Wednesday, June 27, 2012

Psychiatric Group Faces Scrutiny Over Drug Industry Ties - NYT - Published: July 12, 2008

Psychiatric Group Faces Scrutiny Over Drug Industry Ties

Published: July 12, 2008
It seemed an ideal marriage, a scientific partnership that would attack mental illness from all sides. Psychiatrists would bring to the union their expertise and clinical experience, drug makers would provide their products and the money to run rigorous studies, and patients would get better medications, faster.

Doug Mills/The New York Times
Senator Charles E. Grassley, right, Republican of Iowa, is demanding that the American Psychiatric Association give an accounting of its financing from the pharmaceutical industry.
Dr. Alan F. Schatzberg, president-elect of the American Psychiatric Association.
But now the profession itself is under attack in Congress, accused of allowing this relationship to become too cozy. After a series of stinging investigations of individual doctors’ arrangements with drug makers, Senator Charles E. Grassley, Republican of Iowa, is demanding that the American Psychiatric Association, the field’s premier professional organization, give an accounting of its financing.
The association is the voice of establishment psychiatry, publishing the field’s major journals and its standard diagnostic manual.
“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Mr. Grassley said Thursday in a letter to the association.
In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting.
This weekend in Chicago, the psychiatry association’s board will meet behind closed doors, in part to discuss how to respond to the increasingly intense scrutiny and questions about conflicts of interest.
“With every new revelation, our credibility with patients has been damaged, and we have to protect that first and foremost,” said Dr. Steven S. Sharfstein, a former president of the association and now president of the Sheppard Pratt Health System in Baltimore. “I think we need to review all arrangements between doctors and industry and be very clear about what constitutes a conflict of interest and what does not.”
One of the doctors named by Mr. Grassley is the association’s president-elect, Dr. Alan F. Schatzberg of Stanford, whose $4.8 million stock holdings in a drug development company raised the senator’s concern. In a telephone interview, Dr. Schatzberg said he had fully complied with Stanford’s rigorous disclosure policies and federal guidelines that pertained to his research.
Blocking or constraining researchers from trying to bring medications to market “will mean less opportunities to help patients with severe illnesses,” Dr. Schatzberg said, adding, “Drugs that are helpful may not be developed by big pharmaceutical companies, for a variety of reasons, and we need some degree of communication between academia and industry” to expand options for patients.
Commercial arrangements are rampant throughout medicine. In the past two decades, drug and device makers have paid tens of thousands of doctors and researchers of all specialties. Worried that this money could taint doctors’ research plans or clinical judgment, government agencies, medical journals and universities have been forced to look more closely at deal details.
In psychiatry, Mr. Grassley has found an orchard of low-hanging fruit. 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.
Senator Grassley’s investigations have not only detailed how lucrative those arrangements can be but have also shown that some top psychiatrists failed to report all their earnings as required.
After The Times reported on such an arrangement involving Dr. Melissa P. DelBello of the University of Cincinnati, Mr. Grassley asked the university to provide her income disclosure forms and asked AstraZeneca, the maker of the antipsychotic Seroquel, to reveal how much it paid her.
In scientific publications, Dr. DelBello has reported working for eight drug makers and told university officials that from 2005 to 2007 she earned about $100,000 in outside income, according to Mr. Grassley.
But AstraZeneca told Mr. Grassley it paid her more than $238,000 in that period. AstraZeneca sent some of its payments through MSZ Associates, an Ohio corporation Dr. DelBello established for “personal financial purposes.”
The University of Cincinnati agreed to monitor those payments more closely.
