Magazine article Clinical Psychiatry News

A Call for 'Qualitists' in Psychiatry

Magazine article Clinical Psychiatry News

A Call for 'Qualitists' in Psychiatry

Article excerpt

Since I began writing this column, several colleagues have continued to ask when I was going to address the ethics of the relationship of psychiatry to the pharmaceutical industry. Is our relationship to pharma one of collegial education or big brother bribery?

For the most part, I sensed that these colleagues wanted me to be critical of the industry and the psychiatrists who work for it in any capacity. Considering that some data show that psychiatrists have earned more money from pharmaceutical companies than have other medical specialists (see related "Policy & Practice" on p. 58), and the reports that several influential psychiatrists have concealed full, substantial consulting fees they have received from such companies, the ethical concern is justified.

Interest in this issue was aroused in May at the annual meeting of the American Psychiatric Association. There, again, the pharmaceutical companies dominated the exhibit area, which allowed less space for other entities, such as publishing companies (beside the APA's own press operation). As I write this, interest in this issue has piqued yet again--in wake of a call by Sen. Charles E. Grassley (R-Iowa) that the APA provide an account of its finances from pharma.

No longer do we have the infamous dessert buffets, where psychiatrists storm the tables. But sponsored meals with lectures continue to draw large crowds at our annual meeting. At the May gathering in Washington, speculation about the APA's intention to reduce pharma's visibility coincided with less money being available for the companies to spend on marketing.

Up until now, I had abstained from the debate because I wasn't sure how I might advance it. After all, this topic has been explored thoroughly in recent years.

Two books that came out in 2007 seemed to consolidate the arguments. Neither was published by the APA's vast publishing arm, which suggests that a conflict of interest on the APA's part does not exist.

The first book, "Understanding Physician-Pharmaceutical Industry Interactions: A Concise Guide," by the psychiatrist Shaili Jain (Cambridge: Cambridge University Press, 2007) is geared to all physicians. In an easy-to-read 70 pages, Dr. Jain offers a comprehensive discussion of all the relevant issues.

A second book is geared to psychiatrists. "Psychotropic Drug Prescriber's Survival Guide: Ethical Mental Health Treatment in the Age of Big Pharma" (New York: W.W. Norton, 2007) was written by psychiatrist Steven L. Dubovsky, along with his daughter Amelia N. Dubovsky, who was a medical student at the time. This well-researched book seeks to provide psychiatrists with everything we need to know about pharma and how to deal with its influence. The industry does have well-documented influence on the best of us (including me, although I can disclose that never have I served on an industry speakers panel or as an ongoing consultant).

Pharma's influence on us comes from a range of places. Some of it comes through subliminal advertising, and some comes from relationships with pharmaceutical reps. Perhaps some of this influence is connected to the current dominance of biology in our biopsychosocial model of care.

For us, the take-home message is that we must keep up-to-date with the flood [TEXT UNREADABLE IN ORIGINAL SOURCE] psychopharmacologic information.

OK. Why don't I stop here and simply recommend reading these two books?

The paradox is that, as good as those books are, they are insufficient by themselves.

Not only that. Think of the challenge of getting the books to every prescribing clinician. I don't think the pharmaceutical companies would be eager to give them away like they have other books. Even if they did, how could we be sure that the books were read, understood, and followed?

Where does that leave us? Like any good psychoanalytically trained psychiatrist, I searched for a deeper issue here. …

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