The July 18 issue of the APA newspaper "Psychiatric News" has a column about conflict of interest and transparency by APA president Nada Stotland. Dr. Stotland comments that "for reasons that are unclear, much of the [media] attention [to conflict of interest in medicine] has focused on psychiatrists and APA..."
Sadly, the reasons are all too clear. Psychiatry has become so strongly biologically oriented that the profession is in danger of losing the respect it has earned as the most humane of specialties. We have experienced recurrent backtracking on the safety and efficacy of psychiatric medications. The degree to which the pharmaceutical industry supports the APA (30% of revenues) and individual leaders in the field has been widely publicized.
Dr. Stotland's column acknowledges the danger that that "the receipt of money or gifts causes our patients and the public to question our professional integrity - and [potentially] undermines the credibility of everything we do." She cites APA policies about disclosure of commercial relationships and the limits set on Pharma income ($10,000) for participants on key committees, and concludes "I believe we are doing what we can..."
A story on the next page in "Psychiatric News" described an APA resolution presented to the AMA House of Delegates asking for reexamination of the FDA criteria for approving generic medications for bio-equivalence. In her testimony at the AMA Dr. Stotland acknowledged "that at a time when organized medicine is under public scrutiny regarding ties to the pharmaceutical industry, a resolution raising questions about the clinical efficacy of some generics would raise skepticism in some quarters."
I admire Dr. Stotland and I love the APA, but my own reaction was just what she predicted for "some quarters." If loyal 40 year members of the APA feel something between queasiness and shame on the issue, imagine the reaction of those with less trust in the Association and its leadership!
The corrosive impact of conflicts of interest occur not only through actual distortions of judgment, but also through loss of trust in individuals and groups. The APA is at severe risk for losing trust. The problem will only get worse, given the intense scrutiny of the incoming APA president's relationship to a pharmaceutical company. (See, for example, a series of postings on the Health Care Renewal blog.)
Even if our confidence in our own integrity is 100% warranted, we can't expect even the most fair-minded persons to rest easy if it is disclosed that we have stock holdings worth millions in a company whose drug we are studying. (This is what appears to be the case for the incoming APA president.) And if 30% of our budget comes from the manufacturers of branded medications, who is going to trust that our questioning of the bio-equivalence of generics - however justified it might be - rests on scientific and clinical concerns alone?
As I was writing this posting, Bob Dylan's "The Times they are A-Changin" started playing in my mind:
Come gather 'round peopleI don't see any easy answers to the quandary the APA is in. But the status quo with a sprinkling of disclosure will not sustain the trust my profession needs. With regard to the relationship between medicine and the industries that produce pharmaceuticals and devices, the times are definitely changing!
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You'll be drenched to the bone.
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'.
