In recent months, the print media have once again
outed another group of physicians who benefit from
undisclosed financial renumeration from
pharmaceutical companies, accompanied by serious
conflicts of interest. One headline from The New York
Times News Service read "California Docs Paid to
Promote Drugs," while other news outlets carried
similar stories.
The fact that doctors take money from pharmaceutical
companies happens to be old news. But this time
around, the docs in question come from Stanford
University. Previous news stories reported that
doctors receiving pharmaceutical funding hailed from
Harvard, the University of Miami, the Medical College
of Georgia and the University of Cincinnati College of
Medicine. More than a few of these doctors are
psychiatrists who have received tax-supported,
public National Institutes of Health and National
Institute of Mental Health funding for clinical
research, have participated in U.S. Food and Drug
Administation advisory panels or have appeared on,
or on behalf of, various not-for-profit psychiatric
advocacy boards -- some of which are heavily
supported by the manufacturers of psychiatric
medications.
In 2006, my colleagues and I wrote a brief letter to
the editor to the Journal of the American Medical
Association, one of America's premier peer-reviewed
medical journals. Our letter expressed concern about
the lack of honest disclosure of conflicts by certain
psychiatric authors in a previously published article.
Multiple authors had recommended specific
antidepressant therapy but failed to reveal that they
were being paid by multiple antidepressant
manufacturers to speak, advocate and do research for
the companies that sold the drugs. During the review
process, an associate editor at the journal asked the
question (and inadvertently copied me on an email
that had been sent to another associate editor),
"What's the big deal? What's all this [expletive deleted]
about conflicts of interest?" Academic journals,
heavily supported by advertising money, are biased
and complicit in the conflict of interest fiasco.
Sometimes I wonder why I -- or anyone else for that
matter -- should care about psychiatrists who pimp
for drug companies. After all, physician spokespeople
outed another group of physicians who benefit from
undisclosed financial renumeration from
pharmaceutical companies, accompanied by serious
conflicts of interest. One headline from The New York
Times News Service read "California Docs Paid to
Promote Drugs," while other news outlets carried
similar stories.
The fact that doctors take money from pharmaceutical
companies happens to be old news. But this time
around, the docs in question come from Stanford
University. Previous news stories reported that
doctors receiving pharmaceutical funding hailed from
Harvard, the University of Miami, the Medical College
of Georgia and the University of Cincinnati College of
Medicine. More than a few of these doctors are
psychiatrists who have received tax-supported,
public National Institutes of Health and National
Institute of Mental Health funding for clinical
research, have participated in U.S. Food and Drug
Administation advisory panels or have appeared on,
or on behalf of, various not-for-profit psychiatric
advocacy boards -- some of which are heavily
supported by the manufacturers of psychiatric
medications.
In 2006, my colleagues and I wrote a brief letter to
the editor to the Journal of the American Medical
Association, one of America's premier peer-reviewed
medical journals. Our letter expressed concern about
the lack of honest disclosure of conflicts by certain
psychiatric authors in a previously published article.
Multiple authors had recommended specific
antidepressant therapy but failed to reveal that they
were being paid by multiple antidepressant
manufacturers to speak, advocate and do research for
the companies that sold the drugs. During the review
process, an associate editor at the journal asked the
question (and inadvertently copied me on an email
that had been sent to another associate editor),
"What's the big deal? What's all this [expletive deleted]
about conflicts of interest?" Academic journals,
heavily supported by advertising money, are biased
and complicit in the conflict of interest fiasco.
Sometimes I wonder why I -- or anyone else for that
matter -- should care about psychiatrists who pimp
for drug companies. After all, physician spokespeople
and drug manufacturers are capitalists, and
capitalism is our economic cornerstone. Every day,
any financial news consumer hears the refrain
invoking the social advantages of free market
capitalism. It is the mantra of a major financial
television network. And even though I'm a
psychiatrist, I'm also a capitalist, so why should I
worry?
But I do worry, because drug promotion and clinical
decision-making that are brokered on the backs of
dollar bills have a greater chance of causing serious
adverse outcomes, including illnesses and death. If a
physician embellishes the effectiveness of a drug or
minimizes its risk, that directly hurts you and me.
Physicians who are heavily supported by
pharmaceutical companies and medical device makers a
re not forming independent, unbiased decisions.
