From the PresidentPsychiatric Newsby Jeffrey LiebermanAugust 01, 2013Drug companies aren’t held in high esteem by the public these days. There are many reasons for the companies’ poor showing, including high drug prices, aggressive marketing practices and direct-to-consumer advertising, efforts to buy influence with physicians, and, perhaps most egregiously, the suppression of data on drugs’ dangerous side effects. Couple these issues with the fact that innovative drug development has slowed to a crawl, and it’s not easy to muster much defense of the pharmaceutical industry.
But let’s face it, they need us and we need them. We must recognize the important, beneficial role that drug companies have long played in all areas of medicine. While not minimizing problems, we simultaneously must remember how products have improved the quality of health care and quality of life in our society, and their funding has helped to advance research, public outreach, and training. As a point of comparison, the pharmaceutical industry is not the tobacco industry. Were Big Tobacco companies to disappear tomorrow, the negatives of lost tax revenue and wages would likely be far more than offset by improved public health and reduced health care costs. But if drug companies were forced out of business, where would we be? Where would we find the new interventions to reduce disease morbidity and mortality? Who would invest in the production and distribution of medicines, vaccines, and medical devices? And for the field of psychiatry, how would much of the essential treatment development research be funded now that the National Institute of Mental Health is focused increasingly on genetics and basic research? [Indeed, President Obama’s recent announcement of the $100 million Human Brain Mapping Initiative, which will fund the development of nanotechnology for brain research, exemplifies the federal government’s de-emphasis of clinical research]…
You get the drift, "…let’s face it, they need us and we need them" as in, So can we just put the last twenty-five years behind us and move on. It’s all better now. I think that technically the word re-engage means that one has disengaged from something, and now it’s time to re-engage. In this case, I missed the disengagment altogether – particularly in psychiatry. From where I sat, a major segment of psychiatry at its highest level has been deeply engaged with the pharmaceutical industry. And then I belatedly realized along with many others that it was an unholy alliance. And only in the very recent past has that unholy alliance been clear enough for all of us to see. When did anybody in psychiatry disengage? Either I missed it or it didn’t happen [I’m going with didn’t happen]. Says Dr. Lieberman:
Indeed, APA immediately and drastically reduced its relationships with the pharmaceutical industry. We adopted the strictest ethics policy of any professional association for members participating in key programs such as the development of practice guidelines and the revision of DSM. At our annual meeting, “industry-supported symposia” for CME are no longer included in the program. We now are moving forward with careful vigilance in ways that recognize the value of industry relationships. Under the auspices of the American Psychiatric Foundation [APF], interactions with industry are helping to restore important relationships. I recently attended an APF Corporate Advisory Council meeting at which representatives from 14 companies were present. It was clear that they desired re-engagement with physicians and researchers, and, most importantly, they understood that all such interactions must be transparent, rigorously monitored, and without conflict of interest. I know that talking about relationships between psychiatrists and pharmaceutical companies makes people nervous. But speaking for myself, I believe that the rules and models for informational, educational, and research engagement can and should be developed and applied in ways that allow for our optimal engagement with companies. Doing so would not only help us learn from the mistakes of the past; it would help us improve the future for our profession and our patients.
Laudable words, but I’m less interested in his assurances that PHARMA is on the true path to sainthood. I want him to address the behavior of the psychiatrists who are still in bed with PHARMA. The drug companies are going to do whatever they can to maximize their bottom line, no matter what they say. The ethical onus is on physicians, psychiatrists, academic psychiatrists. What is the position of the APA on guest authorship? ghost authors? PHARMA whores who author articles or give interviews about drugs they’ve only read about? Conflicts of Interest? Speaker’s Bureaus? Lieberman’s article doesn’t address the you scratch my back and I’ll scratch yours style that has characterized the last twenty five years of engagement between psychiatry and PHARMA. In fact he institutionalizes it.
Jeffrey, it’s just not all better yet…
hat tip to Uri 
I think this quote from Lieberman’s 6/25/13 article in Psychiatric News about his experience at the White House Mental Health Conference says it all:
Don’t get me wrong: the conference represented, to my mind, the most important and significant presidential effort on behalf of mental health care since Rosalynn Carter’s White House Conference on Mental Illness over 30 years ago. But there were things about it that gave me pause. The tenor and content of the meeting were not as medically oriented or scientifically based as I would have liked. The presentations and discussions got a little too “touchy feely” at times, and the overall focus seemed more on social-science approaches to mental health care than biomedical or neuroscience perspectives.
Sigh. When the biomedical perspective on mental health is all you have, how can you avoid turning to pharma?
Psych Critic, that pretty much says it all about the current state of psychiatry doesn’t it? By the way, that reminds me of a case I read about online in which a teenager tried to commit suicide due to being bullied for years and ended up on lots of psych meds. After she had been on them, a psychiatrist wondered if she might have Bipolar disorder. I am sure this doesn’t surprise you as a psychiatrist who works with kids.
