The latest in a widening stream of stories about the pernicious influence of money on the practice of medicine focuses on the recent rush to prescribe atypical antipsychotics to youngsters. In a report this morning, The New York Times notes that these meds are being prescribed to more than half a million children in the US “to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.”

Once again, off-label marketing grabs a spotlight. And the glare, which has focused so much on drugmakers, is increasingly widening more and more to encompass doctors. The easy money that comes from advisory boards and speakers bureaus, often in the guise of grants, is drawing scrutiny faster than one can write a prescription for Risperdal.

The paper focused on prescribing trends in Minnesota, which is the only state that requires public reports of all drug company marketing payments to doctors. The key findings:

From 2000 to 2005, drugmaker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.

The sudden popularity of pediatric bipolar diagnosis has coincided with a shift from antidepressants like Prozac to far more expensive atypicals. In 2000, Minnesota spent more than $521,000 buying antipsychotic drugs, most of it on atypicals, for children on Medicaid. In 2005, the cost was more than $7.1 million, a 14-fold increase.

Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money.

In Minnesota, psychiatrists collected more money from drug makers from 2000 to 2005 than doctors in any other specialty. Total payments to individual psychiatrists ranged from $51 to more than $689,000, with a median of $1,750. Since the records are incomplete, these figures probably underestimate doctors’ actual incomes, the paper presumes.

One psychiatrist, George Realmuto of the University of Minnesota, who has ties to Risperdal manufacturer Johnson & Johnson, says: “Academics don’t get paid very much,” he said. “If I was an entertainer, I think I would certainly do a lot better.” He makes $196,310.

Then there’s Annette Smick, the psychiatrist who received the most from drugmakers. She was paid more than $689,000 from 1998 to 2004. At one point, Smick was doing so many sponsored talks that “it was hard for me to find time to see patients in my clinical practice.”

We all have our priorities.

One physician understands the problem - Steven Hyman, the provost of Harvard University and former director of the National Institute of Mental Health, who has this to say: “There’s an irony that psychiatrists ask patients to have insights into themselves, but we don’t connect the wires in our own lives about how money is affecting our profession and putting our patients at risk.”

The full story is here.

[tags]Abilify, Conflicts Of Interest, Ethics, Geodon, Risperdal, Seroquel, Zyprexa[/tags]