Instead, their brains have been lined with gifts, perks
and money, which influences their rose-colored
opinions. My psychiatric colleagues are especially
vulnerable here. The result is that your mother, your
husband or my child can't make a reliable decision
about the risks and benefits of particular drugs. How
could they? The prescribing doctors often don't know
the risks and benefits, so how could we be expected
to learn what they don't know?
Conflicts of interest promoted by pharmaceutical
capitalism is our economic cornerstone. Every day,
any financial news consumer hears the refrain
invoking the social advantages of free market
capitalism. It is the mantra of a major financial
television network. And even though I'm a
psychiatrist, I'm also a capitalist, so why should I
worry?
But I do worry, because drug promotion and clinical
decision-making that are brokered on the backs of
dollar bills have a greater chance of causing serious
adverse outcomes, including illnesses and death. If a
physician embellishes the effectiveness of a drug or
minimizes its risk, that directly hurts you and me.
Physicians who are heavily supported by
pharmaceutical companies and medical device makers a
re not forming independent, unbiased decisions.
Instead, their brains have been lined with gifts, perks
and money, which influences their rose-colored
opinions. My psychiatric colleagues are especially
vulnerable here. The result is that your mother, your
husband or my child can't make a reliable decision
about the risks and benefits of particular drugs. How
could they? The prescribing doctors often don't know
the risks and benefits, so how could we be expected
to learn what they don't know?
Conflicts of interest promoted by pharmaceutical
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Doctors' Conflicting Interests Can Cost Money and Lives, and Hinder Medical Discoveries
Are Doctors' Industry Ties Influencing Your Care?
Are Doctors' Industry Ties Influencing Your Care?
manufacturers negatively affect decisions about
current and future medical care. That is tragic,
because those half-baked recommendations come
with a price that no amount of capitalism can justify.
It's simple and ugly: If you or your mom suddenly
succumbs to an arrhythmia whose side effects were
not appreciated by your doctor because your doctor
was misinformed by another doctor serving as the
manufacturer's spokesperson, that is tragic. I see it
virtually every day in my clinical practice: in young
men who have breast lesions and abnormal breast
development from atypical antipsychotics; in sudden
unexpected deaths, or "suds," from psychiatric drugs
in individuals who had no risk factors for sudden
death; in tic and dyskinetic movement disorders in
kids arbitrarily prescribed stimulants, and the huge
weight gain and symptoms of type 2 diabetes in
children and young adults who receive a sedative,
such as quetiapine, for sleep.
The bad news doesn't stop with current care.
Conflicted clinical research -- often done especially
by and for a particular psychiatric pharmaceutical
manufacturer -- whose design and analysis are
biased and whose summary and conclusions are
misleadingly positive, fracture the backbone of
scientific research. The legacy of fraudulent research
lingers for years before it is recognized and
repudiated. That effort impedes real progress, wastes
time, money and human resources that could be
focused on finding real cures to help all of us. And
that's not good for anybody.
Dr. Stefan Kruszewski is an addiction psychiatrist and
CEO of Kruszewski & Associates, a Harrisburg, Pa., c
ompany that focuses on health care and financial
fraud.
current and future medical care. That is tragic,
because those half-baked recommendations come
with a price that no amount of capitalism can justify.
It's simple and ugly: If you or your mom suddenly
succumbs to an arrhythmia whose side effects were
not appreciated by your doctor because your doctor
was misinformed by another doctor serving as the
manufacturer's spokesperson, that is tragic. I see it
virtually every day in my clinical practice: in young
men who have breast lesions and abnormal breast
development from atypical antipsychotics; in sudden
unexpected deaths, or "suds," from psychiatric drugs
in individuals who had no risk factors for sudden
death; in tic and dyskinetic movement disorders in
kids arbitrarily prescribed stimulants, and the huge
weight gain and symptoms of type 2 diabetes in
children and young adults who receive a sedative,
such as quetiapine, for sleep.
The bad news doesn't stop with current care.
Conflicted clinical research -- often done especially
by and for a particular psychiatric pharmaceutical
manufacturer -- whose design and analysis are
biased and whose summary and conclusions are
misleadingly positive, fracture the backbone of
scientific research. The legacy of fraudulent research
lingers for years before it is recognized and
repudiated. That effort impedes real progress, wastes
time, money and human resources that could be
focused on finding real cures to help all of us. And
that's not good for anybody.
Dr. Stefan Kruszewski is an addiction psychiatrist and
CEO of Kruszewski & Associates, a Harrisburg, Pa., c
ompany that focuses on health care and financial
fraud.
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