Scandalous conflicts of interest revealed in psychiatry guidelines

Quick, answer this question: Who writes the guidelines for physicians on how to treat mental illnesses, such as schizophrenia, bipolar disorder or major depression? 

A) Psychiatrists interested in the welfare of patients with these terrible and debilitating diseases?
B) Academic researchers who are willing to lend their expert opinion to help fellow doctors?
C) People financed by drug companies who can be counted on to write the guidelines in a way that serves the company’s interests?
D.) All of the above.

If you answered D, you’re on the money.

In fact, being “on the money” is the operative phrase here, because a recent report on the conflicts of interest in psychiatric guidelines committees reveal some shocking facts about the financial entanglements of the people putting those guidelines together. 

The study published last month found that 90% of the authors of three American Psychiatric Association (APA) clinical practice guidelines in psychiatry had financial ties to drug companies mentioned in those guidelines. Worse yet, the authors had financial associations including owning equity in the companies that made the recommended medications, being a consultant or corporate board member, or receiving honoraria. And these conflicts were not disclosed in the guideline.

The picture becomes even darker when you narrow in on the conflicts of interest of the authors of the guidelines for just bipolar disorder and schizophrenia: Here, 100% of the authors had such conflicts.

Most people would consider this a worrying state of affairs, including Tufts professor Sheldon Krimsky, one of the co-authors of this report.  In an interview from his office in Boston, he told me that we should be worried about conflicts of interest because they can lead to a “distortion of the scientific record” and that drug companies who fund such activities may lead to an “interpretation of the science in a direction that may not be defensible.”

Authors who disclose their conflicts of interest are only an intermediate step, says Krimsky, and more effort should be made to separate the researchers and the clinicians from the drug manufacturers’ influence.

No doubt, guideline committees such as ones sponsored by the APA need to come clean on their financial conflicts. But they must avoid or minimize them in the first place.

John Santa, director of the Consumer Reports Heath Ratings Center, underscores the point by noting, “It is especially concerning that organizations like the American Psychiatric Association have financial relationships with drug companies and have been slow to appreciate the influence these relationships have created. We rely on professional and consumer organizations to protect patients and doctors from industry, not facilitate their influence.”

Here’s a simple skill-testing question I think the APA’s guidelines gurus could use for prospective committee members:  “Do you have financial ties to drug companies which make psychiatric medications?”  

It doesn’t take a brainiac to figure out where to go from there…

—Alan Cassels, guest blogger

Alan is a pharmaceutical policy researcher at the University of Victoria, British Columbia and co-author of "Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients."

Comments

[David hogard]

No doubt, guideline committees such as ones sponsored by the APA need to come clean on their financial conflicts. But they must avoid or minimize them in the first place.

http://healthnbeauty.livejournal.com/8567.html

[brnstrm99]

I am so delighted my husband takes valproic acid
for type 1 bipolar disorder. He has become the
most delightful friend, partner, sweetheart. The
effects were instantaneous, and prior to medication
he did not sleep, had little impulse control, and
had explosive rage attacks. We represent a good side
to the medications.

[Dali Bahat]

This is far worse than just being the ethics matter of conflict of interests. This is criminality on a huge scale. With the horrible "side effects" of these gross subjective diognostics, how many suicides, killing rampages and human vegetables have they "innocently" produced to date on their way to making a buck?
I'd rather not know the answer to that question.

"Mental Health"? No sir. A conspiracy? You bet!

[rain39]

I think that it is absolutely essential that all conflicts of interest be requested and noted on all research, professional articles, Internet and newspaper articles for the public. I am a psychiatric nurse and retired assistant professor and have often been shocked at the number of psych meds people are on. Poly-pharmacy may occasionally be effective in some people but given the expense of the drugs and the significant side effects in many, it seems that far too many drugs are used at once.

Now that I am retired, I work with CASA as a volunteer, a court appointed advocate for foster kids, most of whom have been significantly traumatized in their young lives. You would be amazed at the number of drugs that they are taking that aren't even cleared for use with children. In addition, many could be helped with therapy, rather than drugs, focusing on their traumatized brains which have been damaged by unspeakable experiences.

The latest research is leading towards real and intense therapy over time by OT and cognitive therapists to work with their attachment and sensory issues. Working with these seems to replace most drug therapies and helps the children and their new families attach in adoption, thus helping the kids developmentally, psychologically, emotionally and spiritually.

Psychiatrists are mostly known as drug writers these days and don't do as much therapy. This is left to psychologists or Master's prepared counselors. This is significantly caused by insurance reimbursement and drug therapy. It is lots cheaper to pay the shrink just for meds and let the patient do his therapy with someone who charges much less for therapy. The best of all possible worlds for the insurance company is that the
Primary care doc prescribes the anti-depressant and the patient never enters the mental health care system at all. Of course that is often not best for the patient. So the insurance companies, the doc , the therapists , and the primary care doc is making money but the patient may or may not be receiving the mental health care he or she deserves. If the patient has no money, he isn't getting treated, unless he ends up in the hospital for this mental health issue.

[Susan]

Who authors the medical textbooks? Any ties to the drug industry here?