In early June, the senator reported to Congress that Dr. Joseph Biederman, a renowned child psychiatrist at Harvard Medical School, and a colleague, Dr. Timothy E. Wilens, had reported to university officials earning several hundred thousand dollars apiece in consulting fees from drug makers from 2000 to 2007 when in fact they had earned at least $1.6 million each.
Another member of the Harvard group, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators. The Harvard psychiatrists said they took conflict-of-interest policies seriously and had abided by disclosure rules.
In late June, after Mr. Grassley singled out Dr. Schatzberg, Stanford disputed some of the numbers in the report and has denied that Dr. Schatzberg violated any research rules devised to police such conflicts.
In an interview on Wednesday, Dr. Nada L. Stotland, president of the psychiatric association, said the group had studied Mr. Grassley’s letter and Stanford’s response and agreed with Stanford. Dr. Schatzberg will take over as president of the association as planned, she said.
“The larger issue here is that there’s a revolution going on” in how medicine handles industry money, said Dr. Stotland, a psychiatrist at Rush Medical College in Chicago. “That’s good, that’s what we need, and I believe we’ve been on the cutting edge of that revolution in many ways.”
Dr. Stotland said that the association began reviewing the income it received from pharmaceutical companies last March, to identify potential conflicts. Doctors and academic researchers generally worked at arm’s length from industry until the early 1980s, when Congress passed the Bayh-Dole Act. This legislation encouraged closer collaboration between researchers and industry to bring products to market more quickly. The act helped foster the growth of the biotech industry, and soon professors and universities were busy obtaining patents and building relationships with industry.
Some psychiatrists have long argued that consulting with a company — to help design a rigorous drug trial, for instance — benefits patients, as long as the researcher has no financial stake in the product and is not paid to speak about the drug to other doctors, like a traveling pitchman.
Others say industry and academic researchers are now so deeply intertwined that exposing doctors’ private arrangements only stokes suspicion without correcting the real problem: bias.
“Having everyone stand up like a Boy Scout and make a pledge isn’t going to quell suspicion,” said Dr. Donald Klein, an emeritus professor at Columbia, who has consulted with drug makers himself. “The only hope to rule out bias is to have open access to all data that’s produced in studies and know that there are people checking it” who are not on that company’s payroll.
Studies have shown that researchers who are paid by a company are more likely to report positive findings when evaluating that company’s drugs. The private deals can directly affect patient care, said Dr. William Niederhut, a psychiatrist in private practice in Denver who receives no industry money.
Dr. Niederhut said company-sponsored doctors had spread the word that new and expensive drugs were better in treating bipolar disorder than lithium, the cheaper old standby treatment.
“It’s a sales pitch, and now it’s looking like a whole lot of people would have done better if they’d started on lithium in the first place,” Dr. Niederhut said in a telephone interview. “The profession absolutely has to come clean on these industry deals, and soon.”
Tighter rules, stronger statements and more debate may not make much difference, if Mr. Grassley’s findings are any guide. Universities have rules requiring that faculty members disclose their outside income so that conflicts of interest in research or patient care can be managed. But some of the psychiatrists named in the investigations apparently ignored the rules.
“I think we may be coming to a point where hospitals and medical schools have to get serious about sanctioning,” said Dr. Paul S. Appelbaum, director of the division of psychiatry, medicine and the law at Columbia. “You can suspend doctors’ privileges, or suspend their right to treat patients; both have a huge impact on income and career. But if you’re serious about these disclosure policies, you have to be willing to back them up.”

