APA Responds to Sen. Grassley

In July, I e-mailed to let you know that Sen. Charles Grassley (R-Iowa) had asked APA for detailed information about the revenue that APA has received from pharmaceutical companies from January 2003 onward. The information was delivered to Sen. Grassley's office, as previously agreed, on September 2.

Putting this information together was a major task for our staff. Our income from the pharmaceutical industry comes from many companies; it includes payments for advertising in APA periodicals, payments for exhibits at our meetings, support for minority and resident fellowships in leadership and research, funding for antistigma public education campaigns, and support for continuing medical education. Each specific case required an agreement or contract that we were asked to submit to Sen. Grassley; in each case we required a firewall between the source of funding and the content of the program. Indeed, because of the rigor with which we screen, rate, oversee, and evaluate the content of all our educational activities supported by pharmaceutical companies, we have received a commendation and a six-year accreditation from the Accreditation Council on Continuing Medical Education.

We expect that Sen. Grassley will also ask the pharmaceutical companies to produce detailed information about grants and other financial interactions with APA. We have informed Sen. Grassley that we anticipate that there will be discrepancies between their reporting and ours because of differing accounting methods. For example, a company may include all the expenses it has incurred in relation to an educational event it supported, even though much of that money won't have been provided to APA; it will have gone to pay for expenses such as its employees' travel.

It is important to remember that relationships with medical industries are a challenge for the whole field of medicine. Traditions of many years' standing 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 the practice of the last several decades. An informal survey of medical specialty societies indicates that APA is more or less in the middle when it comes to the percentage of revenue received from medical industries (which includes not only medications, but also devices, equipment, tests, and so on). The numbers range from 2 percent to nearly 50 percent; APA has averaged about 28 percent of our yearly annual revenue.

It is also important to remember that APA has not been accused of any wrongdoing. We have been asked for information, and we have willingly provided it. Information about our pharmaceutical revenues, though not with the level of detail included in the report to the senator, have been available to our members through our members-only Web site for some years. Furthermore, information and articles about APA's relationship with the pharmaceutical industry have appeared in Psychiatric News, which has open access not only to APA members but also to the media and the public at large.

APA has been proactive in examining the pros and cons of our relationships with the pharmaceutical industry. Last March, months before the senator's request, the Board established a work group, chaired by Dr. Jeffrey Geller, which was charged with producing a report detailing our pharmaceutical revenues and offering the Board options for decreasing or eliminating them. That group will produce an interim report at our October meeting and a final report at our meeting next March. Also before Sen. Grassley's request, I wrote a column in the July 18 Psychiatric News addressing transparency and conflicts of interest. We have now established a work group, chaired by Dr. Paul Appelbaum, to develop guidelines for interactions between individual psychiatrists (in addition to our professional association, APA) and medical industries. Dr. Appelbaum and Dr. Laura Roberts, both national experts on medical ethics, will also cochair a presidential symposium on this topic at our May 2009 annual meeting in San Francisco. We are developing a guide for discussing these issues with patients and an online educational program to assist you as well. You may send comments, suggestions, or information about any of these activities to me at APA at [email protected]. The times are changing, and we need to know how you feel about APA and potential conflicts of interest and what you are hearing about it in your offices, hospitals, and communities.

We psychiatrists are physicians who devote ourselves to the care of people afflicted with mental illnesses, and APA exists to help us provide that care. We are proud of what we do, and we are here to answer your questions.▪