NEWS: Psychiatry admits drug problem; MindFreedom reply

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Tue, 23 Aug 2005 18:39:39 -0700

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NEWS: Psychiatry admits drug problem; MindFreedom reply

 

 

 

 

MINDFREEDOM NEWS ALERT - 23 August 2005

http://www.MindFreedom.org - please forward

 

American Psychiatric Association President

Admits the Psychiatric Profession is Now

Dominated by the " Bio-Bio-Bio " Pill Model.

 

APA President warns " Big Pharma's " huge

" kickbacks and bribes " hurt credibility.

 

MindFreedom welcome's APA admission but

replies: " Too little, too late. Meet us. "

 

How *YOU* can e-mail the APA President

with your comments and responses now.

 

The below column by the President of the

American Psychiatric Association (APA) --

Stephen S. Sharfstein, MD of Baltimore --

officially admits that the APA's current

model has become the " bio-bio-bio model "

dominated by a " pill and an appointment. "

 

Dr. Sharfstein laments, " If we are seen as

mere pill pushers and employees of the

pharmaceutical industry, our credibility

as a profession is compromised. "

 

He especially denounces a growing practice

where drug sales representatives actually

sit on on meetings between psychiatrists

and their patients to give advice. The

marketing trick is called " preceptorships. "

 

MindFreedom's response: " Of course we

welcome APA's admission that they have a

drug problem. But this is too little, too

late, " commented David W. Oaks, director of

MindFreedom International. " Just look at

the reforms Dr. Sharfstein recommends at

the end of his column! These are tiny

tweaks compared to the nonviolent revolution

that's needed in the mental health system. "

 

MindFreedom calls for a US Congressional

investigation of what they call a drug

industry takeover of the mental health system.

 

MindFreedom has requested a meeting with

Dr. Sharfstein to discuss far deeper changes

in psychiatry. You are welcome to e-mail

your *civil* comments to Dr. Sharfstein

at ssharfstein.

 

President Sharfstein's column was printed

this week in the APA's official newspaper:

