A conflict of interest, not to mention ethics, is brewing. The influence of pharmaceutical companies on the science of psychiatry is being discussed on two of my favorite blogs, Furious Seasons and Mind Hacks.
The Integrity in Science Project has reported that more than half of the committee members working on the next edition of the DSM have ties to pharmaceutical companies. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the psychiatric bible and the reference manual for making psychiatric diagnoses. If more than half of the people working on the current edition have financial ties to the pharmaceutical industry we can only wonder what the effects those ties will have on how mental disorders are defined.
Another arlicle in Slate discusses the influence of the pharmaceutical industry (affectionately known as Big Pharma) on NPR's host of the Infinite Mind, Dr. Fred Goodwin. A recent segment, "Prozac Nation: Revisited" discussed the controversial link between antidepressants and suicides. Three guest medical experts appeared on the show and all agreed that concerns voiced about antidepressants and suicide were greatly overblown. Slate notes with interest that not only were all three guests and the host have financial ties to the pharmaceutical industry and the show, "Infinite Mind" has received "unrestricted grants" from various pharmaceutical companies including Eli Lilly.
This problem is not unknown or new. The distorting influence of Big Pharma on the medical field is well documented. The Nation reported in 2002 that the New England Journal of Medicine announced that they would drop their policy requiring authors of review articles have no financial ties to drug companies whose medications were being analyzed. Why? Because the influence of pharmaceutical funds was so pervasive in the field they could no longer find independent experts.
The ubiquity of pharmaceutical funding is not surprising considering this report by Science Daily that the pharmaceutical industry spends more on advertising than they do on research. Having worked in psychiatrists' offices for more than 15 years I have seen these marketing efforts first hand. It is nothing for a pharmaceutical company to deliver a trunk load of free samples and cater and expensive meal for an outpatient psychiatric clinic of approximately 20 staff members. Smartly dressed young women (always young and almost always women) have a ton of marketing gizmos at hand: calendars, coffee mugs, desk accessories of every kind, pads and pens, you name it. Janssen-Cilag pharmaceuticals, makers of Risperal, even came with a virtual reality headset that allowed you to experience hallucinations as in schizophrenia. I have to admit, this program, called "Paved with Fear" was an amazing experience, but in my humble opinion the money could have been better spent on finding an antipsychotic without potential life threatening side effects. The money spent on "branding" (impressing a brand name upon the mind of potential consumer) never ceased to amaze me. But what concerned me even more was the naivete of the doctors. Once they had in their possession drawers full of free samples, they handed them out to everyone. This became the drug of choice. And the drug of choice seemed to prescribe the diagnosis to justify it. Instead of the doctor interviewing the patient, making a diagnosis, and prescribing the correct treatment for it, the marketing skills of the drug reps seemed to influence which diagnoses were given to patients. If the latest, greatest new drug was a mood stabilizer, there was an increase in Bipolar Disorder among the patients. I think this may be the reason behind the sudden increase in Bipolar Disorder and ADHD diagnoses in general. Antipsychotics have now been classified as appropriate treatment for Bipolar Disorder and we have a new class of ADHD meds on the market. Not only is this illogical and unethical, it's clearly unscientific. The primary basis of science is that it be unbiased. When it becomes biased it stops being science.
If science sells out to capitalistic endeavors to whom will we turn for medical and psychiatric care? If our doctors are heavily influenced by pharmaceutical companies how can we get an unbiased assessment of what ails us? How will receive any treatment prescribed for us except "take a pill"?
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