Dr. Sharfstein Replies

To The Editor: In my Presidential Address, I supported and acknowledged the important contributions of the pharmaceutical industry, whose products have, in my words, “transformed the outcomes for millions of psychiatric patients.” In discussing the difficult implementation of Medicare Part D, I bemoaned the unacceptable gaps in access to effective drugs. I confronted Tom Cruise and Scientology on the Today Show when he attacked psychiatry and asserted that “there is no such thing as a chemical imbalance.” I agree with Dr. Clary and colleagues that the pharmaceutical industry is an important partner for progress with our profession. However, I take exception to the implication that our partnership must be cheek-to-cheek.

The marketing of medications through millions of dollars in gifts, free trips, meaningless surveys, and other enticements is wrong. It also generates distrust among our patients and drives up costs, as less expensive but equally therapeutic alternative medications fall from routine use.

Too close a relationship with the pharmaceutical industry exacerbates concerning trends in the medical marketplace. Increasingly, psychiatrists are seen as pill pushers, with the result that we are reimbursed for our pharmacologic expertise and very little else. Another unfortunate result (for everyone) is that our profession has less credibility to stand up and object to unnecessary black box warnings.

I have never questioned the ethics and values of psychiatrists who work for pharmaceutical companies. However, the fact that the profit-making motives of industry come into conflict with professional ethics is amply documented and should come as no surprise to the authors. How we work together for the good of patients is the challenge that we face together.