all the crevices…

Posted on Monday 27 May 2013

Having run across the ProPublica article I mentioned last time lead me, as the Internet tends to do, into some pretty strange territory:
Dollars for Docs Mints a Millionaire
by Tracy Weber and Charles Ornstein
March 11, 2013

… Draud’s $1 million in drug company earnings is probably a minimum figure. Some of the seven companies he represented have reported their payouts for only a short time. And Draud has separately disclosed ties with at least four additional companies that haven’t revealed how much they pay speakers.

Draud has friends among the other highest-paid doctors in the database. He teaches continuing medical education courses with fellow psychiatrists Rakesh Jain and Vladimir Maletic. Jain, of Lake Jackson, Texas, has earned $582,049. Maletic, of Greer, S.C., made $527,850 , according to Dollars for Docs. Both also speak for other companies that keep their payments private…

The article mentions Jon Draud MS MD‘s "friends" Rakesh Jain MD MPH and Vladimir Maletic MD MS and the CME courses they teach together, but there’s more. It’s called Psych Congress, something I never heard of before. Add Charles Raison MD, Andrew Penn, RN, MS, NP, CNS, APRN-BC, and Saundra Jain, MA, PsyD, LPC to the list, and you have the Board of Psych Congress. They have yearly and regional meetings with a potpourri of topics from the standard fare to the outer fringe. The web site looks for all the world like a mini-APA except all the presenters are listed right here. Check out a video from the charismatic Dr. Jain or the less charismatic Dr. Raison. It looked like a CME factory to me … and it is! It’s a product of the North American Center for Continuing Medical Education along with many others. There are more ways than just doing clinical trials to squeeze an extra buck out of medicine, CME is a lucrative business too. Looks like these guys have found all the crevices to slither into…
    May 27, 2013 | 12:31 PM


    It’s DSM-5, not DSM-V: Why Little Differences Matter in the Mental Disorders Manual

    “The new edition of the Diagnostic and Statistical Manual of Mental Disorders was released last week, following weeks of controversy prior to its release. The change of the name alone – from DSM-V to DSM-5 – caused tension in the psychiatric community. But the really big question for the new DSM-5 is its ongoing validity as a diagnostic tool, which has been questioned by some leading professionals in the mental health community,”

    “Will there come a day when DSM-5 can be considered obsolete? Will we look back and laugh at how simplistic our view of brain illnesses was? I hope so; I don’t say this to discredit the manual as it stands now, as it remains an invaluable resource. But I believe, with the new advances in science and technology, we can do better. If we want to advance, we must be open to change, recognise advances for the improvements they are, and not be afraid to implement them. For now, a simple change to the DSM-5’s title is a small but symbolic step, signalling the openness to change that we need to move forward.”


    The European Federation of Pharmaceutical Industries and Associations (EFPIA) represents the pharmaceutical industry operating in Europe. Through its direct membership of 33 national associations and 39 leading pharmaceutical companies, EFPIA is the voice on the EU scene of 1,900 companies committed to researching, developing and bringing to patients new medicines that will improve health and the quality of life around the world.

    May 27, 2013 | 2:29 PM

    Off topic, but check out this blog post and the responses to it.

    I beg the universe not to let some of the people who comment on this post be doctors.

    May 27, 2013 | 8:24 PM

    The opportunities are out there, even for drugs yet unborn. If you’re a Key Opinion Leader, you can be a video star for Vortioxetine before it even comes on the market. You don’t even have to speak its name yet. Just theorize about the need for treatments that hit a variety of receptors, treatments you can give to folks who get bad side effects from Paxil, treatments that get them All the Way Well! Six months or a year from now, of course, you can gasp in astonished delight when the very drug you have been dreaming of suddenly appears. Check out this scholarly educational website from Lundbeck and Takeda Pharmaceuticals: Unlocking Be sure to catch the video at the bottom starring Steven Stahl, David Nutt and Pierre Bleier:

    It is not only the KOL MD’s that have been recruited into this game – the Depression and Bipolar Support Alliance has also made a video series called Out of the Blue: The Many Faces of Depression. They are grateful for an unrestricted educational grant from Lundbeck and Takeda that has made this possible. The theme is to educate us that depression is more than sadness, fatigue and lack of pleasure. It can look totally different. It can present as irritablilty. Racing thoughts. Anxiety. Trouble making decisions. Trouble concentrating. A bad temper.

    Some of this sounds like standard descriptions of bipolar disorder, but it’s much broader than that. Perhaps the best title might be “Why not call it all Depression?” That way, of course, you can treat it all with Vortioxetine … which of course is not mentioned in the video. Yet by the time the miracle drug appears they hope to educate thousands more of us that OMG, We Are Depressed Too.
    It’s sad that DBSA, which used to be the closest thing to a patient-initiated, patient-controlled organization out there, has lined up to prep us for our next pill without even alerting us that it’s coming.

    May 27, 2013 | 9:28 PM

    CME is a giant loophole, carved out by OMB, in the Sunshine Act:
    You’ll notice how Dr. Stahl does not figure prominently in the ProPublica databases.

    May 27, 2013 | 9:35 PM

    Plus, if you are looking for a group of three prominent academic psychiatrists from Pittsburgh for your industry-free CME, you can call up Drs. Kupfer, Ryan, and Birmaher.

    May 28, 2013 | 7:01 AM

    CME can also be a tool of indoctrination — hello special doctor person, you will learn this and be the person who can give your poor patients the most state of the art care. Here is your “A” and your pat on the head. Please see our subsidiary for the clinical trials to prove these interventions are effective. Some patients with impaired insight will say that the intervention is not working or is causing harm. Be patient with them, they can’t help it.

    So dangerous. So horribly dangerous.

    Yes, I’m laying it on a bit thick. But no so thick as I wish I were.

    It is important to remember that we are all human.

    May 28, 2013 | 7:05 AM


    And CME is required for licensure!…

    May 28, 2013 | 7:14 AM

    Yes, and the doctor has to give the “right” answer, and no one is immune to that. And, since CME is required, and doctors are busy, extra work to correct what has been “learned” is not (and almost cannot be) a priority, and, since it is not a priority, it will be done rarely, if at all (or so it seems to me).

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