APA explaining to Feds

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Ritz

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Psychiatric Group Faces Scrutiny Over Drug Industry Ties

http://www.nytimes.com/2008/07/12/w...&ei=5087&em&en=eaabf6fb8da6b592&ex=1216008000

"In psychiatry, Mr. Grassley has found an orchard of low-hanging fruit. "

Who invited him ?

Ya, I just got the APA message about them asking for the fundings of the APA. That's funny considering IOWA hardly has that many psychiatrists in it (only one residency program there).

I think it's fair for them to ask for an accounting of the money use, after all the organization is not private (or is it?). If there is someone pocketing something straight from pharm industry that should be APA money not theirs, then that does need looking into.

I am not reading between the lines, why is everyone so distressed? It almost feels like the usual JCAHO inspections.
 
Psychiatric Group Faces Scrutiny Over Drug Industry Ties

http://www.nytimes.com/2008/07/12/w...&ei=5087&em&en=eaabf6fb8da6b592&ex=1216008000

"In psychiatry, Mr. Grassley has found an orchard of low-hanging fruit. "

Who invited him ?

There have been several discussions of late on here regarding the sometimes "too cozy" relationship Big Pharma has with some doctors (and certainly not just Psychiatrists.) Senator Grassley certainly must realize the even bigger problem of Big Phama's potent lobbying power with Congress.

Between 1998 and 2004, the pharmaceutical companies spent more on lobbying then any other industry (they had enough lobbyists that there were two for each member of Congress.) The net result of their lobbying effort was to curtail any attempt by Congress to regulate Big Pharma's promotional practices or pricing, and has created new laws to add years to the average length of time drugs are protected by patents as well as to allow the pharmaceutical companies to profit from medical discoveries made by taxpayer-funded scientists. When these new laws boosted drug company profits to the moon, Congress created more laws that gave those drug companies so many tax credits that, as a group, Big Pharma pays far lower taxes on average than other major industries.

I'm glad to see that one member of Congress is looking into one small aspect of Big Pharma's cozy relationships, but the issue is much bigger, and any serious review and investigation should start with Congress itself.
Congress needs to heed the wise words of Pogo; "We have met the enemy, and it is us."
 
Members don't see this ad :)
This was picked up by The Consumerist and embellished to maintain the attention span of Joe Schmoe:

http://consumerist.com/tag/psychiat...t-to-you-by-selfless-pharmaceutical-companies

Modern Psychiatry: Brought To You By Selfless Pharmaceutical Companies

Psychiatry is nothing more than a well-funded front for big pharma, according to lawmakers investigating the field's premier organization, the American Psychiatric Association. Unlike psychologists, psychiatrists can write prescriptions, giving pharmaceutical companies a powerful incentive to lavishly subsidize both their lifestyle and profession.

Nearly a third of the Association's $62 million budget comes from big pharma, which also showers individual practitioners with lucrative 'consultation fees'. The problem isn't that the profession lacks adequate ethics guidelines or regulations, but that psychiatrists simply ignore the rules.

As a group, psychiatrists earn less in base salary than any other specialists, according to a nationwide survey by the Medical Group Management Association. In 2007, median compensation for psychiatrists was $198,653, less than half of the $464,420 earned by diagnostic radiologists and barely more than the $190,547 earned by doctors practicing internal medicine.

But many psychiatrists supplement this income with consulting arrangements with drug makers, traveling the country to give dinner talks about drugs to other doctors for fees generally ranging from $750 to $3,500 per event, for instance.

While data on industry consulting arrangements are sparse, state officials in Vermont reported that in the 2007 fiscal year, drug makers gave more money to psychiatrists than to doctors in any other specialty. Eleven psychiatrists in the state received an average of $56,944 each. Data from Minnesota, among the few other states to collect such information, show a similar trend.

In both states, individual psychiatrists are not top earners, but consulting arrangements are so common that their total tops all others. The worry is that this money may subtly alter psychiatrists’ choices of which drugs to prescribe.

An analysis of Minnesota data by The New York Times last year found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less money or none. The drugs are not approved for most uses in children, who appear to be especially susceptible to the side effects, including rapid weight gain.

A psychiatrist's office is a "safe space," where it's ok to ask any question, including: "have you received any compensation from any drug company?"
Even better, check out the comments from the general public following the article, all very predictable. It can basically be summarized as "Doctors are horribly overpaid!" & "Psychiatrists are EVIL drug pushing monsters who hate their patients!!".

Doesn't this kind of stuff make you want to foam at the mouth?
 