 

~~~~~~~~~~~

 

http://pn.psychiatryonline.org/cgi/content/full/40/16/3

 

_Psychiatric News_ August 19, 2005 page 3

 

Published by American Psychiatric Association

 

From the President of APA

 

Big Pharma and American Psychiatry:

 

The Good, the Bad, and the Ugly

 

Steven S. Sharfstein, M.D.

e-mail: ssharfstein

 

APA's annual meeting is one of the

largest medical meetings in the United

States and the largest psychiatric

meeting in the world. There is something

for everyone at our wonderful meeting,

but many have commented to me on the

extraordinary presence of the

pharmaceutical industry throughout the

scientific programs and on the exhibit

floor.

 

The U.S. pharmaceutical industry is one

of the most profitable industries in the

history of the world, averaging a return

of 17 percent on revenue over the last

quarter century. Drug costs have been the

most rapidly rising element in health care

spending in recent years. Antidepressant

medications rank third in pharmaceutical

sales worldwide, with $13.4 billion in

sales last year alone. This represents

4.2 percent of all pharmaceutical sales

globally. Antipsychotic medications

generated $6.5 billion in revenue.

 

When the profit motive and human good are

aligned, it is a " win-win " situation.

Pharmaceutical companies have developed

and brought to market medications that

have transformed the lives of millions of

psychiatric patients. The proven

effectiveness of antidepressant,

mood-stabilizing, and antipsychotic

medications has helped sensitize the

public to the reality of mental illness

and taught them that treatment works. In

this way, Big Pharma has helped reduce

stigma associated with psychiatric

treatment and with psychiatrists. My

comments that follow on the

pharmaceutical industry and its

relationship to psychiatry bear this in

mind.

 

The interests of Big Pharma and

psychiatry, however, are often not

aligned. The practice of psychiatry and

the pharmaceutical industry have

different goals and abide by different

ethics. Big Pharma is a business,

governed by the motive of selling

products and making money. The profession

of psychiatry aims to provide the highest

quality of psychiatric care to persons

who suffer from psychiatric conditions.

There is widespread concern of the

over-medicalization of mental disorders

and the overuse of medications. Financial

incentives and managed care have

contributed to the notion of a " quick

fix " by taking a pill and reducing the

emphasis on psychotherapy and

psychosocial treatments. There is much

evidence that there is less psychotherapy

provided by psychiatrists than 10 years

ago. This is true despite the strong

evidence base that many psychotherapies

are effective used alone or in

combination with medications.

 

In my last column, I shared with you my

experience, and APA's, in responding to

the antipsychiatry remarks that Tom

Cruise made earlier this summer as he

publicized his new movie in a succession

of media interviews. One of the charges

against psychiatry that was discussed in

the resultant media coverage is that many

patients are being prescribed the wrong

drugs or drugs they don't need. These

charges are true, but it is not

psychiatry's fault -- it is the fault of

the broken health care system that the

United States appears to be willing to

endure. As we address these Big Pharma

issues, we must examine the fact that as

a profession, we have allowed the

biopsychosocial model to become the

bio-bio-bio model. In a time of economic

constraint, a " pill and an appointment "

has dominated treatment. We must work

hard to end this situation and get

involved in advocacy to reform our health

care system from the bottom up.

 

Furthermore, continuing medical education

opportunities sponsored by pharmaceutical

companies are often biased toward one

product or another, and they are more

akin to marketing than CME. APA has

strict guidelines for the

industry-sponsored symposia presented at

our annual meetings; sanctions are

applied when our rules are broken. Our

guidelines have been held up as a

standard for medical meetings in other

specialties throughout the country. But

there are many grand rounds, evening

dinners, and lectures where such

standards do not prevail.

 

Direct marketing to consumers also leads

to increased demand for medications and

inflates expectations about the benefits

of medications. As a profession, we need

to be concerned about advertising and the

impact it has on the over-medicalization

of our field. Of course, what is marketed

to consumers are the highest-cost,

on-patent products, and the cost of

medications is something rarely

considered by prescribing clinicians.

When doctors don't prescribe cheaper but

equally effective drugs, it consumes

money that could have been used to

provide other psychiatric or medical

services.

 

There are examples of the " ugly "

practices that undermine the credibility

of our profession. Drug company

representatives will be the first to say

that it is the doctors who request the

fancy dinners, cruises, tickets to

athletic events, and so on. But can we

really be surprised that several states

have passed laws to force disclosure of

these gifts? So-called " preceptorships "

are another example of the " ugly " ; that

is, drug companies who pay physicians to

allow company reps to sit in on patient

sessions allegedly to learn more about

care for patients and then advise the

doctor on appropriate prescribing.

 

Drug company representatives bearing

gifts are frequent visitors to

psychiatrists' offices and consulting

rooms. We should have the wisdom and

distance to call these gifts what they

are -- kickbacks and bribes.

 

If we are seen as mere pill

pushers and employees of the

pharmaceutical industry, our credibility

as a profession is compromised.

 

Here are several suggestions for remedies

in our relationship with the industry.

 

** We need to embrace a new professional

ethic. The doctor-patient relationship

should not be a market-driven phenomenon.

 

** Preceptorships should be considered

unethical.

 

** Enticements, gifts, parties, and so on

should be reined in because patients must

believe that their doctor has their best

interests in mind when a prescription is

handed to them.

 

** We must re-evaluate single-sponsored

medical education events and phase them

out in favor of more general support for

CME along with a careful policing of

these events for bias.

 

** The amount and support received by

individual clinicians and researchers

from industry should be transparent and

the information readily available.

 

** When we attend lectures at annual

meetings and other educational events,

and read journals and textbooks, we

should know very clearly about the

industry support given to presenters and

authors.

 

As psychiatrists, we should all be

grateful for the modern pharmacopia and

the promise of even more improvements in

the future. At the same time, however, we

must be very mindful that we cannot accept

gratuities in the new medical marketplace.

 

http://pn.psychiatryonline.org/cgi/content/full/40/16/3

 

- end -

 

MindFreedom has met before with an APA

President. Two years ago this month during

a hunger strike MindFreedom representatives

had a civil and productive meeting with

then APA President Marcia Kraft Goin, MD, PhD.

For info about that hunger strike see:

http://www.mindfreedom.org/mindfreedom/hungerstrike.shtml

 

~~~~~~~~~~

 

ACTIONS: Please e-mail your civil

comments to Dr. Sharfstein at

ssharfstein,

and please forward this alert

to all appropriate places on

and off the Internet.

 

~~~~~~~~~~

 

This news update is a free public

service of MindFreedom International.

 

Since 1987 MindFreedom has won victories

for human rights in the mental health

system. MindFreedom unites 100 sponsor

and affiliate groups and thousands of

members.

 

MindFreedom is one of the few totally

independent groups in the mental health

field with no funding from governments,

drug companies, the mental health system

or religions.

 

The MindFreedom mission calls for a

nonviolent revolution in the mental

health system.

 

TO JOIN or RENEW your MindFreedom

membership please go here:

 

http://www.mindfreedom.org/join.shtml

 

For the all-new improved MAD MARKET of books

and products to support human rights campaigns

in mental health go here: http://www.madmarket.org

Featured book: Peter Lehmann's newest handbook,

_Coming Off Psychiatric Drugs_ written by

28 different psychiatric survivors and allies!

 

MindFreedom International

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Eugene, OR 97440-3484 USA

 

http://www.mindfreedom.org

email: office fax: (541) 345-3737

office phone: (541) 345-9106

USA toll free: 1-877-MAD-PRIDE / 1-877-623-7743

 

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" Human salvation lies in the hands of the

creatively maladjusted. " - Martin Luther King, Jr.

 

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