Grassley Probes Psychiatrists Over Ties To Pharma
65 CommentsBy Ed Silverman // July 11th, 2008 // 8:14 pm
The investigation by the Senate Finance Committee, where Chuck Grassley is the ranking Republican, into the ties between drugmakers and medicine is expanding. After targeting grants issued to academic psychiatrists, Grassley now wants the American Psychiatric Association to open its books for a look-see at pharma funding.
Psychiatrists, of course, prescribe antidepressants and antipsychotics, both of which have stirred controversy. And psychiatrists have frequently shown up at the top of lists of doctors receiving pharma money. This week, for instance, Vermont’s Attorney General released its annual report showing that, of the top 100 recipients, psychiatrists received the highest level of payments, and 11 psychiatrists received a total of about $626,000, or approximately 20 percent of the total value of payments. The average amount received by psychiatrists was nearly $57,000.
Not coincidentally, the Senate committee’s conflicts-of-interest probe into oversight of grants issued by drugmakers and the NIH has focused on three psychiatrists - Harvard University’s Joe Biederman, Stanford University’s Alan Schatzberg and the University of Cincinnati’s Melissa DelBello.
The following e-mail was sent to APA members…
Date: 07/11/2008 11:07AM
Subject: Message from APA Leadership
Fellow Members of the APA:
The APA Office has just received a letter from Senator Grassley of Iowa, requesting a complete accounting of APA revenues, except those from advertising in our journals, from pharmaceutical companies, starting in 2003. We will, of course, provide this information, which had already been available to our members.
These monies have supported activities including symposia, program bags, buses, and exhibits at our annual meetings and research and leadership training for outstanding residents. Our compliance with the rules governing these revenues has earned us accolades from the accrediting agency.
We are not alone; recent public focus on relationships between medicine and the pharmaceutical industry is a challenge for the whole field of medicine. The APA fully endorses the concept of transparency in our relationships with pharma and other entities and has been in the forefront of the disclosure process. In March, 2008, long before this inquiry from Senator Grassley, your Board of Trustees empaneled a working group charged to review all APA pharmaceutical revenues, sort them into categories; and provide the Board with options for ending pharmaceutical support in each category and the implications for the activities they currently fund. We are proud of what we do.
We will continue to keep you informed about this and all matters of importance to members of the APA.
Nada Stotland, M.D., MPH
APA President
UPDATE: The New York Times now has a story about this in its Saturday paper.
Lisa Van S
Ahhhh,…. A.P.A speaks with forked tongue! This is the same group who has opposed our Informed Consent Bill here in N.J.. These Psychiatrists are infamous for prescibing antipsychotics for Babies an Toddlers. I hope the good Senator looks into contributions made by Pharma to NAMI.
Justice in MI
What did they mean by that?
Laurie
This should be interesting!
Thom
APA Statement: “…and provide the Board with options for ending pharmaceutical support in each category and the implications for the activities they currently fund.”
Wow
APA continuted, “We are proud of what we do.”
Doesn’t sound like it.
Stefan
APA to end pharmaceutical support?
Bye bye psychiatry!
The only thing propping it up then would be government funding.
truthman30
Psychiatry simply would not survive as a “profession” without pharmaceutical sponsorship and support. It is a medical-industrial complex. The industry would survive without psychiatry but psychiatry would not survive without pharma.
Personally I would be delighted to see Psychiatry consigned to the dustbin of bad ideas. It has made absolutely no progress in the treatment of mental or emotional suffering. It has completely sold out to the pharmaceutical industry and many people have been harmed as a result of this faustian pact. It colludes with the industry to suppress the true side effect profile of the drugs it helps them to peddle them on unsuspecting (but perhaps not so trusting anymore) patients.
For an example of just how rampant the influence of industry is in the western world, take a look at the Irish Psychiatrist magazine. It is literally littered and smeared with pictures of Psychiatrists attending dinners sponsored by pharmaceutical companies (complete with promotional stands advertising SSRI’s and anti-psychotics).
http://www.irishpsychiatrist.ie/index.php?site_pid=3&page_pid=4
http://www.irishpsychiatrist.ie/irish_psychiatrist/pdfs/Irish%20Psych%20SPRING08.pdf
Absolutely vomit-inducing if you ask me…
(and no I am not in any way connected to scientology!)
Dan
While Psychiatrists are paid the most by pharma as a specialty, that does not mean they are the only specialty paid by pharma. Go after Cardiology, Senator. It’s not support- it is pay, just as one gets paid for a job.
Maxine
It seems that the pattern of conduct and activities, by these individuals and entities might be grounds for investigation and prosecution,for violations, under the “RICO ACT”? Pehaps Senator Grassley might look into this possibility?
Stefan
Dear Dan,
Certainly any medical profession that doles out drugs is influenced by pharma bucks.
