Psychiatrist Contends the Field Is ‘Committing Professional Suicide’

Psychiatry — and medicine in general — has a dangerously close relationship with the pharmaceutical industry

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British psychiatrist and Big Pharma gadfly David Healy is so controversial amongst his colleagues that some have tried to have his medical license revoked — but there he was on Thursday, speaking at the American Psychiatric Association’s (APA) second largest annual meeting at a well-attended session on conflicts of interest.

“It’s a miracle that I was asked along to give a talk [here], and I’m extremely grateful,” Healy said.

His disquisition was perhaps less humble. Arguing that his profession is “committing professional suicide” by failing to address its dangerously close relationship with the pharmaceutical industry, he likened psychiatry’s attitude toward its faltering legitimacy to the Vatican’s widely derided response to its child-sex-abuse scandal by priests — essentially that psychiatry is brushing off justifiable concerns as hype instead of dealing with the source of the problem.

Few experts believe that psychiatry’s relationship with the drug industry is healthy. While several speakers at the session pointed out that other specialties are similarly entangled with industry, “everyone does it” is generally not a valid defense where conflicts of interest are concerned.

(MORE: Antipsychotic Prescriptions in Children Have Skyrocketed: Study)

The conflicts throughout medicine — not just in psychiatry — are clear. In 2004 alone, pharmaceutical companies spent about $58 billion on marketing, 87% of which was aimed squarely at the roughly 800,000 Americans with the power to prescribe drugs. The money was spent mainly on free drug samples and sales visits to doctors’ offices; studies find that both free samples and sales calls increase prescribing of brand-name drugs and raise medical costs without improving care.

Moreover, nearly half of all continuing medical-education classes are sponsored by industry. By their third year of medical school, 94% of psychiatrists in training have already accepted a “small noneducational gift or lunch” from a drug company, according to Dr. Paul Appelbaum, a past president of the APA and director of Columbia University’s Division of Law, Ethics and Psychiatry, who spoke on the panel with Healy.

And while only 34% psychiatrists believe that receiving food or gifts affects their own prescribing patterns, 53% believe that it influences that of their colleagues, according to a study cited by Appelbaum. Research shows that this type of thinking — “Everyone else is prone to biases and social factors, but not me!” — is common and confounds attempts to address conflicts. “At least some of our colleagues are wrong,” Appelbaum said drily of the study.

Healy’s jeremiad was more severe and sharply worded, but it seemed to be well received by the psychiatrists assembled in the audience. Many even asked questions that suggested they too were troubled by the status quo.

“I’m going to argue that we need you to be biased. We want you to be biased by treatments that work,” Healy told his colleagues. “I don’t mind if you’re my doctor and you’ve given talks for industry. My concern is not that you’ve been paid by industry, but that you’ve been fooled by industry. The key conflict is whether people are hiding data from you.”

(MORE: Top 10 Drug Company Settlements)

Healy went on to discuss how drug companies have repeatedly concealed important information about the risks of their medications, whether by hiring ghostwriters to spin the results of scientific studies and then getting renowned experts to put their names on the published papers; by employing tricks in clinical trials like using inadequate doses of comparison medications to make the company’s own drug look better; or by simply keeping unfavorable data out of the public domain.

Healy himself has also been targeted directly by drug companies that haven’t been happy with his critiques. In fact, he’s widely believed to have lost an academic job offer at the University of Toronto as a result of one such critical lecture. At the session on Thursday, one slide in his presentation contained information he sought via a Freedom of Information Act request detailing drugmaker Eli Lilly’s strategy for shutting Healy down. To counter his public insistence that drug companies reveal hidden drug data, Eli Lilly proposed doing things like planting confederates in the audience of his presentations to ask questions that support industry’s view.

Healy also described how in his own attempts to publish formerly hidden data — which all now reside in the public domain — he encountered legal issues with journals, which ultimately resulted in rejection of publication. The clinical-trial data in question in this case showed a greater risk of suicidal acts associated with antidepressants than had previously been revealed.

Healy also referenced hidden data from trials of the antipsychotic drug Zyprexa. “None of them mentioned [that the drug could cause] diabetes or [had] the highest suicide rate in clinical-trial history,” he said. Although drug companies are now required by medical journals to register all of their clinical trials with the National Institutes of Health if they wish to publish them — including those that never end up being published — this is not a legal requirement. They can still hide relevant data from the Food and Drug Administration by not disclosing trials that they never attempt to submit to a journal.

