Conflict of Interest?

[Psyclops]

What do you guys and gals think?

http://www.msnbc.msn.com/id/12395756/from/ET/

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[Smilemaker100]

What do you guys and gals think?

http://www.msnbc.msn.com/id/12395756/from/ET/

That`s not news to me. This type of relationship observed between the pharmaceutical industry and psychiatrists, where there could be a source of conflict, exists in all medical fields and to a certain extent, also in dentistry. According to a recent report in the Journal of the American Medical Association ,about 90 percent of the $21 billion pharmaceutical companies spend on marketing goes directly to physicians. The report suggests that academic medical centers ban most or all of the gift-giving, including drug samples, money for travel, paid speeches and research studies.

JAMA January 25, 2006; 295: 429 - 433.

http://jama.ama-assn.org/cgi/conten...st&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

 

[Psyclops]

Right, not surprising but is it OK?

 

[Smilemaker100]

Right, not surprising but is it OK?

Of course it`s not OK ! It goes against one of the basic ethical tennets of medicine ( "I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone ... I will preserve the purity of my life and my art. In every house where I come I will enter only for the good of my patients") because the interests are not in the interest of the patient.


Perhaps the government should provide more funding to universities so that more medical research could be conducted in a less biased institution.Ideally, the FDA and other regulatory bodies should be keeping a close watch on physicians who are investigators to ensure good clinical practice. Regulatory agencies should establish fines for violation of regulatory policy.

The American Medical Student Association , which represents 30 000 students, interns, and residents throughout the United States, started running a campaign a few years ago which was entitled " PharmFree" —calling for an end to gift giving, free lunches, sponsored education, and paid speaking. They have suggested a revised Hippocratic oath, called a "model oath for the new physician," which includes the commitments: "I will make medical decisions... free from the influence of advertising or promotion. I will not accept money, gifts, or hospitality that will create a conflict of interest in my education, practice, teaching, or research."

http://www.amsa.org/prof/pharmfree.cfm

Some of the PharmFree suggested reforms :

-Restrictions or prohibitions on drug representatives visiting doctors

-Restrictions or prohibitions on educational events funded by industry

-Prohibitions on individuals or organisations with conflicts of interest running accredited continuing medical education

-Moves towards independently funded continuing medical education and reliance on independent sources of information

-Campaigns to end acceptance of all gifts and trips

-Campaigns to end acceptance of honorariums for speaking at educational conferences

-Professional bodies reducing reliance on drug company sponsorship

-Professional associations' prohibitions on researchers with conflicts of interest conducting research

-Medical journals reducing reliance on advertising revenue and sponsored supplements

-Calls to set up "blind trusts" at an institutional level to independently handle outside funding

-Introduction into guidelines of the "rebuttable presumption" that researchers with conflicts of interest cannot do research using human subjects

-Calls for new national bodies to conduct research driven by public interest

-Calls for regulatory and advisory committee members to avoid conflicts of interest

 

[Psyclops]

I thik the article brings ups ome interesting points, bringing up the possibility that the syptomology is being tailored to fit the medication's effects. I'm interested to know what the psychiatrists on this forum think. Even though this does not neccesarily mean a conflict of interst, from what we know about the influence that various factors have on people, even the best intentioned reserachers might fall prey to scewing some results, data, diagnostic cirteria, etc.

 

[Solideliquid]

"substantial ties to industry"

Big surprise psychologists are analyzing the fact that psychiatrists have ties to the pharm industry. Well can't that be said of all the other fields of medicine? Too bad the old days are gone when drug reps sent us on a cruise for free. I really wouldn't mind going.

You know, the last time I read the entire DSM IV (last night, my usual reading) I did not see many (any?) treatment options or referrals to particular drugs.

 

[Solideliquid]

I thik the article brings ups ome interesting points, bringing up the possibility that the syptomology is being tailored to fit the medication's effects. I'm interested to know what the psychiatrists on this forum think. Even though this does not neccesarily mean a conflict of interst, from what we know about the influence that various factors have on people, even the best intentioned reserachers might fall prey to scewing some results, data, diagnostic cirteria, etc.

SO...it seems like pharm industry is paying schizophrenics to have particular symptoms that only zyprexa can alleviate. Damn conspiracies!

 

[soaringheights]

Hey psyclops I was thinking of putting this thread when I came across that article. I have been naive about this possibility of pharma companies backing the researchers in a substantial manner and was taken aback with this study. So I guess I have to take the DSM with a greater pinch of salt.
Solide u don't need to get so defensive...granted that symptom manifestation isnt fully determined by the drug u'll prescribe, but the availability of a specific drug ought to alert u to specifically search for the effects that it targets. Which means that psychiatrists on some level, are influenced by the marketing done by pharma companies. And just because it happens in other medical specialities too doesnt mean it is correct.