But perhaps you have not seen the many and various recent articles that show psychiatrists in the main are the top ones raking it in and the big money makers are the antipsychotic drugs prescribers.
http://tmap.wordpress.com/
Laurie
“It’s not support- it is pay, just as one gets paid for a job.”
Am I understanding your rationale here….it’s ok to be on pharma’s payroll, commit to prescribing a particular product and then charge patients too without disclosing that relationship? I don’t think many patients would feel to comfortable with that arrangement. The thought “guinea pig” and being charged for the priviledge comes to mind.
Nathan
Laurie writes: doctors “commit to prescribing a particular product.”
Laurie, that simply isn’t true — and you should know it since you are a nurse. It’s LONG been illegal for any sort of “quid-pro-quo” to take place. The prescriber may FEEL compelled to write prescriptions after recieving money from pharma, but there is no implicit agreement. If this were the case, we would be arguing about legal action rather than just about disclosure.
Nathan
Truthman writes: “…psychiatry would not survive without pharma. Personally I would be delighted to see Psychiatry consigned to the dustbin of bad ideas.”
Interesting. And you consider yourself to be unbiased?
If psychiatrists were quacks (excuse the pun), then patients wouldn’t bother going to them and the profession would have died long ago. They must be serving a particular need of society otherwise they would have already been relegated to the “dustbin of bad ideas”.
truthman30
No, I consider myself totally biased Nathan, as In , yes I am proudly anti-psychiatry , just as much as you are anti-consumer…
You think you are very clever Nathan, but your ignorance will bite you on your ass some day…
Stephany
An anonymous commenter”Izzy”, left a comment at this (witchhunt)post on the Carlat Blog.(then posted the email from the APA, signed Nada Stotland, M.D., MPH
APA President
Comment left on July 11, 2008 9:36 PM -(Carlat Psychiatry blog, authored by Daniel Carlat)
“Here is what I received from the A.P.A. this morning. Along with having a signer of the Declaration of Independence on our logo, we can now boast of being the first medical society in the U.S. to be the subject of a Senate investigation. It is unfortunate that, for Dr. Stotland, it is the “public focus” on our relationships with pharma that is the challenge for medicine, not the nature of the relationships themselves.
Being that “Izzy” received the email, and is assumed to be a member of the APA; I think that comment speaks for itself. “izzy” left previous comments earlier in the day as well, quite interesting.
I’m glad to see this investigation happen, personally.
Stephany
http://carlatpsychiatry.blogspot.com/
http://carlatpsychiatry.blogspot.com/2008/06/six-million-dollar-man-witch-hunt-or.html
Stephany
TheCarlat Psychiatry blog.
Carlat blog with the breaking APA email left in comments mid-day Friday July 11
Mary
With all thanks, Senator Grassley, for investigating the profession that killed my father (ECT 1943), my son (Zyprexa, 2002), and almost my daughter.
The only psychiatrist that ever showed real warmth and competence was wonderful to my son and had him on lithium, but when he discovered, after my son’s death, that I had turned into an “anti-psychiatry person”, with due cause, he accused me of being a Scientologist and started telling me of his success with a patient who was taking Zyprexa. May you rake in the cash out at Stanford, my former friend.
Stefan
Nathan writes:
“If psychiatrists were quacks …then patients wouldn’t bother going to them and the profession would have died long ago.”
This is faulty logic. Blood letting as an example was used for centuries before it died out.
Psychiatry will go the way of blood letting.
No science - no cures.
truthman30
Thanks Stefan , I agree absolutely..
Psychiatry has been trying to validate its existence for 200 years..
The regime is dying..
Lili
This has been happening forever. Many illness, like Thyroid conditions mimic depression and Psychiatrists have prescribed anti-deprssants instead of solving the true cause. Dr. Sydney Waler, Dr Al Seibert, and many other doctors wrote articles on the corruption of the Pharma and Psychiatric prfession. Also Dr.Barda Banes wrote a book about these issues but all the results were buried so that Phharma could prosper and today stains are like anti-deprssants. Many people assiciated with pharmaceuticals Companies respoding to this web site favor the pharmaceutical companies, not interested that pharmaceuticals do kill and not cure.
Laurie
“It’s LONG been illegal for any sort of “quid-pro-quo” to take place. The prescriber may FEEL compelled to write prescriptions after recieving money from pharma, but there is no implicit agreement.”
And the difference to the consumer in the above scenario would be…???
Nathan, I know that you’re not naive enough to believe that a doc who is willing to accept funds from pharma would not, in turn, encourage the use of that companies product…no one is that naive.
Nathan
Laurie writes: “I know that you’re not naive enough to believe that a doc who is willing to accept funds from pharma would not, in turn, encourage the use of that companies product”
Ok, if I’m so naive, then please give me a straightforward answer to the following question. I’ve asked this before (other threads) and never gotten a strait answer: Pay-for-prescription is obviously very, very illegal. So where is the connection between the payments from pharma and prescription patterns? How would prescribing a particular brand of medication benefit bring a future financial benefit to a doctor?