Healy noted further that when data surfaced showing a link between antidepressant use and risk of suicide in children, the APA issued a statement proclaiming that “we believe that antidepressants save lives.”

“What I believe they should have said is that the APA believes that psychiatrists can save lives because it takes expertise to manage the risks of risky pills,” he said; if psychiatrists’ only role were to dole out drugs, then less trained physician’s assistants could easily replace them, he noted.

(MORE: A Doctor’s Dilemma: When Crucial New-Drug Data Is Hidden)

But when a questioner, claiming himself “speechless” in the face of Healy’s arguments, asked whether he should just stop prescribing antidepressants, Healy said no. Healy prescribes them himself, but believes that the role of the doctor is to manage risks, not view drugs as harmless. “Medical treatment is poison, and the art of medicine is trying to find the right dose,” he said.

As for what could be done to disentangle medicine from industry, Healy wasn’t entirely pessimistic. “The key issue in the short term is access to data. We have to insist on that,” he said. “We let industry come to our meetings and let them talk in our programs. I don’t think it’s huge problem that they get paid. The big problem is that if you ask for data, they can’t give it to you. That’s not science, that’s marketing masquerading as science.”

But what of the issue of doctors being visited by paid-industry types — or being paid by industry themselves? The panel’s organizer, Dr. Daniel Carlat, director of the Pew Prescription Project, noted a new disclosure law, passed as part of President Obama’s health-reform bill in 2010. Under the legislation, drug companies must reveal which doctors have taken any payment or gift from them worth more than $10, and describe the exact amounts taken and the purpose for them on a publicly available website. (Unfortunately that website will not be up and running until 2014 at the earliest.) All of the panelists agreed, however, that while public disclosure is good, it is not enough.

Dr. Roy Perlis, who heads the Center for Experimental Drugs and Diagnostics at Massachusetts General Hospital, cited research showing that disclosure can actually backfire in unexpected ways. In one study, for example, people were asked to estimate the number of coins in a jar and provided an “adviser” to help them guess. Unbeknownst to them, the adviser had been paid to try to push people to make higher estimates than they otherwise might.

In one condition of the trial, participants were told in advance that the adviser had this bias, but that made matters worse. Under this circumstance, the adviser encouraged participants to make even higher estimates than in the situation without disclosure.

(MORE: How a Study of a Failed Antidepressant Shows That the Drugs Really Work)

“There are two different mechanisms” to explain the phenomenon, says Perlis. “One is strategic exaggeration: ‘I know you’re going to discount what I say, so I deliberately will be more effusive and tell you a higher number.’ The other is so-called moral licensing: ‘I’ve disclosed my conflict, therefore I’m allowed to be biased.’ This very thing may well also play out when disclosing conflicts of interest in medicine.”

Maran Woolston, a woman with multiple sclerosis, also spoke on the panel about how betrayed she felt when she learned her doctor had referred much of her care to a drug-company subsidiary, but had not revealed it to her — and had also taken $300,000 in funding from various drugmakers.

“In my opinion, transparency isn’t a silver bullet,” she said. “My ideal solution — and this may be naive — is that [doctors should] accept no payments whatsoever because then there can be no conflict of interest.”

Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

34 comments
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rijul
rijul

i mean rules.

i say this due to many personal experiences of mine, i used to have depression for 4 years and spent thousands. I went to a psychologist for 6 months and i am cured without the use of any drugs 

rijul
rijul

this is why psychology rule!!

blahhh666
blahhh666

Exactly the reason why you should go to the doctor for advice on medication and buy it without limits and not get permission for buying medication and if you get in other place than pharmacy be treated as a dangerous criminal ...

Shannon Brownlee
Shannon Brownlee like.author.displayName 1 Like

Great article about a medical hero! For more than a decade, David Healy has courageously spoken out about the enormous problem of conflict of interest in medicine, and he's been punished for it. I'm glad to see this article in the popular press, because patients need to understand that commercial interests are corrupting the medical profession and biasing medical science -- and they can take action.  If you see drug industry branding in your doctor's office, ask your doctor about it. It may not stop him or her from accepting freebies, but it will alert him or her to the fact that you noticed the conflict of interest. (Drug company branding means the physician has been listening to drug salespeople and taking free samples, which influences their prescribing decisions -- sometimes to your detriment.) Don't accept free samples if you can possibly afford to pay for your prescription. And if your doctor prescribes any drug, not just a psychiatric medication, ask about side effects and the evidence that this drug is the right one for your condition.