And yet I dont see them stopping those psychiatry consults. I guess imprisoning people who hear voices is still not a better alternative than treating them eh? Sounds like something Iowa wants to try.
 
Well, when you're playing with rabid dogs, you shouldn't be surprised when you start foaming at the mouth. We have only ourselves to blame for this public perception--distorted or not.
I don't totally agree with that statement. Psychiatry seems to get a lot of **** from a number of outside sources which you don't see in many other specialties.

From a personal perspective I don't really care what they have to say, but it bothers me because you can just see 1000's of people reading this and making the decision (or having their previous decision reinforced) not to seek psychiatric help as a result even if they truly need it. I can only imagine the harm to the general public from these publications is much greater than that from a few docs that might prescribe something because they got a nice dinner somewhere. But I doubt anyone involved in writing the above article really thought or cared about that.
 
I don't totally agree with that statement. Psychiatry seems to get a lot of **** from a number of outside sources which you don't see in many other specialties.

From a personal perspective I don't really care what they have to say, but it bothers me because you can just see 1000's of people reading this and making the decision (or having their previous decision reinforced) not to seek psychiatric help as a result even if they truly need it. I can only imagine the harm to the general public from these publications is much greater than that from a few docs that might prescribe something because they got a nice dinner somewhere. But I doubt anyone involved in writing the above article really thought or cared about that.

Writing a prescription based solely on receiving a dinner, cash or because the pharmaceutical salesman said it is safe can be lethal: prescription pills taken as directed by physicians kills one American every five minutes.
 
Writing a prescription based solely on receiving a dinner, cash or because the pharmaceutical salesman said it is safe can be lethal: prescription pills taken as directed by physicians kills one American every five minutes.

Oh please... you are killing me. You know very well that many medical errors happen. We are not talking about medical errors (someone giving you 100 mg instead of 10 mg).

The spirit and point made about the pharm industry is exactly what everyone has been talking about. It's you giving someone Lexapo instead of Celexa or Abilify instead of Risperdal or pick your favorite new brand instead of old generic. The fact is many of the newer drugs have better side effects than the older ones, but they are more expensive. In the ideal world, we all want the more expensive drugs for cheap.
 
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Oh please... you are killing me. You know very well that many medical errors happen. We are not talking about medical errors (someone giving you 100 mg instead of 10 mg).

The spirit and point made about the pharm industry is exactly what everyone has been talking about. It's you giving someone Lexapor instead of Celexa or Abilify instead of Risperdal or pick your favorite new brand instead of old generic. The fact is many of the newer drugs have better side effects than the older ones, but they are more expensive. In the ideal world, we all want the more expensive drugs for cheap.

I wasn't talking at all about medical errors....I was talking about BoxTortoise's point that publications are more dangerous then doctors prescribing something "because they got a nice dinner somewhere." My point is that if you prescribe anything because you got a nice dinner, you're playing with fire. Doctors should do their homework and prescribe based on their best judgement and knowledge, not on the advice of a salesman or a free dinner, key chain or pen. Gee, i thought what i said would be fairly simple and uncontraversial.

I agree with your second paragraph...maybe getting the more expensive drugs for cheaper could move from the "ideal world" to the real world if drug patents were shortened in length...but I'm no expert...
 
I wasn't talking at all about medical errors....I was talking about BoxTortoise's point that publications are more dangerous then doctors prescribing something "because they got a nice dinner somewhere." My point is that if you prescribe anything because you got a nice dinner, you're playing with fire. Doctors should do their homework and prescribe based on their best judgement and knowledge, not on the advice of a salesman or a free dinner, key chain or pen. Gee, i thought what i said would be fairly simple and uncontraversial.

I agree with your second paragraph...maybe getting the more expensive drugs for cheaper could move from the "ideal world" to the real world if drug patents were shortened in length...but I'm no expert...
You don't really seem to understand the actual issue that is at hand. Where are you in this whole arena of medicine?, your status indicates you are a "non-student".
 
Interesting article, and rightfully pointing out plenty of conflicts of interest. We should as doctors take some stand to make sure conflicts of interest do not adversely affect our practice & the direction of the field.

Likewise, I wonder if the good Senator from Iowa is also keeping a watchful eye of the plenty of conflicts of interest in the federal government.
 
You don't really seem to understand the actual issue that is at hand. Where are you in this whole arena of medicine?, your status indicates you are a "non-student".

Thanks for your concern and interest. The actual issue at hand is the article posted by Ritz which entails scrutiny by Senator Grassley over the APA's potential ties to the "Drug Industry." My status is concerned citizen, consumer of drugs and medical services, and a very close friend of members of the medical community.
 