 

[Solideliquid]

Hey psyclops I was thinking of putting this thread when I came across that article. I have been naive about this possibility of pharma companies backing the researchers in a substantial manner and was taken aback with this study. So I guess I have to take the DSM with a greater pinch of salt.
Solide u don't need to get so defensive...granted that symptom manifestation isnt fully determined by the drug u'll prescribe, but the availability of a specific drug ought to alert u to specifically search for the effects that it targets. Which means that psychiatrists on some level, are influenced by the marketing done by pharma companies. And just because it happens in other medical specialities too doesnt mean it is correct.

Well I didn't mean to be, I mean I thought my post came on sort of nonchalant. Albuterol works wonders for mild-moderate asthma attacks (beta-2 agonist), why don't you point your finger there?

 

[PublicHealth]

Ah, come on, you know you love the drug company perks!

 

[Milo]

Ah, come on, you know you love the drug company perks!

I'd give it up joyfully if we could also get rid of the direct to consumer marketing.

pt: "hey doc, give me the one with the butterfly."

 

[Solideliquid]

I'd give it up joyfully if we could also get rid of the direct to consumer marketing.

pt: "hey doc, give me the one with the butterfly."

I love those Lunesta commercials! Makes me sleepy!

 

[Anasazi23]

The analysis did not reveal the extent of their relationships with industry or whether those ties preceded or followed their work on the manual.

Because this researcher is a psychologist, it is likely she is not privy to the wide range of relationships, uses of medications, and the subtle interplay between so-called pharmaceutical relationships and clinical decision-making. If I ever do a promotional speech as a new attending to make $750 on a Thursday night, I have to disclose that for the rest of my life? There's the ivory tower, and there's reality.

Of course, I don't condone pharmaceutical companies influencing a physician's clinical decision making, but claiming that use of samples, for example, is a conflict of interest, is just naive. There are lots of reasons I'll give samples to a patient - the least of which is because I received some small kickback from the drug rep themselves. It is curious as to why psychiatry is continually under attack with this. As Solideliquid stated, the finger could just as easily be pointed at other specialties.

Psychiatrists use medications. It's a major part of our treatment regimen. It's not an unfair notion that psychiatrists, therefore, have ties to various pharmaceutical companies, have done research for them, etc.

There is an entire subculture of pharmaceutical representation and doctor's prescribing habits. Physician formulary dispensing records are available for pharmaceutical company review. If the Abilify rep, for example, sees that the NY market share of Abilify prescriptions is low, they'll hit the offices and hospitals, trying to drum up business. If they see a physician who prescribes a lot of this med, they'll provide incentives for them to continue doing so. In the older days, these incentives were in the forms of televisions, trips, and so on. This still occurs, but in more subvert ways so that the rules are not technically broken.

Is this right? No.

However, while it is easy to jump on the pharmaceutical company for being unethical, it helps to analyze the greater situation. Bristol Myers, for example, produces Abilify. Let's assume, for the purposes of this discussion, that their market share compared to other similar drugs is lower. That is, considerably less Abilify scripts are written than for other atypicals. The reason for this may be legitimate i.e. the drug doesn't work as well. Who's to say, however, that the next drug produced by BMS will not be one which demonstrates supreme efficacy with few side effects compared to other comparable drugs, or that a new effective drug class will not be produced all together?

This can only happen is BMS recoups their 28 million dollar investment in bringing Abilify to market. Public outcry that medicaions should reach generic status in 2 years instead of 5 or 7 seems to them reasonable - that patients should have access to cheap medications for their debilitating illnesses as soon as possible. What they don't know, however, is that it takes an average of 5-7 years for a drug company to break even on research, development, and marketing costs for a particular drug. Creating a generic in 2 years eliminates the incentive for a company to further their research into new, potentially life-saving or highly efficacious drugs, knowing that they'll lose money on the deal.

So in all, can you blame aggressive marketing by drug companies on psychiatrists? No. This is a capitalist society, and the US produces more medications than any other country in the world. Does this mean the psychiatrists should prescribe based on drug-rep information or external influences? No. But to not consider the greater market forces in the reality of healthcare is a mistake also.

Clinically speaking and in reference to the article, I think this is a case of a few bad apples spoiling the bunch.

 

[Psyclops]

Of course there is the ivory tower and reality, but we need something to strive for.

And I think that samples are wonderful, we can give that sample of abilify to our shcizoaffective mothers who can't work because of thier condition.

But, if you want to talk about capitalism, and abilify isn't curing schizophrenia then MDs shouldn't prescribe it and BMS should take a huge hit. That's how capitalism is supposed to work. But regardless of the efficacy, they company will continue to push it to psychiatrists. The fact that they may produce something useful in the future is arguing from that vacuum again. Right now I have unlimited potential to produce any number of things that might benefit society in the future. But I shouldn't get rewarded for sub-par performance now.

