporate advisory council lists drugmakers, they continue, that contribute "significant funding" to APF and that make meds recommended in the APA’s clinical practice guidelines. Although it was not possible to discern the total amount of industry funding given to APF, in fiscal year 2008 APF lists 11 pharmaceutical companies and 1 medical device manufacturer that contributed monies; 6 of the companies are listed as giving $40,000 “and above” per year.
They go on to write that APIRE, like APF, doesn't require disclosure of financial conflicts of interests, and that nine of 16 APIRE board members have ties to drugmakers. They also note current disclosure policies don't require reporting of pooled industry money to academic departments, units, hospitals, and med schools. And because there is no independent monitoring of industry ties, they maintain "underreporting is very likely a problem. For example, one board member who reported 'no disclosure' in an APA publication was found to be on the speakers’ bureau of multiple pharmaceutical companies."
Then they analyzed the DSM-IV, DSM-V work group panels, and the authors of the DSM-based Practice Guidelines, and found what they call "a striking lack of balance between industry-tied and industry-independent work group members." Approximately 68 percent of the members of the DSM-V task force reported having industry ties, an increase of 2 percent over the proportion of DSM-IV task force members with such ties.
And of the 137 DSM-V panel members who posted disclosure statements, 56 percent reported industry ties, such as holding stock in drugmakers, serving as consultants, or serving on company boards, which amounts to "no improvement" over the 56 percent of DSM-IV members who had industry relationships. Also, 90 percent of the authors of three major clinical practice guidelines had financial ties to drugmakers explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses.
Meanwhile, Tom Insel, the director of the National Institute of Mental Health writes in this week's Journal of the American Medical Association that "as public trust in the pharmaceutical industry has plummeted, the close connection between leading psychiatrists and the pharmaceutical industry, once a sign of progress for the profession, is now cited as evidence of corrupt influence." As do Cosgrove and Bursztajn, he points to an ongoing investigation by US Senator Chuck Grassley into ties between drugmakers and academic researchers (see here , here and here).
He poses several questions. First, are psychiatrists in clinical practice receiving more industry money than other specialists? He notes that Lilly lists 25 faculty receiving more than $50 000 in the first three quarters of 2009, and of these, 17 were psychiatrists, although Lilly's investment in psychotropics "may skew this sample...Not surprisingly, companies are paying the specialists most likely to promote or prescribe their products."
What about academic thought leaders and researchers who may influence practice through publications and lectures? In a recent study of med school department chairs, 60 percent reported receiving personal income from industry, usually as a consultant or scientific advisory board member. And 80 percent of faculty reported a departmental relationship with industry, most often for support of continuing medical education. But, he concludes, "there is no published evidence that departments of psychiatry or chairs of these departments receive more or less industry funding than their colleagues in other specialties."
Are academic psychiatrists disclosing more financial interests in publications? "Relative to other professional journals, the major psychiatric journals appear to have comparable standards for disclosing financial interests," he writes. "Based on a review of 397 published reports of clinical trials in four psychiatric journals, a study found 60 percent had industry funding and 47 percent had at least one author reporting a financial relationship. The prevalence of industry funding in general medical journals has been reported to range from 40 percent to 66 percent, with industry support between 34 percent and 43 percent, slightly lower than reported in psychiatry journals." Insel notest the study found articles with reported industry support were nearly five times more likely to report positive results.
Do financial payments to academic leaders influence clinical practice guidelines? He points to a study by Cosgrove and others who reviewed the folks who authored APA guidelines for treating schizophrenia, bipolar disorder, and major depressive disorder, and reported 90 percent had financial ties to industry - and none were disclosed.
Last but not least, is psychiatric practice biased by industry? Insel worries that "aside from the evident success of marketing of specific medications, what is perhaps most worrisome is the relative neglect of effective nonpharmacological interventions such as cognitive-behavioral therapy for mood and anxiety disorders or powerful psychosocial interventions for schizophrenia. Numerous studies have demonstrated the effectiveness of such interventions, and their use has been recommended in the practice guidelines mentioned above, yet they are woefully underused and frequently not reimbursed."
His conclusion? "The greatest threat to an era of improved public health stemming from the productive and ethically sound relationship among academia, industry, and practice is a defiant embrace of the status quo, in which psychiatrists are seen as a leading source of the problem rather than as leaders in finding the solution for financial conflicts of interest."
17 Comments
We also need to ask to what extent have these companies infiltrated the regulatory agencies and corrupted the approval process.
We should probably be looking at the funding sources for patient advocacy groups as well -- NAMI, for instance may be doing some great work for families, but may also be doing some phenomenal PR work for pharmaceutical companies...
A brief historical footnote--
Freud was never a psychiatrist but a neurologist by training. Mainstream psychiatry, as it existed during Freud's life, was mostly distrustful and rejecting of psychoanalytic (Freudian) approaches, with a few significant exceptions, particularly in the U.S.
In those days, the majority of psychoanalysts were also neither psychiatrists nor M.D.s. That changed once psychoanlysis became institutionalized, again especially in the U.S., with non-psychiatrists mostly excluded.
In more recent years, that has changed again, particularly as psychiatry and pharma have become so intertwined.
To that degree, psychoanalysis has remained a center of challenge to the pharma-centric model of psychiatry as it has "evolved."
Part of the relevance of the above--not clear that Freud would _not_ be pleased by the "corruption of psychiatry," or at least it would not have particularly surprised him.
LF Velez...