Members don't see this ad :)
Thanks for your concern and interest. The actual issue at hand is the article posted by Ritz which entails scrutiny by Senator Grassley over the APA's potential ties to the "Drug Industry." My status is concerned citizen, consumer of drugs and medical services, and a very close friend of members of the medical community.
I thought as much.
 
Interesting article, and rightfully pointing out plenty of conflicts of interest. We should as doctors take some stand to make sure conflicts of interest do not adversely affect our practice & the direction of the field.

Likewise, I wonder if the good Senator from Iowa is also keeping a watchful eye of the plenty of conflicts of interest in the federal government.

I agree. I noticed that campaign contributions to Senator Grassley from pharmaceutical companies has gone down each of the last three years, not that this would influence anyone in Congress.
 
I thought as much.

Nice attitude. I guess only "medical student" status qualifies someone to post an opinion on things medical.

Now, how old are you and in what year of medical study are you?
 
I wasn't talking at all about medical errors....I was talking about BoxTortoise's point that publications are more dangerous then doctors prescribing something "because they got a nice dinner somewhere." My point is that if you prescribe anything because you got a nice dinner, you're playing with fire. Doctors should do their homework and prescribe based on their best judgement and knowledge, not on the advice of a salesman or a free dinner, key chain or pen. Gee, i thought what i said would be fairly simple and uncontraversial.

I agree with your second paragraph...maybe getting the more expensive drugs for cheaper could move from the "ideal world" to the real world if drug patents were shortened in length...but I'm no expert...

Misunderstood, reread the post and I see your point, sorry.
Tiphat.gif
 
Nice attitude. I guess only "medical student" status qualifies someone to post an opinion on things medical.
No, but it does explain your lack of understanding with regard to some of the issues being discussed here.

It can be frustrating when one wants to have a discussion with other members of the medical community on a site intended for that purpose and the general public decides they want to participate. There are plenty of sites on the internet for discussion of this and similar subjects that are designed for the general public.
 
I don't totally agree with that statement. Psychiatry seems to get a lot of **** from a number of outside sources which you don't see in many other specialties.

From a personal perspective I don't really care what they have to say, but it bothers me because you can just see 1000's of people reading this and making the decision (or having their previous decision reinforced) not to seek psychiatric help as a result even if they truly need it. I can only imagine the harm to the general public from these publications is much greater than that from a few docs that might prescribe something because they got a nice dinner somewhere. But I doubt anyone involved in writing the above article really thought or cared about that.

I think that since we struggle against stigma, scientologists, ****, and other such sociocultural forces, we ought to be all the more eager to be above reproach ethically.

In Minnesota, the requirement to report industry payments applies to all physicians, not just psychiatrists. Why are psychiatists singled out? Because it's not internists, radiologists, and dematologists leading the list of those getting these payouts![/I] If psychiatrists wish to take handouts from industry, they'd best not be complaining when the public takes a closer look.

My thoughts on this subject have been well-deliniated in a previous thread, so I'll say no more. However, I will mention that HCE has been a civil and thoughtful member of this particular sub-forum for quite a bit longer than you have, and you would be well-advised to not be portraying yourself as in any way more qualified to comment than they.
 
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No, but it does explain your lack of understanding with regard to some of the issues being discussed here.

It can be frustrating when one wants to have a discussion with other members of the medical community on a site intended for that purpose and the general public decides they want to participate. There are plenty of sites on the internet for discussion of this and similar subjects that are designed for the general public.

BoxTortoise, I really don't think one needs to be a medical student to understand this particular issue. I might add that I have some familiarity with issues in Psychiatry. I suspect that some time before you were born, I was an attorney representing developmentally disabled individuals who were inappropriately housed in a state mental hospital. I also represented a class of autistic children who were placed in a behavor modification program that used shock treatment.

I found this site back when my son started medical school, as a way to better understand what the whole medical school experience is about. Turns out he just graduated, and has started a Psychiatry residency.

Perhaps you make a good point when you state that it is frustrating for you (and I assume you mean for others as well) to have discussions with other members of the medical community only to have the "general public" seap in to the conversation. In fact I do visit other sites to discuss these and other issues. I enjoy getting the medical community's perspective on health issues as well.

I have no problem with just reading posts here (particularly posts by OldPsychDoc, Annasazi, DocSampson and others) vs. posting comments myself. But don't question my understanding of the issues; I suspect I understand the issues at least as well as you do. I would recommend you lose your elitist attitude toward the public on health issues...it will serve you well.

