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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Phillipa on March 30, 2010, at 3:19:11
Seems public trust in pdocs is eroding with the paybacks from pharmacitical company's. Dr. Nemeroff Of Atlantic Named. Suggestions for non pharmaticical interventions instead of Med. Phillipa
From Medscape Medical News
"Culture of Influence" Eroding Public Trust in Psychiatrists
Caroline Cassels
Public trust in psychiatry is being eroded by the specialty's real and perceived ties to the pharmaceutical industry, says a leading psychiatristIn an editorial in this week's issue of the Journal of the American Medical Association, Thomas Insel, MD, director of the National Institute of Mental Health (NIMH), highlights the entrenched relationship between psychiatry and big pharma that has resulted in what he describes as a "culture of influence."
According to Dr. Insel "psychiatrists have rarely enjoyed a surplus of public trust." However, recent events have further eroded this tenuous relationship.
In his editorial Dr. Insel details recent events that have served to further undermine public trust in psychiatry foremost among them accusations that several leading academic psychiatrists, including Charles Nemeroff, MD, PhD, from Emory University in Atlanta, Georgia, were accused of failing to accurately disclose payments from drug companies.
"As public trust in the pharmaceutical industry has plummeted, the close connection between leading psychiatrists and the pharmaceutical industry, once a sign of progress for the profession, is now cited as evidence of corrupt influence," he writes.
Dr. Insel notes that these allegations have had major effects, including more rigorous disclosure requirements in many US universities and major initiatives by the National Institutes of Health to tighten restrictions on outside income and overhaul its regulations on financial conflicts of interest, which were originally adopted in 1995.
He also points out that the NIMH has launched an internal review system to "detect potential problems with the management of financial conflicts of interest and has implemented changes to minimize possible bias in its funded studies."
However, Dr. Insel notes that the largest effect of these events has been to bring psychiatrists' integrity into question.
Lion's Share
Research shows that at least in the state of Vermont, which requires public disclosure of all pharmaceutical industry payments to physicians and has comparative data across all medical specialties, psychiatrists receive the lion's share.
He also notes that a number of pharmaceutical companies are now voluntarily publicly posting payments to physicians.
Although state and pharmaceutical company registries largely reflect payments to individual physicians, Dr. Insel notes that a major concern is whether academic leaders and researchers who are in a position to influence practice through their academic work may be similarly unduly influenced by drug company money.
He notes that a recent study of all medical school department chairs shows 60% reported receiving personal income from industry and that 80% of faculty reported a relationship with industry.
To date, he writes, there are no data to show whether departments of psychiatry or their chairs receive more or less industry funding than their counterparts in other specialties.
Dr. Insel also points out that a recent review of 20 work groups members who authored American Psychiatric Association guidelines for the treatment of schizophrenia, bipolar disorder, and major depressive disorder showed 90% had industry ties but none was disclosed.
In contrast, a similar review of 192 authors of 44 clinical practice guidelines across a wide range of common adult disease showed 87% had some form of industry involvement but disclosures were only included in 2 cases.
"...it is difficult to conclude that academic psychiatrists receive more or disclose less than their colleagues in other areas of medicine. But what is clear is that current pharmaceutical industry investment in academic psychiatry is prevalent," he writes.
Nonpharmacologic Treatments Woefully Underused
But perhaps the most pressing question, says Dr. Insel, is whether psychiatric practice is biased by industry. He notes that psychiatric treatments have become largely pharmacologic, with antidepressants and antipsychotics representing 2 of the top 5 drug classes sold in the United States and sales that ran more than $25 billion in 2008.
Although many generic medications have been shown to be effective, Dr. Insel points out that more expensive, brand name drugs continue to hold most of the market share.
Most "worrisome," says Dr. Insel, is the relative neglect of effective nonpharmacologic interventions, including cognitive behavioral therapy and psychosocial interventions.
"Numerous studies have shown efficacy of such interventions, and their use has been recommended in the practice guidelines ... but they are woefully underused and frequently not reimbursed," he notes.
