Wednesday, September 10, 2008

Can America's premier psychiatric assocation heal itself?

Judging by its response to the Senate Finance Committee, the leadership of the American Psychiatric Association (APA) still doesn't seem to get it. For the past several months, the Finance Committee has been investigating conflicts of interest between academic psychiatrists and the drug industry and in July, the committee widened its probe to include the APA, which represents most of the nation's psychiatrists; see (back story). Sen. Charles Grassley (R-Iowa), the ranking Republican on the Finance committee, demanded that the APA cough up detailed information about the revenue that the organization has received from drug companies since January 2003.

Grassley shone his spotlight on the APA shortly after the publication of my book, Side Effects, which reveals in detail the longstanding and mutually beneficial relationship that the APA has had over the years with the pharmaceutical industry. Beginning in the 1990s and continuing to the present, drug companies have paid the psychiatry profession’s trade association millions of dollars to sponsor industry symposiums at the APA’s annual meeting each year. Speakers at those well-attended symposiums often talk up drugs made by the same companies sponsoring their talks.

The conflicts that exist in the psychiatric community go far beyond that, of course. In Side Effects, I chronicle the millions of dollars that one academic psychiatrist, Martin Keller, chief of psychiatry at Brown University, was getting paid in consulting and speaking fees by the very drug companies whose drugs he was studying and touting in medical journals and at APA conferences. Keller is among the psychiatrists being probed by the Senate Finance Committee (back story). Another psychiatrist under Grassley's spotlight whom I also mention in my book is Alan Schatzberg, chief of psychiatry at Stanford University and president-elect of the APA (back story).

This past Monday, Nada Stotland, current president of the APA, wrote a long memo to the association's members explaining that the requested information was delivered to Sen. Grassley's office on Sept. 2, along with a letter explaining the revenue information. In her Sept. 8 memo, Stotland said the letter could be "accessed at APA's website by logging into the Members Corner and clicking on Grassley response." In other words, only paying members can access the letter, not to the general public. The APA's communications office has yet to respond to my request for a copy of the letter. Transparency this is not.

In her memo, Stotland makes it sound as though she's not exactly on board with the recent calls for reform. She writes, "Long traditions and established practices are not only being questioned, but also criticized across the board. Both the American Medical Association and the Association of American Medical Colleges have developed or are developing new standards that differ sharply from many decades of practice." It almost sounds like Stotland's problem is with the criticism of these longstanding practices, not the practices themselves.

Stotland does go on to say that well before Grassley's request (last March), the APA had put together several work groups to examine the extent of her organization's reliance on drug company funding and to establish guidelines for individual psychiatrists who take money from drug companies. However, the guidelines work group has yet to have their first conference call, according to Paul Appelbaum, director of the division of psychiatry, medicine and the law at Columbia University College of Physicians and Surgeons, who is chairing the latter group.

Appelbaum says he expects his group to examine the whole range of possible conflicts that emerge when psychiatrists are paid speaking and consulting fees by drug companies and given free meals, junkets and drug samples by company reps.

In his interview with me yesterday, Appelbaum sounded a less equivocal note than Stotland. "Merely because something has been a long-established practice is not justification for it to continue," he said. "I think in general we ought to be worried about money that flows from interested parties to researchers because it has the potential to alter their research findings and distort people's judgement."

It's good to see that somebody in a position of responsibility at the APA understands what's at stake here.

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