Do Pharmaceutical Companies Control Modern Psychiatry?

It is no secret that individual pharmaceutical companies try to influence psychiatry by getting psychiatrists to prescribe the medications they manufacture and provide. This is how the companies make money. They do the same thing in all fields of medicine, from general practice to cardiology.

A good psychiatrist will not prescribe an inappropriate medication in response to pressure by a drug company. A problem arises when doctors take money from pharmaceutical companies as consulting fees or other payments for services rendered and do not disclose that fact to their colleagues, the public, or their patients. Everyone has the right to know if a potential conflict of interest exists. Fortunately, such unethical doctors are in the minority.

Other Possible Conflicts of Interest

Many mental health advocacy groups have accepted funding from pharmaceutical companies. Many of these groups do an outstanding job educating the public and promoting the cause of better mental health care. There is, however, an appearance of a conflict of interest when an advocacy group accepts money from a company that would profit financially from a recommendation.

In an ideal world, communities or the federal government would assure the health care treatment of its citizens, and conflict of interest would not be a problem. But in the real world, organizations compromise in order to survive financially. People worry that groups and individuals who accept money may be more inclined, even if in a subtle way, to favor that company's products when making recommendations or writing prescriptions. They worry about what an organization may not say in deference to a sponsor. Because it is difficult to know if an organization has self-edited itself, the appearance of a conflict of interest can be troubling for some watchdogs.

In the summer of 2008, even the American Psychiatric Association attracted criticism because it accepted money from pharmaceutical companies.

Influencing Doctors' Choices

In 2007, the New York Times found evidence that payments from pharmaceutical companies can influence the drugs doctors prescribe. Reporters analyzed prescription data and payments from drug companies to psychiatrists in Minnesota. They found that psychiatrists who received $5,000 or more from the manufacturers of atypical antipsychotic medications issued, on average, three times the number of prescriptions for this class of drugs for use in children than did psychiatrists who received less than $5,000 from the companies.

However, it also reasonable to consider the possibility that the drug companies observed their data first and identified those doctors who seem to prescribe their drugs more than others. The companies may then have picked those doctors to be on their speakers' bureau or their advisory boards because they had more experience with the company's drugs. If so, the fact that the doctors are paid more than $5,000 would not have influenced their decision to write prescriptions for certain drugs, because they were already doing so.

This is a tricky problem because psychiatrists can help pharmaceutical companies design better drugs and judge their effectiveness. However, to avoid the appearance of conflict of interest, and to rule out any chance of conscious or unconscious bias or favoritism, the physician-consultants should not benefit financially from the success of the product.

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