American Psychiatric Association Under Scrutiny

Last night I watched Good Night, And Good Luck, a compelling drama about Edward R. Murrow’s out-on-a-ledge decision to ask questions about Joe McCarthy. Joe McCarthy, if you remember your U.S. history, was the junior senator from Wisconsin who somehow managed to get himself appointed to lead a Senate committee investigating the spread of Communism in the U.S. It led to the infamous McCarthy hearings, where innuendo and hearsay were all the evidence needed to convict people in the media.

It was a chilling reminder that government can sometimes turn a legitimate investigation into corruption or scandal and simply take it one step too far. As we now fight our “war on terrorism,” U.S. citizens are reminded of this every time government imposes another restriction on its people in the name of “terrorism” (which was one of the same reinforcements McCarthy used to create fear and doubt).

I thought it apropos to mention this only because I read the article in the New York Times yesterday about the Senator from Iowa, Charles Grassley, now setting his sights on the American Psychiatric Association.

Perhaps it is a natural extension to go after the professional association that represents psychiatry, after digging into a few researchers’ failures to declare all of the money they received from drug companies (or money that came from drug companies, but was funneled through third parties). I can see that.

But a part of me also is concerned that an entire profession is being maligned because of a few researchers’ poor judgment and bad decisions, and now they are going after the organization that represents all psychiatrists. That, to me, smells of overkill and an effort to gain publicity for the sake of the cause.

What will they find when they dig into the American Psychiatric Association’s finances? Well, likely nothing unexpected — they make a lot of money from pharmaceutical companies (which we already know):

In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting.

I don’t think this qualifies as a witch hunt yet, but I’m getting concerned it’s turning into one. It’s easy to go after the American Psychiatric Association, because its incoming president next year is one of the guys Grassley’s office investigated (and found wanting). They are a huge target since they receive so much funding from pharmaceutical companies to help them publish their journals (as do many other professional associations, I might note), and have exhibits at the annual convention (as does virtually every other profession, from selling medical equipment, books, technology and computers). Time will tell as Senator Grassley releases his findings from his investigation.

Is the field of psychiatry a corrupt, money-driven, pharmaceutical-focused profession? No. The vast majority of psychiatrists who treat patients every day are caring, thoughtful doctors who went into psychiatry for the same reason anyone gets into a mental health profession — they want to help others with their emotional needs. Are there some bad apples, especially amongst researchers and educators, who are just industry shills? Absolutely, and every profession has them. Should we demonize the entire profession of psychiatry because some researchers have decided to take advantage of the current legal and ethical system to better line their own pockets? Of course not. Psychiatry is a good profession that provides a valuable service. We shouldn’t fall into maligning an entire profession because it’s easy to do so.

My own take on this, and the responses from the universities defending their researchers’ and their financial disclosures, is that the current financial incentive system needs adjusting and fixing. There is apparently a fair amount of financial shenanigans going on to hide the real amounts pharmaceutical companies are paying some researchers and educators. This needs to stop. Universities, as well as the American Psychiatric Association, need to change their ethics rules to ensure this does stop. One partial solution is to require that any of these shell companies that derive more than half of their income from a single pharmaceutical company be required to publicly disclose that information. That would be a good, albeit small, start.

What universities and professional associations (and heck, other non-profit associations that get a significant portion of funding exclusively from a handful of pharmaceutical companies, such as NAMI) need to understand is they need to get ahead of the ball on this one. These organizations need to come out with clear, consistent, and enforceable guidelines that will ensure such funding doesn’t influence their primary purpose and mission. And they need to do it yesterday.

On a related note, we publish our next timely On the Couch interview with psychiatrist Dr. Daniel Carlat, who has become one of the largest critics of the current state of continuing medical education — the classes doctors take in order to keep up on their knowledge (and maintain their license).

Read the full article: Psychiatric Group Faces Scrutiny Over Drug Industry Ties