{"id":38902,"date":"2013-08-02T22:00:08","date_gmt":"2013-08-03T02:00:08","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=38902"},"modified":"2013-08-07T20:47:29","modified_gmt":"2013-08-08T00:47:29","slug":"the-wrong-we","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/08\/02\/the-wrong-we\/","title":{"rendered":"the wrong we<\/font><\/u>…"},"content":{"rendered":"
All those pictures you saw on the news last night and this morning of the flash floods in North Georgia happened within a few miles of my cabin – 8" of rain overnight with exploding power stations is something to behold. So my last post [all better now?…<\/a>] was dashed off during the intervals where I had Internet service – which came and went throughout the day. Today has been less hectic, and I wanted to say some more about Dr. Lieberman’s article in the Psychiatric News [Time to Re-Engage With Pharma?<\/a>]. Like most of us writing about his article, I focused on:<\/div>\n
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But let’s face it, they need us and we<\/font><\/strong><\/u> 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…<\/div>\n

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…<\/p>\n

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<\/u>, somehow in this process, our field became the poster child for physician misbehavior.<\/font><\/strong> 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…<\/div>\n<\/blockquote>\n
I wanted to revisit the two underlined words: we<\/font><\/strong><\/u> and Ironically<\/u><\/font><\/strong>. I’ll start with Ironically<\/font><\/strong>. I don’t see anything remotely ironic about the field of psychiatry being seen as the poster child for physician misbehavior. He implies that we didn’t come by that moniker honestly. Senator Grassley’s list had three Chairmen of prominent Departments of Psychiatry, a soon to be Dean of a major Medical School,  and the President of the American Psychiatric Association – and all of them earned their places in the investigation honestly. Our literature is filled with distorted Clinical Trial reports guest authored by people in high places in our field. The preponderance of inflated blockbuster drugs were psychoactive drugs, and the record holding settlements against pharmaceutical companies were for psychiatric medications with, again, psychiatrists in high places prominently placed on the court docket. There was nothing ironic about out poster child status. We earned that label fair and square to our own great shame.<\/div>\n

In fact, it was Dr. Lieberman’s logic ["let’s face it, they need us and we<\/font><\/strong><\/u> need them<\/em>"] that got us there. And that brings up the second word, we<\/font><\/strong><\/u>. Back in the early 1980s, I was in academic medicine and a part of the we<\/font><\/strong><\/u> he’s referring to. we<\/font><\/strong><\/u> 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<\/font><\/strong><\/u> 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<\/font><\/strong><\/u> wasn’t our patients nor necessarily practicing psychiatrists. we<\/font><\/strong><\/u> was organized and academic psychiatry. PsychPractice<\/font><\/strong> has a nice post about who we<\/font><\/strong><\/u> were and the why of things [Who Needs Who<\/a>].<\/p>\n

Dr. Lieberman talks the talk of the 1980s. we<\/font><\/strong><\/u> need research money and other funds to operate our institutions. That money has come from the pharmaceutical industry for decades. His article suggests that he sees our future is in going that route again. His article says, "Have we<\/font><\/strong><\/u> done enough to get back to that system?" I find that discouraging. In fact, I find everything he writes discouraging [psychiatry inc…<\/a>, prove it…<\/a>, humility about now…<\/a>, etc.]. It’s hard to trust what he writes here, at least hard for me:<\/div>\n
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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.<\/div>\n<\/blockquote>\n
I think Dr. Lieberman has got the wrong we<\/font><\/strong><\/u> in his mind, and apparently doesn’t know it… <\/div>\n","protected":false},"excerpt":{"rendered":"

All those pictures you saw on the news last night and this morning of the flash floods in North Georgia happened within a few miles of my cabin – 8" of rain overnight with exploding power stations is something to behold. So my last post [all better now?…] was dashed off during the intervals where […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-38902","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38902","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=38902"}],"version-history":[{"count":12,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38902\/revisions"}],"predecessor-version":[{"id":39039,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/38902\/revisions\/39039"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=38902"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=38902"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=38902"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}