Friday, April 03, 2009

More PHARMAcology

I've written before about the extensive reach into doctors' offices and medical school classrooms by the large pharmaceutical companies. Yesterday, the The Boston Globe detailed yet another way in which those pharmaceuticals have influenced the practice of medicine.

Virtually all the psychiatrists who wrote the latest clinical guidelines for how to treat depression, bipolar disorder, and schizophrenia had financial ties to drug companies, according to preliminary findings by Boston-based researchers.

Their study is the first to examine potential conflicts of interest in the American Psychiatric Association panels that write the treatment guidelines widely used by practitioners, the paper's authors said.

The guidelines focus heavily on medications and give relatively little attention to nondrug treatments and how and when to phase out drugs prescribed for mentally ill patients, the authors wrote. They said three common diagnoses generate some $25 billion in drug sales per year. ...

The study, scheduled to be published online this month in the journal Psychotherapy and Psychosomatics, found that among 20 authors of the guidelines, 18 had at least one financial tie to drug companies. It did not name names or specify sums, but found that 12 guideline authors had ties in at least three categories, such as consulting, research grants, speaking fees, or stock ownership.
[Emphasis added]

While having such connections does not necessarily mean that the physicians involved were biased in favor of using specific drugs in the treatment regimen, it is suspicious that the guidelines are so heavily weighted in favor of drugs over other treatment options, especially when 90% of the authors have such connections.

The pharmaceuticals, which have finally come under closer scrutiny for their intricate ties to doctors, clinics, hospitals, and medical schools, once again defend their practices by pointing to the over-all benefits of funding research by physicians.

The pharmaceutical industry defends its practice of paying "thought leaders" in various specialties to lend their expertise to drug development and marketing, saying that their input benefits both colleagues and patients and that they must be paid for their work. ...

But there is a growing backlash against conflicts of interest in medicine. A posse of those pushing for change in the medical culture is centered in Boston and includes Drs. Marcia Angell and Jerome Kassirer, former editors of the New England Journal of Medicine, and researchers such as Cosgrove and Krimsky. These critics contend that financial ties introduce the potential for bias, and at the very least, all such ties must be disclosed.

"What we're saying," said Krimsky, is 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."

Such transparency would indeed be a good start, especially when it comes to treatment guidelines relied upon by working professionals, and especially when it comes to psychiatry. The patients and their families are usually in no position to evaluate those guidelines from the standpoint of potential conflicts of interest of those who produced the guidelines. They must rely on the treater for that kind of expertise.

The full disclosure such transparency would require, however, is only a start. Removing even the appearance of impropriety by excluding those with such financial ties to the industry from authorship of the guidelines is the logical next step. Cutting those ties completely should be the ultimate goal.



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