Friday, April 03, 2009
Most Psychiatrists Who Wrote Clinical Guidelines Had Financial Ties to Drug Companies, Study Shows
Most of the psychiatrists on the American Psychiatric Association
panels who wrote the newest clinical guidelines for how to treat
depression, bipolar disorder and schizophrenia had financial ties to
drug companies, according to a study by Boston researchers scheduled to
be published this month in the journal Psychotherapy and Psychosomatics, the Boston Globe reports.
For the study, Lisa Cosgrove of the University of Massachusetts-Boston and colleagues, including Sheldon Krimsky of Tufts University and Harold Bursztajn of Harvard Medical School, searched publicly accessible databases such as Medline
and the records of the federal patent office to identify financial
ties. According to the study, 18 of the 20 authors of the guidelines
had at least one financial tie to drug companies. Twelve authors had
ties in at least three categories, such as consulting, research grants,
speaking fees or stock ownership, the study found. In addition, the
study found that all of the authors of schizophrenia and bipolar
guidelines had relationships with the drug industry, while 60% of the
authors of the depression guidelines had such connections. According to
the study, more than 75% of the authors received funding for research
from drug companies. In addition, one-third of the authors served on
the speakers' bureaus of drug companies, the study shows.
study authors wrote that the guidelines focus heavily on medications
and give little focus to nondrug treatments. The guidelines also do not
focus on the time and process of removing mentally ill patients from
prescription drugs, the study found. Three common diagnoses result in
around $25 billion in drug sales annually, according to the study.
psychiatric association now requires psychiatrists who write guidelines
to publish their financial ties to drug companies, but the rule did not
exist when the current guidelines for depression, bipolar disorder and
schizophrenia were published in 2004 and 2005.
Cosgrove said, "Most patients assume that when they're prescribed a
drug, the decision is made on the basis of an objective review of the
scientific evidence." She said that asking whether the guidelines
actually are objective is "an important question because the lack of
biological tests for mental disorders renders psychiatry especially
vulnerable to industry influence." Krimsky said that guideline writers
"should be totally transparent about their relationships with the drug
companies so people reading a guideline might ratchet up the skepticism
they might have about the use of drugs as the first line of therapy."
McIntyre, chair of the association's guideline steering committee, said
the association works to ensure the guidelines are "free of bias to the
greatest possible extent." He said they screen members who work on each
set of guidelines in order to avoid having people writing rules who
receive more than roughly 5% to 25% of their income from pharmaceutical
firms. In addition, the pharmaceutical industry defends its right to
pay "thought leaders" in various fields to use their knowledge to aid
drug development and marketing. The industry says that specialists'
input benefits colleagues and patients, and that those specialists must
be paid for their expertise.
Roy Perlis, a consultant on the
bipolar guidelines, said, "The people who are most responsible for
developing new treatments right now are the pharmaceutical companies.
What is being lost in all this is that if I didn't work with them, I
couldn't do my job as a scientist -- the part of my job that says we
have people who are suffering that need new treatments" (Goldberg, Boston Globe, 4/2).