Tuesday, October 21, 2008

Psychiatry, Pharma and Conflict of Interest

I've been critical of the way psychiatry and the American Psychiatric Association (APA) have handled conflict of interest over drug company money (here and here). Today I want to praise Dr. Nada Stotland, president of the APA. Here's her letter from today's New York Times:
"Your Oct. 11 editorial “Drugs and Disclosure” expressed fear that the integrity of medical research is being threatened by conflicts of interest and the manipulation of scientific data. The American Psychiatric Association shares your concerns and supports full disclosure and transparency.

We deplore transgressions of the laws and regulations. Equally important, we worry about the impact of accusations and revelations concerning a small number of psychiatrists on those undergoing or in need of treatment.

Psychiatrists and patients have struggled with stigma for millenniums. It is less than one month since Congress approved, and President Bush signed, a landmark bill requiring coverage for care for mental disorders to be on a par with other medical conditions. It would be a tragedy if the possible misdeeds of a few were to undermine this historic achievement."
To a casual reader this letter might seem perfunctory.

It's not!

When Dr. Stotland refers to "the possible misdeeds of a few" she's being bold. She is acknowledging (in diplomatic language) that two of the most eminent psychiatrists in the U.S. - Dr. Charles Nemeroff (Emory) and Dr. Alan Schatzberg (Stanford), president elect of the APA - may have committed "misdeeds." In my view, this is courageous and spot on.

As bad as the revelations about how Drs. Nemeroff and Schatzberg have handled their ties to Pharma look, they are "accused," not "convicted." The word "possible" reflects our tradition of presupposing "innocence" until proven otherwise. But "misdeeds" acknowledges that what has been published doesn't smell right.

Being president of a professional society is a tough job. Dr. Stotland's letter to the New York Times puts patient care and the need for public trust first without either rushing to judgment of her colleagues or brushing off the allegations against them. Hat's off!

No comments: