Psychiatrists may cut some ties to drug firms

Dr. Daniel Carlat knows all too well how easy it is for doctors to be seduced by drug industry money.

In 2002, he earned $30,000 in speaking fees to promote Wyeth’s antidepressant Effexor XR to fellow doctors.

“I quit doing it because I felt I was beginning to push some ethical boundaries in terms of what I was saying and what I was not saying,” said Carlat, a psychiatry professor at Tufts University in Boston who believes doctors need to cut their financial ties with drug companies.

“My own story was really nothing special,” he said in a telephone interview. “I made $30,000 for the year, which is less than some of these doctors make in a weekend.”

Carlat and other psychiatrists have been studying the issue and have proposed that the American Psychiatric Association cut back on medical education seminars funded by drug companies.

Dr. Nada Stotland, president of the group that represents 38,000 doctors, said the proposal is one of several the association’s board will take up next month to address concerns that psychiatrists have become too cozy with drugmakers.

The APA and some prominent psychiatrists have been targeted in a probe by Iowa Republican Senator Charles Grassley. He has faulted several noted child psychiatrists, including Dr. Joseph Biederman of Harvard University in Boston, for failing to disclose hefty payments from drug companies.

Psychiatric drugs represent billions of dollars in global sales, with Wyeth’s Effexor alone generating sales of $4 billion last year.

Several drugmakers last month stopped passing out pens and other items as part of a set of voluntary ethics guidelines, but getting U.S. doctors to give up free medical education, often at fancy resorts, will be a harder sell.

“Most people see the ban on trinkets as being a small step in the right direction but not really the major source of worry or concern,” said Carlat, editor of The Carlat Psychiatry Report, a continuing medical education publication supported by subscriptions alone.

“I think much more important is the fact that companies are paying for legitimacy in different ways by hiring doctors to give talks and hiring companies to put on continuing medical education,” he said.

“As long as that continues, it is really hard to see that medical practice won’t continue to be biased toward always prescribing the newest and most expensive drugs, even when we don’t have much clinical experience with them.”

‘INTEGRITY OF INFORMATION’

The drugmakers’ new ethics guidelines do specify that industry-funded seminars are intended to cover “a full range of treatment options, and not to promote a certain medicine.”

And they recommend that medical education grants should not come from a company’s marketing budget.

“Doctors rely on accurate and appropriate information about new medicines in order to provide the best possible care to patients,” David Norton, a Johnson & Johnson executive who worked on the new code, said in a statement announcing the changes.

“We take this responsibility seriously and are constantly re-examining ways we can enhance these essential company-physician interactions and reinforce the integrity of information about our medicines.”

Still, many doctors think the model of drug company money paying to educate doctors is patently flawed.

“It is self-evidently absurd to look to a company for information about a product it makes,” Dr. Marcia Angell of Harvard Medical School and former editor of the New England Journal of Medicine, said in a telephone interview.

“Why can’t doctors, who are among the most privileged members of society, pay for their own continuing medical education?” Angell said. “Why have they abdicated that responsibility to the companies who make drugs?”

Stotland has heard a range of opinions on whether to ban industry-sponsored talks but she said the APA board will likely cut out at least some of the seminars during their meetings.

“There are still those who feel strongly that they can hear things but it doesn’t influence their practice,” she said. “But the evidence points the other way.”

By Julie Steenhuysen
CHICAGO (Reuters)