Drug companies and doctors

Happy 2009!  As promised, I’ll start adding photos to brighten up the page, and maybe illustrate a point at times.  This one is a mid-winter tribute to spring.

As you might surmise from past posts, I have long-standing concerns about commercial influence on the practice of medicine generally, and psychiatry in particular.  I have two bits of personal news to report on that front.  First, I authored the lead article in the current issue of Ethical Times, the quarterly bulletin of the Program in Medicine and Human Values established at the medical center where I teach.  Although Ethical Times eventually appears online, I may seek permission to reprint my article here.  Basically, I argue that it is incumbent upon ethical physicians to resist commercial influence in making clinical decisions — whatever pharmaceutical companies or device manufacturers do or don’t do.

Also, starting this month, I will serve as chair of the medical center’s CME committee.  As I posted in October, continuing medical education (CME) is both required to maintain medical licensure, and is rife with potential conflicts of interest when funded, as most of it is, by industry.  It will be interesting to be on the front lines dealing with these challenges.

In related news, the Pharmaceutical Research and Manufacturers of America (PhRMA) recently revised and expanded its voluntary restrictions on interactions with physicians.  The full text is available here.  The relevant New York Times article emphasizes the new moratorium on branded office items such as pens, notepads, and coffee mugs.  While my view is that the onus more appropriately rests with the medical profession itself to resist commercial influence — and accordingly some groups have tried for years to convince doctors not to fill their offices with promotional giveaways — this is a step in the right direction.  By my reading, though, the new PhRMA standards are considerably more limiting than the prior version in other areas as well.  New restrictions on wining and dining doctors may ultimately wield a bigger impact than the disappearance of cheap pens with drug logos.

Much more commercial influence remains, as an editorial in today’s New York Times points out.  Meanwhile, in the current issue of the New York Review of Books, Marcia Angell, former Editor in Chief of the New England Journal of Medicine, presents the field of psychiatry as Exhibit A in a shocking review of undue industry influence on research and practice.  We still have quite a ways to go.

2 comments to Drug companies and doctors

  • Three cheers. I agree wholeheartedly. I believe further that the influence of the drug industry in psychiatry is one of the seminal issues of the field. It is an influence with remarkable positive impact–decrease of stigma, improved medications, and increased research– yet, if poorly managed, equally powerful negative impacts. The chief risk is an industry-funded paradigm change in the field towards the biomedical model (the genes-and-medications model) rather than towards an integrated model which combines the best of humanistic, psychological treatments with the medication model. Ensuring that there is no controlling influence by drug companies in all their interactions with psychiatry is the singular, critical step necessary to protect the field– and patients–from the ill effects of a monopoly of the medications model over other equally or more efficacious models.

    Eli Merrit, MD

  • Thank you for writing. Of all medical specialties, psychiatry may be the most vulnerable to money-fueled paradigm shifts. Lacking consensus on a basic theoretical framework for the field, we unwittingly invite vested interests to try to define psychiatry for their own benefit. I imagine this was just as true in the heyday of Freudian psychoanalysis; it’s just that the Freudians never had the money, sales force, or television ads that drug makers do. I hope that someday the field reaches a consensus on the integrated model you describe. When that happens monopolistic models and monied interests will have less traction.

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