Later.
 
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Did anybody else see the following? For what it is worth, most on this forum know that I am opposed to movements from congress meant to control marketing. I'm sure glad that congress doesn't tell me how I can market my own business. Here is the letter I got from the APA:

Fellow Members of the APA:



The APA Office has just received a letter from Senator Grassley of Iowa, requesting a complete accounting of APA revenues, except those from advertising in our journals, from pharmaceutical companies starting in 2003. We will, of course, provide this information, which had already been available to our members.



These monies have supported activities including symposia, program bags, buses, and exhibits at our annual meetings and research and leadership training for outstanding residents. Our compliance with the rules governing these revenues has earned us accolades from the accrediting agency.



We are not alone; recent public focus on relationships between medicine and the pharmaceutical industry is a challenge for the whole field of medicine. The APA fully endorses the concept of transparency in our relationships with pharma and other entities and has been in the forefront of the disclosure process. In March, 2008, long before this inquiry from Senator Grassley, your Board of Trustees empaneled a working group charged to review all APA pharmaceutical revenues, sort them into categories, and provide the Board with options for ending pharmaceutical support in each category and the implications for the activities they currently fund. We are proud of what we do.



We will continue to keep you informed about this and all matters of importance to members of the APA.



Nada Stotland, M.D., MPH
APA President
 
I never did what you indicated, try re-reading what I wrote more closely.

Well, I did re-read it---

--you dismissed HCE as a "non-student" in post 11, stating "You don't really seem to understand the actual issue that is at hand".

--in post 14, you dimissed HCE's explanation of their role as a concerned community member with personal experience with a simple "I thought as much".

--in post 18 you implied that those not "members of the medical community" have no useful input to this discussion.

All in all, I haven't seen that you are wanting to engage in any thoughtful discussion of the issue of industry-clinician relations except to "foam at the mouth" and make unfounded claims that others don't understand the issue. I am more than willing to hear evidence to the contrary from you, and would look forward to you making positive contributions to this forum in the future.
 
Did anybody else see the following? For what it is worth, most on this forum know that I am opposed to movements from congress meant to control marketing. I'm sure glad that congress doesn't tell me how I can market my own business. Here is the letter I got from the APA:

Yup.

Alright... lets discuss reality and the big elephant in the room that everyone is dancing around.

Drugs are expensive. If the drugs were cheap (e.g. Concentra, Lexapro, Abilify, Arixtra, Tygicil, blah blah blah) would the public have a problem with the drug companies letting doctors do talks about them? I doubt it. Would they even mind if they got paid to do that? I doubt it.

So the issue is not that the drugs are good or bad, better or the same... the issue is that the drugs are expensive and the public want to avoid expenses. I guess we could start being like canada and use the government as a single purchaser. That oughta fix it all and kill many new drugs.
 
So, how bad do you think it would be if the APA voluntarily (i.e. not under any threat of legislation) refused to accept any funding from Pharma?

How would it affect your lifestyle if you were to similarily choose to have a completely "untainted" practice?
 
Yup.

Alright... lets discuss reality and the big elephant in the room that everyone is dancing around.

Drugs are expensive. If the drugs were cheap (e.g. Concentra, Lexapro, Abilify, Arixtra, Tygicil, blah blah blah) would the public have a problem with the drug companies letting doctors do talks about them? I doubt it. Would they even mind if they got paid to do that? I doubt it.

So the issue is not that the drugs are good or bad, better or the same... the issue is that the drugs are expensive and the public want to avoid expenses. I guess we could start being like canada and use the government as a single purchaser. That oughta fix it all and kill many new drugs.

I think the issue is not just that drugs are expensive, but that there's not a whole lot of great evidence that the expensive ones work that much better than the cheap ones, and that Pharma is spending a whole lot of moolah to try to convince us to steer our patients (the "public") to the expensive ones.
 
Well, I did re-read it---

--you dismissed HCE as a "non-student" in post 11, stating "You don't really seem to understand the actual issue that is at hand".

--in post 14, you dimissed HCE's explanation of their role as a concerned community member with personal experience with a simple "I thought as much".