Let’s face it: Lieberman and others of his ilk are only going to be happy when not one penny of funding goes to psychotherapy research; and every psychiatrist’s office is quipped with an operating room where psychosurgery, informed by “the truly breathtaking, spectacular, stunning, jaw-dropping, incredible, orgasm-inducing and erectile promoting” discoveries of neuroscience, is the standard of “treatment.” Don’t you just love how Lieberman denigrates psychotherapy and social science as “touchy feely” (aka “feminine” or “soft”) as opposed to the truly hard, erect, masculine medical-psychiatry he advocates? Hey, if you want to be a big prick psychiatrist, you have to prescribe medications. . . or carve up someone’s cranium.
Re engagement with Pharma? Is a prenup via a patent pull ok?
http://pharmagossip.blogspot.com/2013/08/india-pulls-gsks-tykerb-patent-by-kevin.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+blogspot%2FDlJuM+%28PharmaGossip%29
Who belongs to the APA today? People who are clueless or corrupt, or both. And they look for leadership that both promotes agendas to fill wallets/purses or just gives false hopes and expectations that the status quo will prevail.
This organization disgusts me. But, so do people in entrenched positions of power and public/professional opinion. As do people with entrenched ignorance and lack of vision. Just keep pining away for pills to treat ills.
And false leadership to rape the public good. Dog days of August, looking like a fun month, eh?
I see the motivation a little differently:
http://psychpracticemd.blogspot.com/2013/08/who-needs-who.html
PsychPractice: I agree to a point. But remember that Psychiatry needs Pharma more than Pharma needs us (meaning psychiatrists). Me thinks that psychiatrists are increasingly marginal in Pharma’s playbook. They just need script-writers. And any M.D. or D.O. or APN and, in the near future, any PhD can write prescriptions.
“They just need script-writers. And any M.D. or D.O. or APN and, in the near future, any PhD can write prescriptions.” -Tom
Would this include medical devices as well? Would the selling of these shiny new ideas follow the same pattern as the pharmaceuticals?
“An Early – and Necessary – Flight of the Owl of Minerva: Neuroscience, Neurotechnology, Human Socio-cultural Boundaries, and the Importance of Neuroethics”-Abstract
James Giordano
Center for Neurotechnology Studies
Potomac Institute for Policy Studies
Oxford Centre for Neuroethics
Oxford-Uehiro Centre for Practical Ethics
University of Oxford
Department of Electrical and Computational Engineering
University of New Mexico
http://jetpress.org/v22/giordano-benedikter.htm
As far as pharma is concerned regarding psychiatric drugs go, vending machines would do the job:
Health industry group: Replace psychiatrists with vending machines
Measure to reduce health care costs
1 April 2013 Health Insurance Times (Dubuque, Iowa) A health care industry thinktank, US Health Insurance Consortium on Cost, advocates replacing psychiatrists and other doctors with vending machines to prescribe and dispense antidepressants.
“We believe this will cut the cost of psychiatric services significantly,” Uli Arnowsky, spokesperson for USHICost, said. “Our studies show the diagnosis and prescription process can be automated, with no loss in quality of care. Specialist costs are just not necessary for this type of treatment, and psychiatrists are overworked anyway.”
USHICost’s plan is to make the Psychiatric Diagnostic Screening Questionnaire (PDSQ), based on the new diagnostic manual DSM-5, available online to health plan members. Answers would be captured in a database and analyzed to produce a recommendation for a prescription. A psychiatric nurse reviews the recommendations and authorizes the prescription, which is then attached to the patient’s database record.
Vending machines, in convenient medical center locations and on a secure network, would be stocked with the most common generic antidepressants.
“We prefer the generics,” Arnowsky said. “They’re part of the cost-cutting. Our studies show they’re just as effective as the name-brand drugs.”
According to Arnowsky, to get a prescription filled, a patient would input a health plan ID and a password at a vending machine. The machine would look in the database, dispense the authorized prescription, and charge the copay to a credit card on file in the patient’s health plan record.
“We really like the way this system keeps electronic medical records, too,” Aronowsky said. “It’s a win-win-win for all concerned.”
Patients reporting side effects would be advised to see their doctors, who could then adjust the prescription if needed.
“There’s a lot of trial and error in prescribing antidepressants already,” he said. “This system is no more error-prone than present prescribing practices. In fact, we put fuzzy logic in the system to rotate prescriptions among the antidepressants, because we’ve found doctors prescribe them in an almost random fashion. We built the human element right into the system — it thinks just like a doctor about these drugs.”
He stated that USHICost’s studies had shown diagnosis by PDSQ was at least as accurate as by doctors, including psychiatrists. “This will take a big burden off primary care physicians, too, who are bearing the brunt of prescribing antidepressants,” he noted.