Joanne Cacciatore
Joanne Cacciatore

Just the proposal to remove the bereavement exclusion itself is indicative of the medicalization of normal human behavior and existential suffering. This post tells more about why psychiatry is moving away from human connection http://drjoanne.blogspot.com/2...

dakinsky
dakinsky

Whatever may be wrong with Scientology but here I think they are pretty close to reality. 

Choking Kojak
Choking Kojak

"Psychiatry -- and medicine in general -- has a dangerously close relationship with the pharmaceutical industry."  

I salute Maia Szalavitz for calling it like it is!  

JustMarti
JustMarti like.author.displayName 1 Like

If you have problems with dealing with something...go to a psychologist...this person does not believe that drugs are the way to work you through your poroblems.   You have problems relating, dealing, controling, or whatever it is, talk about it...don't let someone give you a quick gratificatrion with medication.  Meds prove to subdue problems, later making them problems that may eventually be the catalyst to suicide.

AngryBuddha
AngryBuddha

The article fails to mention the smokin' hot lil drug reps they send to your office to pitch their wares.  I'm sure those dollars are not counted in the advertising budget.

Neon Jeff
Neon Jeff like.author.displayName 1 Like

I look around -  where money is involved - people will manipulate the system.  It is common throughout most countries including the US.  The bias about medicine deals with the expense drug companies have to incur in order to find something a bit better.  They are in a situation that forces them to manipulate data in favor of products - in order to satisfy investors desire for profits.  Burying bad data is common. Publishers prefer stories of success - instead of stories of failure.  The bias is real. The next thing is  that Doctors are often paid by how many procedures they perform - instead of how many they have avoided performing.  Look at medicare, which is a cost plus based on procedures - the most fraud is perpetrated by Doctors.  Why?  Money. Money. Money.

petemcmanus
petemcmanus

Hey, everybody. Let me repeat the post from flyintheointment55, because it's VERY good information. There is a website

http://projects.propublica.org...

where you can find the payments the drug companies have been making to YOUR doctor! Take a look; I found it a real eye-opener. One of my doctors is going to have some 'splainin' to do.

Daniel Guibord
Daniel Guibord

It is directly contrary to the interests of multinational drug manufacturers to spend some of their profits on any research that  may lead to finding the actual causes of any psychiatric illness — for their drugs are their bread and butter, their repeat business; fundamental reason for which their drugs only alleviate symptoms. 

It is for this reason that multinational drug manufacturers (should we call them legalized drug pushers?) fund only university research for which they are certain that such research will not lead to finding the actual causes of any psychiatric illness.

Thank you for reading me.

Ed Bowser
Ed Bowser

I recently experienced a situation that speaks to this topic. I've been bipolar my entire life and have been treated by a plethora of physicians, psychologists, psychiatrists and therapists on and off for the better part of the past thirty years. For the last ten years my symptoms have been largely under control with medication (Lexapro/Escitalopram) and regular counseling by my family physician. As I have recently developed Type II Diabetes and have a heart condition, I take an enormous amount of medications twice daily, closely supervised by my doctor.

Several months ago, I experienced an severe crisis brought about through a seemingly overwhelming mixture of external events and influences. I frantically consulted with my doctor (the very epitome of a caring, involved and comprehensive physician) who, on my request, referred me to a local psychiatrist for help.

Several weeks later I met with the psychiatrist. After an interminable time in the patient waiting room, I met him in his office for what turned out to be a ten minute quiz on my medical history and a cursory review of my emotional state. At meeting's end, he escorted me to a hall closet to dispense a sample of the medication he was recommending I take. As the door swung open, I had to suppress a gasp at the stockpile of Abilify (Aripiprazole) he revealed. I can't begin to guess at the total supply there, but it was all this one medication. I took the two sample boxes he offered me and made an appointment for the following week. Leaving the office, I finally noticed all the 'wellness' posters, handouts and clipboards extolling the benefits of Abilify.

On reaching home, I promptly searched the internet for all the information I could find on Abilify. Not gossip sites or chat rooms, but medical references and, even this column's archives. What I found appalled me. Hundreds of statements concerning documented side-effects from taking Abilify including, but not limited to, facial tics, some permanent even after ceasing treatment with Abilify, and enough other concerns, like function-creep that I decided against treatment with this drug.