Martha Rosenberg: Psychiatrists Seek New Patients at Annual Meeting Monday, 28 May 2012

Psychiatrists Seek New Patients at Annual Meeting Monday, 28 May 2012

11:16 By Martha Rosenberg, Dissident Voice |
The first week in May brought a new leader in France and new prospects for same sex couples seeking marriage. But at the American Psychiatric Association’s annual meeting in Philadelphia, attended by 11,000 psychiatrists, it was the same old same old. Instead of listening to the public outcry about overmedicated children, soldiers, elderly and everyday people watching too many drug ads, the psychiatry group re-affirmed its resolve to pathologize healthy people and even rolled out new groups to target.
This is the year the APA puts the finishing touches on DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, a compendium that determines what treatments insurers will cover, what disorders merit funding as “public health” threats and, of course, Pharma marketing and profits. Some question the objectivity of a disorder manual written by those who stand to benefit from an enlarged patient pool and new diseases. Furthering the appearance of self-dealing is the revelation that 57 percent of the DSM-5′s authors have Pharma links.
No kidding. Present at this year’s meeting were former APA president Alan F. Schatzberg, MD and Charles Nemeroff, MD, both investigated by Congress for murky Pharma income. Schatzberg and Nemeroff are co-editors of the APA-published Textbook of Psychopharmacology whose 2009 edition cites the work of Richard Borison, MD former psychiatry chief at the Augusta Veterans Affairs medical center who was sentenced to 15 years in prison for a $10 million clinical trial fraud. Also present was S. Charles Schulz, MD, who was investigated for financial links to AstraZeneca believed to alter his scientific conclusions.
Even though Assistant Secretary of Defense Jonathan Woodson sent a memo to all branches of the military in February about over-prescription of antipsychotic medications like Seroquel and Risperdal for PTSD, military figures closely linked to that over-prescription were also listed in attendance at the APA meeting.
Elspeth Ritchie, MD, told the Denver Post that AstraZeneca’s Seroquel was “very useful for the treatment of anxiety and combat-related nightmares,” though it was (and is) not approved for such treatment while she was medical director of the army’s Strategic Communications Office in 2008, participated in many symposiums. Ritchie, who is now chief clinical officer for the District of Columbia’s department of mental health, appeared in an AstraZeneca and Eli Lilly funded webcast for the Massachusetts General Hospital Psychiatry Academy in 2008 in which she lauds the use of “sophisticated” psychiatric medicines “on the battlefield.”1
Seroquel earned AstraZeneca nearly $6 billion in revenue last year, reports the Philadelphia Inquirer. “IMS Health, a healthcare information and services company, said that in the 12 months ending in February of this year, 14.1 million Seroquel prescriptions were written, more than any other antipsychotic,” it reports.
Also participating in the military and PTSD content at the APA meeting was Matthew Friedman, MD, Executive Director of the VA’s National Center for PTSD who reported, “I received an honorarium from AstraZeneca in the past year,” in a 2009 government slide show called “Pharmacological Treatments of PTSD and Comorbid Disorder.” Friedman also served as a Pfizer Visiting Professor at the Medical University of South Carolina College of Medicine last year yet is listed in the APA meeting guide as having no “significant relationships to disclose.” APA officials have not responded to several requests for comment.
Of course, disorders that Big Pharma has helped monetize like bipolar (which was termed “under diagnosed” and emerging in the elderly at the meeting) and “mood disorders” (once called “life”) were well represented. But an alarming amount of attention also went to the apparent new Pharma profit center of alcoholism and drug addiction.
Addiction specialists have known for more than 70 years that the only “treatment” for drug addiction and alcoholism (after patients are detoxed) are anonymous, self-help programs that are also free. In fact, medicine is as powerless to understand or treat drug addiction and alcoholism as alcoholics and drug addicts are over their addiction.
Still the National Institutes of Health, in conjunction with Big Pharma, continues to spend millions, some say billions, developing “animal models” of addiction and vaccines to “cure” them. Nora D. Volkow, MD director of the National Institute on Drug Abuse, says she seeks a vaccine to treat those at risk of alcoholism and drug addiction on the basis of “biological and environmental factors,” before they get sick. (See: treating those “at risk” for psychosis or depression or bipolar disorder on the basis of their family histories with no symptoms evidence.)
It is pretty fair to say Volkow is not an alcoholic or drug addict. Any of them could tell her they don’t seek “help” until they’re out of options — and even then not from a doctor but from each other. In fact, if Pharma, the National Institute on Drug Abuse and the American Psychiatric Association think they can treat a disease caused by drugs with a drug, that’s pretty insane. In fact, one of the treatments suggested for alcoholism at the meeting was quetiapine, also known as Seroquel.
  1. “The Returning Veteran: PTSD and Traumatic Brain Injury,” Massachusetts General Hospital Psychiatry Academy, May 28, 2008 []

Martha Rosenberg

Martha Rosenberg is an investigative health reporter. Her first book, "Born With a Junk Food Deficiency," has just been released by Prometheus books.

Psychiatry: See what psychiatric doctors say about psychiatry

Psychiatry: See what psychiatric doctors say about psychiatry. 

Uploaded by on Jun 1, 2006
See what psychiatric doctors say about psychiatry.



