1 Boring Old Man

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…

The contributions that pharmaceutical companies make to our society do not excuse any past or present excesses, misbehavior, or unethical activity. But the most honest assessment acknowledges the good as well as the bad. And the truth is that the industry is indispensable. Our society needs the private sector to advance critical drug and device development and distribution. Physicians need companies to provide the materials and training on how treatments should be used. Certainly, scientists need support from the same in the form of sponsored research and fellowships that contribute to the future of the medical profession…

In psychiatry, past problems arose when companies engaged in aggressive marketing practices in the guise of educational activities and paying clinicians and researchers—so-called key opinion leaders—for their advice or research in ways that were perceived as potential conflicts of interest. The issue came to a head in 2007 when Sens. Herb Kohl and Charles Grassley held hearings on the financial relationships between drug and device companies and psychiatrists and called for corrective and punitive actions. Ironically, somehow in this process, our field became the poster child for physician misbehavior. The attention and criticism prompted universities to adopt stricter ethics and financial-disclosure policies, and professional associations, including APA, to pull back and keep companies at arm’s length…

In fact, it was Dr. Lieberman’s logic ["let’s face it, they need us and we need them"] that got us there. And that brings up the second word, we. Back in the early 1980s, I was in academic medicine and a part of the we he’s referring to. we were in a severe funding crunch, lacking the kind of high value services that allow other specialties to generate funding for academic departments and activities. The we of academic psychiatry were rescued by the influx of money from the pharmaceutical companies that came with the medicalization of psychiatry. For a million reasons scattered throughout this blog, I wasn’t involved with what followed. So what I know about what happened is as something of an outsider, but I saw enough to know that we wasn’t our patients nor necessarily practicing psychiatrists. we was organized and academic psychiatry. PsychPractice has a nice post about who we were and the why of things [Who Needs Who].

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.