Things have since smoothed out significantly since this crisis, without taking Abilify. I reported to my physician my decision not to use the drug and we found alternatives that are working well. I told my doctor that, in my opinion, that particular psychiatrist was not much more than a shill for Bristol-Myers Squibb, the makers of Abilify. I've been to many psychiatrists in my lifetime and have never experienced a doctor who would prescribe such an intense medication without having thoroughly examined the patient's background to determine underlying problems, treatment history and explore alternatives to medication.

This is by no means an indictment by me of Abilify, but further research since this incident has convinced me that the drug would have been completely inappropriate in my situation.

Doctors need to be doctors, whatever their specialty, not compensated reps for drug companies.

bigomega73
bigomega73

I'm sorry to say I've had a very similar experience to you, Ed. My therapist referred me to a psychiatrist when he believed that I had "low-level long-term depression", whatever that may mean. I went on the condition that the doctor he was referring me to was not a pill-pusher. Well within 20 minutes of meeting me, the doctor has diagnosed me with moderate depression and had planned out a minimum 2 year (!!) regimen of antidreppresants. I refused the prescription and never went back to him or my therapist.

Colleen I. Place
Colleen I. Place

@facebook-826679094:disqus That's what makes us human, just as a painting is more than the sum of colors on a piece of canvas. ..NDOQESB.TK

Blue-eyed Gal
Blue-eyed Gal

Psychiatry needs to get away from this "your mind is your chemistry" garbage. Consciousness, dreams and hangups cannot be reduced to pure chemistry, although it's obviously a contributing factor.

We are conscious. That's what makes us human, just as a painting is more than the sum of colors on a piece of canvas.

Any psychological approach that does not deal with a person as a person, but only as a sum of chemical reactions is bound to fail, at best, or at worse, reduce the patient to something less than human, the pharmaceutical equivalent of a lobotomy.

msjp
msjp

@Blue-eyed Gal Both views are necessary to understand how the mind/body/spirit connects. 

Judith J. Broussard
Judith J. Broussard

@facebook-826679094:disqus Psychiatrist are lackies for the drug companies, and it is not getting any better.. $85 an hour! Seriously I don't know why more people haven't tried this, I work two shifts, 2 hours in the day and 2 in the evening…And whats awesome is Im working from home so I get more time with my kids. Heres where I went,>>..NDOQESB.TK

Steve Pan
Steve Pan

You mean to say that modern medicine is crooked as all hell? Color me surprised. 

yourstrulysieweMD
yourstrulysieweMD

Three months ago, i received information material about an emergency contraception pill (morning-after pill) from a pharmaceutic company. The information provided me an alternative to the drugs i usually prescribed. Last week i received another letter from this company urging me to file in information about my experience with that drug. It would take me just 15 - 20 mins of my time. My first thought was only after ten weeks and why should i do that? I waste my time doing little productive work, like watching tv, reading and commenting to time articles etc. However i expected some incentive for helping them in their statistics.

Does that make me greedy? Would i have a conflict of interest?

Cheers

Dr. Siewe

elotrolado
elotrolado

The drug company is hardly conducting a scientific survey.  What are they going to do with the info from those few who took the time and answered their request for feedback?  Select the positive ones and promote their drug?

seraphimblade
seraphimblade

If you don't want to fill it out, don't. But in my opinion at least, any doctor taking money or gifts from any pharmaceutical company for any reason have a conflict of interest in prescribing that company's treatments.

Determining what the appropriate treatment for a condition is should be based upon what the most effective and least invasive course of action is, never upon whose treatment it is. Doctors who accept drug company favors jeopardize that neutrality. Will the cash and gifts keep coming if you don't "come through"? Probably not. Can you keep that from influencing your decisions, even subconsciously? Almost certainly not.

SmallSpeakHouse
SmallSpeakHouse

Please correct me if I am wrong but it makes me think that they're trying to use your patients as guinea pigs (if it's a fairly new drug). Also, shouldn't your patients be the ones getting these "incentives" you mentioned?

yourstrulysieweMD
yourstrulysieweMD

@ MVKaz.. My questions are rhetoric. Of course i expect compensation for atleast my time. And ofcourse it may be of advantage to patients if there are many alternatives for a particular condition particularly in price, since the patients have to buy the medications themselves.

@ Smallspeakhouse...see comment toMVKaz and  the active substance of the pill is ulipristalacetate, which is on the market atleast since 2009 under different names. I believe doctors need financial incentives from pharmaceutical companies. However checks and balancies and transparencies should be enforced and upheld.