NAMI has been looked at hard:
http://www.nytimes.com/2009/10/22/health/22nami.html
This is just a morphing of T-MAP. Pharma will pay to influence, and others will accept the pay. And the groups will become more closed, more self-referential, to lower the risk of whistle blowers.
but i agree. many out there that need to be looked at.
NAMI is a mess.
Addressing the influence of the pharma industry on the psychiatric community, do not forget the major practise of disease mongering wherein the DSM, once a small manual in the early 50's is now a huge compendium of diseases invented by big Pharma in order to sell drugs.
I run into a lot of people in Pharma whom I would have no other way to describe other than neurotic or narcissistic. They could benefit from intensive psychoanalysis. On the other hand there are some pharmaceutical executives, as referred to on these boards that could not be classified as neurotic. Since neurosis pertains to conflicts between desires and conscience, and since many of these individuals have no conscience, they could not be considered as neurotic; psychotic perhaps, but not neurotic.
NAMI is an organization that needs to be throughly investigated. Their undue influence, in the provision of treatment and services to mental health clients, by Public Mental Health System of Care, has been the major factor, as to why the 'first line to treatment' is with toxic, brain disabling chemicals.
While it is obvious that they would promote these chemicals, on behalf of their Pharmaceutical Company Sponsor(s) it is also questionable as to why the Government has allowed them to be the primary voice to influence mental health policy and to continuously refer parents, of mental health clients to this corrupt organization.
The indoctrination, by NAMI, in their "Family to Family" program agenda, also sponsored by the government and Big Pharma also raises concern.
NAMI has organized themselves not unlike the NAZI's had done and gained the undeserved and corrupt influence that they have been allowed, for so many years,imo. Why parent's are so ignorant as to keep supporting this activity, in light of the obviousness of the expose's, adverse effects and deaths caused by these chemicals and corrupt influence is unconscionable.
Wake up NAMI membership!!! Your activities have harmed and killed enough innocent Children, Adults and Seniors.
NAMI certainly deserves every criticism mentioned above but by now there are several other front groups that are equally guilty of accepting Pharma's money to do PR work.
For instance Mental Health America, the Depression and Bipolar Support Alliance, and Children and Adults with Attention Deficit Disorder.
I've got the research that shows theses groups get just as much of their funding from Pharma as NAMI does and yet NAMI is the only front group singled whenever this topic comes up.
saw somewhere Evelyn that Senator Grassley has inquires into a bunch of them.
Psychiatrists And Pharma: Undue Influence?
That question is OBE. The train has left the station. Normative psychiatry has morphed into a drug culture.
Money no longer influences psychiatrists to prescribe drugs. A script is the product of almost every patient engagement even without monetary inducements. Money only influences what drugs the psychiatrists prescribe.
Pharma and psychiatry have created this mess...but the public perpetuates the fraud with the belief that life should be puppies and butterflies at all times. Lose a loved one...take a pill, lose a job...take a pill, tired one day....take a pill. People have bought into the hype and until we stop the demand side, the supply side will continue. Life isn't perfect, never was never will be, but if society continues to search for Nirvana in a pill box, the cycle will continue.
There are so many stories of the now well accepted corruption of the psychiatric profession by pharmaceutical influence that I wonder whether anyone on these boards has ceased to be amazed by them, like me.
I believe that the ultimate influence has filtered down to the American Board of Psychiatry, which certifies psychiatrists in the practice of psychiatry. Board certification is an ever-increasing necessity to have for many reasons. Like most students, psychiatry residents will study hardest for what they anticipate will be on the Board Exams. The feedback thet I get from newly Board-certified psychiatrists is the exam is at least 50% psychopharmacology, with increasingly less emphasis on the other aspects of training.
This naturally has a trickle-down effect on the psychiatric residency curriculum. Not only is there heavy emphasis on psychopharmacology, but residents are encouraged (or in academia required) to spend time in the resrarch lab on a psychopharmacology project.
Antidepressant advertising is directly targeted at manipulating normal healthy women to want to be medicated. Women must stand up to big pharma’s bullying them to over-medicate with antidepressants washing out their emotions & personalities and interfering being mothers, sisters, brothers, daughters, partners and lovers.. Women are targeted for antidepressants by big Pharma in the same way that tobacco companies targeted us 70 years ago. Drug companies are so effective at selling unhappiness to women that women take more than twice as many antidepressants as men. Like effexor Wyeth/Pfizer plans on using modern marketing techniques and direct payments to doctors to have Pristiq over prescribed instead of used based on evidence based diagnosis. http://sadnessaddiction.blogspot.com/
I am currently forced to take 300mg daily of Seroquel XR AGAINST MY WILL, because of a Community Treatment Order that does not expire until the 21st December 2010. This is DESPITE Seroquel BEING THE CAUSE OF DIABETES, OBESITY & DOUBLING THE RISK OF A FATAL PNEUMONIA ATTACK in the ELDERLY........I am 66 years old, am borderline DIABETIC and am 23 kg (50 pounds) OVERWEIGHT after being prescribed 75 mg Zyprexa (Olanzapine) from September 2003 until March 2010, which I took religiously every day, despite Zyprexa being NOTORIOUS for PATIENT OBESITY. It appears that DOCTORS & PARTICULARLY PSYCHIATRISTS are MORE INTERESTED in getting KICKBACKS from the BIG PHARMA COMPANIES for PRESCRIBING HIGH DOSES OF ANTIPSYCHOTIC DRUGS than in the PHYSICAL HEALTH & WELLBEING of their PATIENTS.