Feelings About Pharma
In the September 5 Psychiatric News, I described APA's response to Sen. Charles Grassley's request for information about every kind of revenue that APA has received from the pharmaceutical industry, and I asked for your opinions. (Unfortunately, the APA members-only Web site link to the cover letter that accompanied the 50-page report to Sen. Grassley, which outlines the issues and the contents, was not functional at the time of that column; you can read that letter now at<http://psych.org/MainMenu/Newsroom/APAMemberDBSAResources/GrassleyLetter.aspx>. I heard from many of you. This is not a random sample; probably those with the strongest feelings took the time to write. Nevertheless, the messages reflect the wide range of attitudes among our members. I thought I would give you a sampling from those messages. Although these were not confidential communications, members were not advised that their messages might be printed, and therefore I have omitted their names. I have also corrected the occasional typographical error.
A few members expressed indignation over what they considered to be prejudicial and unwarranted criticism of psychiatrists and APA.
The predominant view is reflected in the following quotes:
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“I would be in favor of eliminating all sources of income from the pharmaceutical companies even if this meant eliminating fellowships, antistigma campaigns, education funding, etc. I believe that we as a profession would do well to eliminate even the potential appearance of a conflict of interest.”
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“The APA annual meeting provides a great chance to take courses which are not industry sponsored. As a private practitioner I have to pay for my own CMEs ... and feel free to make decisions regarding medications based on scientific evidence ... but have felt like the lone voice in the wilderness.
“I am dismayed that so many colleagues I know rely on 'free' CME courses, feel entitled to gifts from industry, continue to believe they prescribe without bias....
“Let's go back to training ourselves.... The ties to industry were the most important reason why I did not belong to the APA for almost 20 years ... and I joined back up when I saw that the APA was moving away from that position.”
Several members urged moderation. For example, two messages reminded us to consider context.
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“In considering guidelines, please consider rural psychiatrists without access to grand rounds.”
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“When you see many people who are 'dumped out' of the ... hospital or jail,... the samples that the ... pharmacy companies provide are a gift from God.... If Sen. Grassley or others want to really help, fix this and we will all come out ahead.... Please keep hammering this point to all the politically correct people who only talk about one side of this dynamic relationship....”
One message asserted that the profit motive is part of human nature, that physicians are not immune, and that medicine's relationships with pharma can be beneficial.
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“APA must work with the drug companies ... to make sure the work benefits the patients,... research, and care.... If not for the industry-supported symposia and activities, APA convention ... activities would not have attracted the attention they have.... Make sure we do not destroy the relationship to foster a quasi-ethical relationship.... Medicine ... will not survive or grow if deprived of all the financial ... frills, bells, and whistles.... How can we take financial ... incentives from medicine,... government, or any human venture?”
Another writer saw the situation as an opportunity to broaden, or perhaps refresh, our vision:
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“... Having to reflect on how much we depend on ... pharmaceutical companies can be taken as an opportunity to consider what else besides ... medication psychiatrists have to offer.... We could research a lot more on prevention of mental illness and fostering mental health if our mindset was more focused on the whole individual rather than the brain.... Using medication alone is limiting our possibilities of ... helping a patient master his/her difficulties in life. We can take this opportunity to learn to give medication its proper place in the treatment of a patient.”
Thanks to everyone who wrote. I am proud, but not surprised, that every message focused on the welfare of our patients. I am heartened that many of you think APA is heading in the right direction. Our healthy self-examination preceded any inquiry from outside. As one member proclaimed:
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“Let's be bold. Let's make the rules. Let's not wait for the drug companies or the Congress to tell us what to do.”▪
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Published online: 3 October 2008
Published in print: October 3, 2008
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