Top Comments

  • This is a horrendous video. It talks as though mental illness doesn't even exist. Now I understand that psychiatry has a lot of problems with doctors being too preoccupied with diagnosis and prescription. And yes I know that isn't how the human mind works. But to act like mental illness and learning disabilities don't exist is just plain stupid. It cannot be denied that some people have problems that need to be addressed. Don't buy into the idea that all psychiatrists are snake oil salesmen
  • So they're saying there's no such things as a mental illness? Every single person in the world is normal? There's nothing wrong with my autistic cousin, there's nothing wrong with my depressed friend whose family history is full of mental illness, there's nothing wrong with people who hallucinate? Look, I believe there is over medication. But what do you want? You can suffer your disease or you can suffer the meds. If you don't like meds so much don't take them and suffer your ailment.

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                              Forensic Psychiatry (book review)

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                              Krugman calls another one right – Privatizing prisons creates hells on earth

                              Krugman calls another one right – Privatizing prisons creates hells on earth

                              People who run privatized prisons want more people to go to jail, so they will make more money. - promoted by Bob_Neer

                              Photo courtesy New York Times
                              In Paul Krugman’s Editorial he makes clear that the “privatized half way houses” that former private prison lobbyist Gov. Chris Christie champions are hell on earth. However, he reminds us that all of these “privatized governmental functions” rely only on taxpayer dollars and government money. There is no “competition” behind the job degradation involved. Plus, do you remember the kickback schemes and the Judges who went to prison in Pennsylvania for sending innocent teens as young as 11 years old to private prisons so their crony paymasters could pocket taxpayer dollars? Kids who were sent to the “privatized prisons” in Pennsylvania for crimes they did not commit committed suicide, were damaged beyond repair so that these private hell holes masquerading as governement services could suck dollars from taxpayers into the pockets of cynical rogues.

                              Great representation of Mammon aka “The God Money”. When fundamental government services are privatized to a provider that has, in fact, only the motivation of pocketing money and insuring that it has its maw sucking down taxpayer dollars, it is lobbyists who benefit. Not the Commonwealth of Massachusetts (and certainly not, Pennsylvania or New Jersey).

                              Granted, Beacon Hill is not subject to Open Meeting Laws, and is more and more “efficient” as in power is being consolidated and elected officials like Charley Murphy with a marine backbone and solid ego squeezed out – but at least in theory, one can vote out incumbents and just maybe, more incumbents, especially those who exhibit zeros in the spine department, will grow challengers. Once the experience, knowledge, counter-punch of a strong union are lost, they are not easily regained. No, privatization where taxpayer dollars line peoples pockets rather than provide solid services with true oversight is a loss for we the people, is not subject to market forces, and is, I submit a victory only for Mammon and the forces of greed and cynicism.


                              6 Comments . Leave a comment below.
                              1. Free market needs certain conditions to be effective
                                Comperition, transparency, consumer choice (and here the ‘comsumer’ is the government entity, not the inmate). Prisons have none of these, which is why they are an extraordinarily poor choice to be moved from government function to private sector.
                              2. Never did understand private prisons.
                                In my view they exist entirely because there is a stable state with laws to enforce, sometimes by incarceration. OF COURSE such law enforcement should be the provence of the state.
                              3. Worth remembering if Mittster picks Gov. Christie
                                Just what we want, of course, is a cynical lobbyist with deep pockets in which to put other folks money to lock up the poor and the mentally ill for profit.
                                • Doubt he'll pick Christie
                                  My guess is he’ll go for someone as ‘safe’ as possible who won’t overshadow him on the campaign trail and who can be counted on to do what they’re told. Christie is somewhat of a loose cannon, just don’t think that will appeal to Mitt’s inner CEO.
                              4. It will be Rubio
                              5. Paul Krugman has indeed called this one right.
                                Not only have Krugman and others at the the NY Times exposed the corruption underlying New Jersey’s prison halfway houses, The Times has also recently reported on substandard care and unexplained deaths in the group home system for the intellectually disabled in New York State. The horror stories unveiled in these news reports are becoming pervasive throughout the country.
                                Unfortunately, elected leaders in both political parties are continuing to buy into a bottom-line approach to the delivery of public services. Massachusetts is no exception to this. As Krugman points out, however, any monitary savings in this approach have come not from better and more efficient management, but from low wages and benefits to direct-care workers.
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