Although bias is not unique to psychiatry, writes Dr. Insel, this fact alone "doesn't diminish the severity of the problem."
Psychiatrists, he adds, have an opportunity to take the lead and set new standards for interactions between all medical disciplines and industry and develop a "culture of transparency."
"The greatest threat to an era of improved public health stemming from the productive and ethically sound relationship among academia, industry, and practice is a defiant embrace of the status quo, in which psychiatrists are seen as a leading source of the problem rather than as leaders in finding the solution for financial conflicts of interest," Dr. Insel writes.
Dr. Insel has disclosed no relevant financial relationships.
JAMA. 2010;303:1192-1193.
Posted by Lou Pilder on April 2, 2010, at 14:17:53
In reply to Redirect: Trust In Pdocs, posted by Dr. Bob on March 30, 2010, at 3:20:01
> > Seems public trust in pdocs is eroding with the paybacks from pharmacitical company's.
>
> Sorry to interrupt, but I'd like to redirect this thread to Psycho-Babble Social. Here's a link:
>
> http://www.dr-bob.org/babble/social/20100305/msgs/941422.html
>
> Thanks,
>
> BobMr. Hsiung,
Your TOS states that the board here is for related issues concerninig what is called here medications.
Now Phillipa has posted a link concerning the issue as to the relation of the makers with the one's that prescribe their products as called medications here.
I am unsure as to what your reasoning is here to move Phillpa's post to a social forum that is about being social when the link contains infomation about what I think your TOS states concerning what this forum is about. Could you post here what your rationale is for putting the link on a social forum?
Lou Pilder
Posted by herpills on April 2, 2010, at 14:17:53
In reply to Eroding Trust In Pdocs Due To Ties With Drug Compa, posted by Phillipa on March 29, 2010, at 21:14:00
This has always been a concern for me. At one time I started with a new pdoc (whom I no longer see, this was a few years ago) who put me on a combo in which ALL of the meds were made by GlaxoSmithKline. I couldn't help but be a little suspicious...
herpills
Posted by herpills on April 2, 2010, at 14:17:54
In reply to Redirect: Trust In Pdocs, posted by Dr. Bob on March 30, 2010, at 3:20:01
I'm sorry but I don't understand why this is being redirected? This article is very applicable to the discussions which take place on the medications board.
herpills
> > Seems public trust in pdocs is eroding with the paybacks from pharmacitical company's.
>
> Sorry to interrupt, but I'd like to redirect this thread to Psycho-Babble Social. Here's a link:
>
> http://www.dr-bob.org/babble/social/20100305/msgs/941422.html
>
> Thanks,
>
> Bob
Posted by Phillipa on April 2, 2010, at 14:17:54
In reply to Re: Redirect: Trust In Pdocs » Dr. Bob, posted by herpills on March 30, 2010, at 13:50:15
Sure is and there have been similar articles in the past on the same subject on meds. Lots of responses about the pads of paper, cups, pens etc with drug names stamped on them. As the drug reps educate the docs on their meds they sell. According to my docs they reiterated same info to me. And the samples. You always know when a new med is out. "Here's a sample try this". Phillipa
Posted by Dr. Bob on April 2, 2010, at 14:27:48
In reply to Re: Redirect: Trust In Pdocs » Dr. Bob, posted by herpills on April 2, 2010, at 14:17:54
> I am unsure as to what your reasoning is here to move Phillpa's post to a social forum that is about being social when the link contains infomation about what I think your TOS states concerning what this forum is about. Could you post here what your rationale is for putting the link on a social forum?
>
> Lou Pilder> I'm sorry but I don't understand why this is being redirected? This article is very applicable to the discussions which take place on the medications board.
>
> herpillsI agree, it's applicable, but I don't see it as directly related to medication. And the link there enables those who are interested to continue the discussion here.
Also, this forum is for general discussion and support as well as being social. Sometimes I think of it as Psycho-Babble NOS. :-)
Bob
This is the end of the thread.
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