Is American Psychiatric Association too Tight with Drug Industry?

The psychiatric profession continues to be scrutinized by Congress over concerns it is too cozy with <"">drug makers.  Following a number of investigations of individual doctor’s relationships with drug makers, Senator Charles E. Grassley—Republican-Iowa—is demanding the American Psychiatric Association provide an accounting of its financing.

“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Grassley said in a letter to the association.  In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing, with half that money going to drug advertisements in psychiatric journals and exhibits at the annual meeting; the remainder sponsored fellowships, conferences, and industry symposiums at the annual meeting.

Dr. Alan F. Schatzberg of Stanford and the association’s president-elect, is among those named by Grassley.  Schatzberg has $4.8 million stock holdings in a drug development company.  These sorts of arrangements are common throughout medicine.  For instance, in the past 20 years, drug and device makers have paid tens of thousands of doctors and researchers of all specialties.  But, now, concerned this money could taint doctors’ research plans or clinical judgment, government agencies, medical journals, and universities are looking more closely at such deals.

A Vermont study found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less or no funding.  The drugs prescribed are not approved for most uses in children, who appear to be especially susceptible to the side effects, such as rapid weight gain.

Grassley’s investigations have detailed how lucrative those arrangements can be and note some top psychiatrists failed to report all their earnings, as required.  For instance, Dr. Melissa P. Dobell of the University of Cincinnati reportedly worked for eight drug makers and told university officials that from 2005 to 2007 she earned about $100,000 in outside income.  Meanwhile, AstraZeneca told Grassley it paid DelBello over $238,000 in that period, making some of those payments through MSZ Associates, an Ohio corporation DelBello established for “personal financial purposes.”

In June, Grassley reported to Congress that Dr. Joseph Biederman, a renowned child psychiatrist at Harvard Medical School, and a colleague, Dr. Timothy E. Wilens, reported to university officials earning several hundred thousand dollars apiece in consulting fees from drug makers from 2000 to 2007.  In truth, they earned at least $1.6 million each.  Another Harvard group member, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Grassley’s investigators.

Studies have shown that researchers paid by a company are more likely to report positive findings when evaluating that company’s drugs. The private deals can directly affect patient care, said Dr. William Niederhut, a psychiatrist in private practice in Denver who receives no industry money.

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