Sen. Grassley Asks Psychiatry Association To Provide Information on Drug Industry Contributions

Sen. Chuck Grassley (R-Iowa) on Thursday in a letter to the American Psychiatric Association asked that the group provide an accounting of its financing to address concerns that monetary contributions from drug makers could improperly influence the decisions of researchers and physicians, the New York Times reports. The association is the "voice of establishment psychiatry, publishing the field's major journals and its standard diagnostic manual," according to the Times. In 2006, the drug industry comprised 30% of the APA's $62.5 million in financing. About half of that money went to drug advertisement in journals and exhibits at the annual meeting, and the other half went to fellowships, conferences and industry symposiums at the annual meeting.

Grassley, the ranking member on the Senate Finance Committee, in the letter wrote, "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." Studies have shown that researchers paid by a drug maker are more likely to report positive findings when evaluating that company's drug, the Times reports. Psychiatrists earn less than other doctors on average, but many seek to supplement their income through speaking arrangements with drug makers. Grassley's investigations have shown that these arrangements can be "lucrative" and that "some top psychiatrists" don't report all their income, the Times reports. Grassley's letter named several psychiatrists taking contributions from drug makers. In addition, a study of Vermont psychiatrists showed they receive more money from drug makers than any other specialty, according to the Times.

The APA board held a closed-door meeting this weekend, in part to discuss the increasing amount of scrutiny and questions about conflict of interest. "With every new revelation, our credibility with patients has been damaged, and we have to protect that first and foremost," former APA president and current president of Sheppard Pratt Health System Steven Sharfstein said. APA President-Elect Alan Schatzberg said that blocking or restricting researchers from trying to develop medications "will mean less opportunities to help patients with severe illnesses," adding, "Drugs that are helpful may not be developed by big pharmaceutical companies ... and we need some degree of communication between academia and industry" to expand options available for patients.

Nada Stotland, the current APA president, said, "The larger issue here is that there's a revolution going on" in how medical professionals handle drug industry money. She added, "That's good, that's what we need, and I believe we've been on the cutting edge of that revolution in many ways." She said the organization began reviewing contributions from drug makers last March.

Paul Applebaum, director of the Columbia University Department of Psychiatry, said, "I think we may be coming to a point where hospitals and medical schools have to get serious about sanctioning," adding, "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" (Carey/Harris, New York Times, 7/12).

Opinion Piece
Pharmaceutical industry money, particularly in the field of psychiatry, is "corrupting medical practice and the maintenance of our country's health," Lawrence Diller, a behavioral-development pediatrician living in California, writes in a San Francisco Chronicle opinion piece. The failure of leading psychiatrists to report drug financing is "important, scary and tragic," Diller writes, and is "one more stake in the heart of American academic medicine's credibility with frontline doctors." According to Diller, in the current climate, "drug company research money, professional medical education and direct advertisements ... tilt" patients toward "biologically brain-based solutions, rather than nondrug ... approaches." He adds, "Research funding must be directed to the needs of patients and their doctors -- not the bottom line of stockholders."

Diller continues, "More money must be directed toward head-to-head competition between existing generics and the new products, and toward more studies comparing nondrug or combination approaches to drug-only interventions." Legislation introduced by Grassley and Sen. Herb Kohl (D-Wis.) would "require more vigorous reporting and enforcement on payments" received by medical professionals from drug makers, according to Diller. He states, "But in addition, we need laws to have the federal government, along with the major academic research centers, coordinate and direct the use of drug company money in medical research. This is not pie-in-the-sky wishing," concluding, "Such reform was precisely what the doctors of 100 years ago accomplished in this country" (Diller, San Francisco Chronicle, 7/13).