[Vision2020] Is psychiatry committing 'professional suicide'?

[Art Deco]

   Is psychiatry committing 'professional suicide'?
 [image: TIME.com] <http://www.time.com/>
 By *Maia Szalavitz*, TIME.com
updated 10:09 AM EDT, Tue October 9, 2012
 [image: Drug companies must reveal which doctors have taken any payment or
gift from them worth more than $10.]
Drug companies must reveal which doctors have taken any payment or gift
from them worth more than $10.
 *STORY HIGHLIGHTS*

   - Psychiatrist says failing to address close relationship with
   pharmaceuticals is dangerous
   - In 2004, pharmaceutical companies spent about $58 billion on marketing
   - Nearly half of all continuing medical-education classes are sponsored
   by the industry

 *(TIME.com)* -- British psychiatrist and Big Pharma gadfly David Healy is
so controversial amongst his colleagues that some have tried to have his
medical license revoked — but there he was, speaking at the American
Psychiatric Association's (APA) second largest annual meeting at a
well-attended session on conflicts of interest.

"It's a miracle that I was asked along to give a talk [here], and I'm
extremely grateful," Healy said.

His disquisition was perhaps less humble.

Arguing that his profession is "committing professional suicide" by failing
to address its dangerously close relationship with the pharmaceutical
industry, he likened psychiatry's attitude toward its faltering legitimacy
to the Vatican's widely derided response to its child-sex-abuse scandal by
priests — essentially that psychiatry is brushing off justifiable concerns
as hype instead of dealing with the source of the problem.

Few experts believe that psychiatry's relationship with the drug industry
is healthy. While several speakers at the session pointed out that other
specialties are similarly entangled with industry, "everyone does it" is
generally not a valid defense where conflicts of interest are concerned.

TIME.com: Antipsychotic prescriptions in children have
skyrocketed<http://healthland.time.com/2012/08/09/antipsychotic-prescriptions-in-children-have-skyrocketed-study/>

The conflicts throughout medicine — not just in psychiatry — are clear. In
2004 alone, pharmaceutical companies spent about $58 billion on marketing,
87% of which was aimed squarely at the roughly 800,000 Americans with the
power to prescribe drugs.

The money was spent mainly on free drug samples and sales visits to
doctors' offices; studies find that both free samples and sales calls
increase prescribing of brand-name drugs and raise medical costs without
improving care.

Moreover, nearly half of all continuing medical-education classes are
sponsored by industry. By their third year of medical school, 94% of
psychiatrists in training have already accepted a "small noneducational
gift or lunch" from a drug company, according to Dr. Paul Appelbaum, a past
president of the APA and director of Columbia University's Division of Law,
Ethics and Psychiatry, who spoke on the panel with Healy.

And while only 34% psychiatrists believe that receiving food or gifts
affects their own prescribing patterns, 53% believe that it influences that
of their colleagues, according to a study cited by Appelbaum. Research
shows that this type of thinking —

"Everyone else is prone to biases and social factors, but not me!" — is
common and confounds attempts to address conflicts. "At least some of our
colleagues are wrong," Appelbaum said drily of the study.

Healy's jeremiad was more severe and sharply worded, but it seemed to be
well received by the psychiatrists assembled in the audience. Many even
asked questions that suggested they too were troubled by the status quo.

"I'm going to argue that we need you to be biased. We want you to be biased
by treatments that work," Healy told his colleagues. "I don't mind if
you're my doctor and you've given talks for industry. My concern is not
that you've been paid by industry, but that you've been fooled by industry.
The key conflict is whether people are hiding data from you."

TIME.com: Top 10 drug company
settlements<http://healthland.time.com/2012/09/17/pharma-behaving-badly-top-10-drug-company-settlements/>

Healy went on to discuss how drug companies have repeatedly concealed
important information about the risks of their medications, whether by
hiring ghostwriters to spin the results of scientific studies and then
getting renowned experts to put their names on the published papers; by
employing tricks in clinical trials like using inadequate doses of
comparison medications to make the company's own drug look better; or by
simply keeping unfavorable data out of the public domain.

Healy himself has also been targeted directly by drug companies that
haven't been happy with his critiques. In fact, he's widely believed to
have lost an academic job offer at the University of Toronto as a result of
one such critical lecture.