--in post 18 you implied that those not "members of the medical community" have no useful input to this discussion.
As far as the "points" you listed, for post 11 I don't see that I was being dismissive, and there is nothing wrong with indicating my perception of his understanding. For post 14, again, I don't see it as being dismissive, I was simply stating the confirmation of my suspicion that this individual was indeed not a member of the medical community and I was correct. Concerning post 18, that may be your interpretation, but that was not my statement. Regardless, I don't see any of the points you mentioned as "portraying yourself as in any way more qualified to comment than they."
 
the issue is that the drugs are expensive and the public want to avoid expenses. I guess we could start being like canada and use the government as a single purchaser. That oughta fix it all and kill many new drugs.

I love it! I wish more people thought like you. I'm so sick of people wanting a free ride.
 
I think the issue is not just that drugs are expensive, but that there's not a whole lot of great evidence that the expensive ones work that much better than the cheap ones, and that Pharma is spending a whole lot of moolah to try to convince us to steer our patients (the "public") to the expensive ones.

Sounds like a challange for university programs that are dying for research projects. :cool:

Remember the number 1 reason for readmission of the inpatient unit is non compliance. Some is indeed $$$$ but much is side effects. The classic "It makes me drowsy" and "It makes me fat".
 
As far as the "points" you listed, for post 11 I don't see that I was being dismissive, and there is nothing wrong with indicating my perception of his understanding. For post 14, again, I don't see it as being dismissive, I was simply stating the confirmation of my suspicion that this individual was indeed not a member of the medical community and I was correct. Concerning post 18, that may be your interpretation, but that was not my statement. Regardless, I don't see any of the points you mentioned as "portraying yourself as in any way more qualified to comment than they."
I can hear crunchy sounds as you are chewing your foot at this point.
 
I agree. I noticed that campaign contributions to Senator Grassley from pharmaceutical companies has gone down each of the last three years, not that this would influence anyone in Congress.

Exactly.
http://www.opensecrets.org/politicians/contrib.php?cid=N00001758&cycle=2002
contributions from Lilly & GSK in 2002
Eli Lilly & Co $13,000
GlaxoSmithKline $13,000

In 2006, their contributions to the good Senator were way down.

In the Senator's defense, he truly may have sincere & good motives. I cannot read his mind, but the way I'm seeing it, idiot x is going after idiot y for being an idiot.

I say instead get rid off all the idiots.
I do believe that conflicts of interest need to be removed & there needs to be a major cleanup---not just in our own field but in Washington as well.

How would it affect your lifestyle if you were to similarily choose to have a completely "untainted" practice?

As an attending, in general, I don't see much reason to sell out to big pharm. Its not like I can't afford an expensive dinner now that I'm an attending. I can understand residents who are overworked, in major debt & being paid little going to a dinner, and yes some of those dinners can be educational, especially to one who's mind is a blank slate that needs to be filled in data. As an attending, though, I don't see much reason to go to the dinners.
 
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I've heard that there are still some psychiatrists that do therapy (even family therapy).

<flogging dead horse but too tech unsavvy to put in the little icon of said horse being flogged>

LOL....I can so relate to this unsavviness...
 
I think the issue is not just that drugs are expensive, but that there's not a whole lot of great evidence that the expensive ones work that much better than the cheap ones, and that Pharma is spending a whole lot of moolah to try to convince us to steer our patients (the "public") to the expensive ones.[/QUOTE]

Its funny that you decided to quote this Carlat guy. I head him speak at one of the grand rounds, and it was clear it was more an exercise at self promotion. Talk about preaching to people after lecturing for drug companies and making huge amounts of money.

I think 'Sazi asked a very good question. That explains a lot about our hypocrisy on the issue.
 
I think the issue is not just that drugs are expensive, but that there's not a whole lot of great evidence that the expensive ones work that much better than the cheap ones, and that Pharma is spending a whole lot of moolah to try to convince us to steer our patients (the "public") to the expensive ones.[/QUOTE]

Its funny that you decided to quote this Carlat guy. I head him speak at one of the grand rounds, and it was clear it was more an exercise at self promotion. Talk about preaching to people after lecturing for drug companies and making huge amounts of money.

I think 'Sazi asked a very good question. That explains a lot about our hypocrisy on the issue.

At least Carlat self-discloses his conflicts of interest (e.g. selling his newsletter). I think that the criticisms he raises about industry-funded CME are more than valid.

I'm not saying that I only prescribe generic SSRIs and haloperidol.
Yes, 2nd generation antipsychotics have great advantages over their predecessors in many ways. Re-packaged metabolites---not so much.
I am saying that it is ethically imperative that our potential conflicts of interest be disclosed, and that we should not have to be bribed, even subtly, to change our prescribing habits.

(I think that the fact that this topic keeps coming up with such vehemence indicates that the equine is not yet fully deceased...)
 
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