SmallSpeakHouse
SmallSpeakHouse

Sorry for the late reply, I've been offline for a few days. With checks and balances, it doesn't seem so bad to me. But like a lot of things, I still think that it poses a risk (as it can be abused by some unscrupulous doctors).

yourmom5
yourmom5

these same shills for big pharma are the ones demonizing cannabis..making false claims about IQ..and schizophrenia... there is massive corruption behind those reports. A recent report about a "psychiatrist" actually petitioning his state to remove PTSD from the list of reasons to recommend medical cannabis. Obviously he feels threatened because there are a lot of veterans in that state taking advantage of the good herb...instead of filling his pockets.

Neon Jeff
Neon Jeff

The best research on cannabis that I have found has a 91% to 9% ratio.  It gives some benefit and 91% do not have bad side effects.  But there is 9% who have a terrible time with cannabis and develop a drug dependence that effects work, schooling, and relationships.  There is a small subset of women who smoke marijuana while pregnant that have children with low IQ - but more studies need to be made to determine if anything beside cannabis might be causing the decline.  Habituation of cannabis is common, even when nothing is wrong with the individual.  If you want to compare it to many other drugs like nicotine, cocaine, heroin, alcohol or meth -  cannabis is better, when it comes to long term usage.  But not using cannabis at all, if one is healthy, would be the best advice.  However, when it comes to legalization - you are dealing with a system that makes money from cannabis - from the prison system - government income from penalties - drug dealers, growers, distributors - being illegal has become big business.  Make it legal - and you have a loss of billions.  If you want to know why after 60 years of criminalization of cannabis - with relatively good statistics - it is still illegal - follow the money.

yourmom5
yourmom5

I think I love you..thank you for writing this.,

Kristina Johnson
Kristina Johnson

Psychiatrist are lackies for the drug companies, and it is not getting any better...

David Reiss
David Reiss

As a psychiatrist for 25+ years,  (including recently interim medical director of a 126-bed psychiatric facility, IMO, the point of view expressed, sadly is all too true.    Except that I am not as optimistic that it's not too late.  Individual psychiatrists are becoming more unbiased and more aware, but the institution of psychiatry - as run by insurance companies - is becoming more entrenched in the opposite direction.

charles000
charles000

I couldn't agree more - Maia has got it exactly right.  

The intersection of "big pharma" and real, applied psychiatry has taken a very dark turn in many directions, but perhaps none worse than the exploding market of prescribing psych drugs to children, even very young kids.

I've been a quasi ADHD type all my life (now in my 60s), but much of that is driven by insatiable curiosity and passion for exploring new ideas, concepts, etc.  

This notion of making kids more docile and "manageable" in the classroom by prescribing mind numbing drugs might look good on paper, but what is really occurring is the crushing of the creative spirit that so many kids have, especially some of the brighter ones who are essentially bored out of their minds, being stuck in a "dumbed down" classroom environment which is all too common.

Perhaps that's a bit presumptive on my part, and I make no claims of being any sort of pediatric psychiatrist by any stretch of the imagination, but I can certainly relate to my own personal experiences and those of others I have personally been with from those times and now.

Fortunate am I that no such psych meds were ever prescribed to me in those earlier times.   What we see now is a horrific train wreck in the making . . . in my humble opinion.

charles000
charles000

I couldn't agree more - Maia has got it exactly right.  

The intersection of "big pharma" and real, applied psychiatry has taken a very dark turn in many directions, but perhaps none worse than the exploding market of prescribing psych drugs to children, even very young kids.

I've been a quasi ADHD type all my life (now in my 60s), but much of that is driven by insatiable curiosity and passion for exploring new ideas, concepts, etc.  

This notion of making kids more docile and "manageable" in the classroom by prescribing mind numbing drugs might look good on paper, but what is really occurring is the crushing of the creative spirit that so many kids have, especially some of the brighter ones who are essentially bored out of their minds, being stuck in a "dumbed down" classroom environment which is all too common.

Perhaps that's a bit presumptive on my part, and I make no claims of being any sort of pediatric psychiatrist by any stretch of the imagination, but I can certainly relate to my own personal experiences and those of others I have personally been with from those times and now.Fortunate am I that no such psych meds were ever prescribed to me in those earlier times.  

What we see now is a horrific train wreck in the making . . . in my humble opinion.