The whole pharmacuetical company MD thing is reminiscent of K-street and congress. It's shady and affects us all. Especially those interested in doing reserach and practice in the MH field.

But as you mention this is not only limited to the specialty of psychiatry, which is a travesty. It shouldn't be happening at all. But just because the other fields are doing it doesn't make it ok, sorry to sound like a mom, but that's just the way it is. Also, does anyone know what portion of a drug's production cost goes towards advertisement and marketing? I'd love to know.

 

[Anasazi23]

The point was, there may be a vacuum, as you put it, but there are only so many drug companies. If ivory tower academics had their way, all drugs would be free, companies would not make a profit, and we'd all therefore still be using thorazine for all our patients, since it doesn't make financial sense to produce new drugs.

You can't just say that because Abilify isn't curing schizophrenia, that BMS should take a huge hit, because it leaves out the percentage of patients that respond well to it, although it may be small. The ivory tower academics at this point want the best of both worlds...to have all drugs available to them, and to have them all cheaply (and new ones on the horizon). BMS has recently, for example, been advertising to us heavily for the expressed purpose of getting us to change our dosing strategies. Their claim is that the med was released too early to fully understand how the most efficacious titrating schedule would work. If this turns out to work miracles (it won't), then we'd all have lost a lot by damning them to bankruptcy.

I still prescribe serzone to patients that need it.

 

[Psyclops]

Of course I agree with you. My point should have said helping instead of curing. Basically if a drug is garbage it shouldn't get bought.

What I thought was interesting about this piece, (that hadn't occured to me before) is that the way some of the research is conducted on mental disorders, using drugs that effect changes and infering the process of the disorder from there, opens the door for drug companies and their marketing to influence the way a disorder is conceptualized. (That was a cumbersome sentance to write. I hope my point came across.) I think it is important that Drs. First and Pincus remember that we as humans can be influenced by things that we aren't aware of.

 

[Anasazi23]

Of course I agree with you. My point should have said helping instead of curing. Basically if a drug is garbage it shouldn't get bought.

What I thought was interesting about this piece, (that hadn't occured to me before) is that the way some of the research is conducted on mental disorders, using drugs that effect changes and infering the process of the disorder from there, opens the door for drug companies and their marketing to influence the way a disorder is conceptualized. (That was a cumbersome sentance to write. I hope my point came across.) I think it is important that Drs. First and Pincus remember that we as humans can be influenced by things that we aren't aware of.

I'm not sure how much truth there is to this - that diagnoses are based on medication response. The famous example is "social anxiety disorder." Psychiatrists thought this was a ploy by Pfizer to create a diagnosis and create a pharmaceutical niche. It takes a long time to get diagnosis approval; by the time the other companies caught on with their SSRIs and got an indication, they would have made their billion, and moved on.

The diagnosis never picked up, however, and the ovoid entity (See that OPD?! ) has stopped moving in that direction.

Then again, in medicine, we can often infer the diagnosis of a condition by it's response to empirical treatment. Obviously, it's not as easy in psychiatry. But, if you're struggling between a diagnosis of something on the schizophrenic spectrum and bipolar with psychotic features, and they respond beautifully to Lithium, it makes you lean toward the latter.

 

[Psyclops]

I wanted to add something, I think this article did a poor job of noting that this is a common occurence accross specialties. Which as you mentioned is the case, and it is also a shame. This is the kind of article that the Cruise cohort can use against you and that's not fair.

Which brings me to another question, in terms of politics, is there a clear leaning either left or right for psychiatrists? I ask because the washington post a traditionally conservative publication wrote this article. But I tend to see MDs as also leaning towards the right (in general). Although I tend to see MH providers leaning to the left? Is there a general tendecy for psychiatrists?

 

[Anasazi23]

I wanted to add something, I think this article did a poor job of noting that this is a common occurence accross specialties. Which as you mentioned is the case, and it is also a shame. This is the kind of article that the Cruise cohort can use against you and that's not fair.

Which brings me to another question, in terms of politics, is there a clear leaning either left or right for psychiatrists? I ask because the washington post a traditionally conservative publication wrote this article. But I tend to see MDs as also leaning towards the right (in general). Although I tend to see MH providers leaning to the left? Is there a general tendecy for psychiatrists?

This probably doesn't make sense, but it seems that organizations (the APA) lean toward the left, while individual clinicians lean toward the right. Of course, there are thousands of exceptions and I'm only thinking of my personal knowledge.

 

[Psyclops]

This probably doesn't make sense, but it seems that organizations (the APA) lean toward the left, while individual clinicians lean toward the right. Of course, there are thousands of exceptions and I'm only thinking of my personal knowledge.

Makes perfect sense to me. Those who like to organize tend to be a little more socialist. Those loner clinicians tend be a little more let me be, everyone for themselves.