At the session on Thursday, one slide in his presentation contained
information he sought via a Freedom of Information Act request detailing
drugmaker Eli Lilly's strategy for shutting Healy down. To counter his
public insistence that drug companies reveal hidden drug data, Eli Lilly
proposed doing things like planting confederates in the audience of his
presentations to ask questions that support industry's view.

Healy also described how in his own attempts to publish formerly hidden
data — which all now reside in the public domain — he encountered legal
issues with journals, which ultimately resulted in rejection of
publication. The clinical-trial data in question in this case showed a
greater risk of suicidal acts associated with antidepressants than had
previously been revealed.

Healy also referenced hidden data from trials of the antipsychotic drug
Zyprexa.

"None of them mentioned [that the drug could cause]
diabetes<http://topics.time.com/diabetes/>or [had] the highest suicide
rate in clinical-trial history," he said.

Although drug companies are now required by medical journals to register
all of their clinical trials with the National Institutes of Health if they
wish to publish them — including those that never end up being published —
this is not a legal requirement. They can still hide relevant data from the
Food and Drug Administration by not disclosing trials that they never
attempt to submit to a journal.

Healy noted further that when data surfaced showing a link between
antidepressant use and risk of suicide in children, the APA issued a
statement proclaiming that "we believe that antidepressants save lives."

"What I believe they should have said is that the APA believes that
psychiatrists can save lives because it takes expertise to manage the risks
of risky pills," he said; if psychiatrists' only role were to dole out
drugs, then less trained physician's assistants could easily replace them,
he noted.

TIME.com: When crucial new-drug data is
hidden<http://healthland.time.com/2012/09/24/a-doctors-dilemma-when-crucial-new-drug-data-is-hidden/>

But when a questioner, claiming himself "speechless" in the face of Healy's
arguments, asked whether he should just stop prescribing antidepressants,
Healy said no. Healy prescribes them himself, but believes that the role of
the doctor is to manage risks, not view drugs as harmless. "Medical
treatment is poison, and the art of medicine is trying to find the right
dose," he said.

As for what could be done to disentangle medicine from industry, Healy
wasn't entirely pessimistic.

"The key issue in the short term is access to data. We have to insist on
that," he said. "We let industry come to our meetings and let them talk in
our programs. I don't think it's huge problem that they get paid. The big
problem is that if you ask for data, they can't give it to you. That's not
science, that's marketing masquerading as science."

But what of the issue of doctors being visited by paid-industry types — or
being paid by industry themselves? The panel's organizer, Dr. Daniel
Carlat, director of the Pew Prescription Project, noted a new disclosure
law, passed as part of President Obama's health-reform bill in 2010.

Under the legislation, drug companies must reveal which doctors have taken
any payment or gift from them worth more than $10, and describe the exact
amounts taken and the purpose for them on a publicly available website.
(Unfortunately that website will not be up and running until 2014 at the
earliest.) All of the panelists agreed, however, that while public
disclosure is good, it is not enough.

Dr. Roy Perlis, who heads the Center for Experimental Drugs and Diagnostics
at Massachusetts General Hospital, cited research showing that disclosure
can actually backfire in unexpected ways. In one study, for example, people
were asked to estimate the number of coins in a jar and provided an
"adviser" to help them guess. Unbeknownst to them, the adviser had been
paid to try to push people to make higher estimates than they otherwise
might.

In one condition of the trial, participants were told in advance that the
adviser had this bias, but that made matters worse. Under this
circumstance, the adviser encouraged participants to make even higher
estimates than in the situation without disclosure.

TIME.com: Study of a failed antidepressant shows the drugs
work<http://healthland.time.com/2010/10/18/how-a-failed-antidepressant-study-shows-antidepressants-actually-work/>

"There are two different mechanisms" to explain the phenomenon, says
Perlis. "One is strategic exaggeration: 'I know you're going to discount
what I say, so I deliberately will be more effusive and tell you a higher
number.' The other is so-called moral licensing: 'I've disclosed my
conflict, therefore I'm allowed to be biased.' This very thing may well
also play out when disclosing conflicts of interest in medicine."

Maran Woolston, a woman with multiple sclerosis, also spoke on the panel
about how betrayed she felt when she learned her doctor had referred much
of her care to a drug-company subsidiary, but had not revealed it to her —
and had also taken $300,000 in funding from various drugmakers.

"In my opinion, transparency isn't a silver bullet," she said. "My ideal
solution — and this may be naive — is that [doctors should] accept no
payments whatsoever because then there can be no conflict of interest."

*This story was originally published on **TIME.com<http://healthland.time.com>
*


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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