From what I can tell, the payments in question are generally consulting, CME, and honorarium for lectures. We aren’t talking about kickbacks.
It’s fine to ban the funding. But I’m tired of the insinuation that the whole system is morally corrupt. If it is, you’ll be able to provide me with a simple answer to the above question I pose.
Dan
My earlier comment was meant to illustrate the need for no doctors to be paid by pharma. Yes, Psyche doctors are paid the most, but the behavior will continue of paying doctors until the drug companies are prohibited to do so.
No, I don’t agree with paying doctors at all from pharma companies. For any reason.
Laurie
” So where is the connection between the payments from pharma and prescription patterns? How would prescribing a particular brand of medication benefit bring a future financial benefit to a doctor?”
Dr.Biederman is only one example. He is making money from pharma and prescribing drugs off label from the company that he is recieving funds from. His endorsement of a particular drug increases the use of that drug by him and his collegues.
“Although many of his studies are small and often financed by pharma, his work helped fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotics in children, the Times writes, adding that the Senate investigation did not address research quality.”
http://www.pharmalot.com/2008/06/harvard-psychiatrist-didnt-report-pharma-income/
Another example is those doctors involved in the tmap program.”Dr. Steven Shon, former medical director of behavioral health at the Department of State Health Services, was forced to leave after Attorney General Greg Abbott investigated whether drug companies improperly influenced Shon to promote one of their medicines in a state treatment plan, according to state documents and officials.” Dr. Shon, it was discovered, was a paid consultant to Janssen (subsidiary of Johnson & Johnson) who actively lobbied other states to adopt TMAP.
I believe his influence in the creation of tmap would qualify as increasing prescribing of certain drugs(on the tmap list) considerably.
I’m not saying that all doctors are on the take from pharma. I know alot of ethical physicians who would never consider making this a part of their practice. But there are alot who don’t share that ethical barometer.
Lisa Van S
Ahhh,.. I just felt the gotcha moment.
Carol
Nathan,
The system itself is not morally corrupt, but there is still corruption in the system. The ‘pay for prescription’ is implemented through being a ‘high prescriber’ of brand x. High prescribers are typically the only ones targeted for being speakers, faculty for selected CME programs, getting invitations to CME with added benefits, participation on’advisory boards’, etc. If you don’t support the product, you just happen to be left off the invitee lists for certain activities.
Nathan
Let’s take this point-by-point:
“prescribing drugs off label from the company that he is receiving funds from.”
1) Prescribing drugs off-label is perfectly acceptable. Shame on you for saying otherwise.
2) Why is he receiving funds? It’s not for prescribing drugs. It’s most likely for giving the lectures (”endorsements”) that you speak of later. Again, nothing wrong with that. He isn’t going to speak for free.
“His endorsement of a particular drug increases the use of that drug by him and his colleagues.”
1) How could his endorsement increase his OWN use of the drug? That doesn’t make any sense.
2) OF COURSE his endorsement increases the use of drugs among his colleagues! So what? If he likes a drug, and tells his friends and colleagues about it, so what? People hate drug reps. No one believes them. But people trust doctors and colleagues.
“Although many of his studies are small and often financed by pharma, his work helped fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder.”
This is the only thing that makes a little sense so far. Pharma funds the studies that shows that their own drugs are more necessary. A conflict of interest? Yes, absolutely. But who else is going to fund the research? The research should stand or fall on its technical merits — not on where its funding came from. But I agree the funding sounds fishy.
Nathan
Carol — that makes some sense. Thanks.
In general, it’s important to keep in mind that a company isn’t interesting in having consultants and speakers that aren’t supportive of thier own drugs. While I can understand your concern, you can’t expect a company to hire its enemies to give lectures and be consultants.
Thom
Gotta’ love Nathan. He does more work creating bogus controversy as a regular ‘ol contrarian than a dozen highly paid specialist at Hill and Knowlton.
Dr. Sal Giorgianni
Now let’s look at the good senator Grassley’s inquiry to APA in light of the notice by Pfizer (which I am sure will be followed by other firms) that they will support educational programs conducted by academic institutions and professional associations. In theory funding educational programs in this way should provide a safe-harbor from criticism of undue bias. How could program content be compromised by giving support to huge independent and unimpeachable institutions? Well, my guess, unfortunately, is that folks like Mr. Grassley will now just turn their scrutiny on to academic institutions and associations. It is apparently the mere fact that there is a relationship at all that distresses.
So, get ready PhARMA and get ready academia and professional associations. This is the last bastion of defense against those who would completely cut any and all funding of education of health professionals by commercial entities. With Pfizer’s well thought through and gutsy move, the debate has just now switched from “what is the best way to fund industry sponsored education” (a legitimate issue) to, what I believe has always been in the minds of many in the anti-industry crowd, “should industry fund any education”.
Laurie
“Let’s take this point-by-point:
“prescribing drugs off label from the company that he is receiving funds from.”
1) Prescribing drugs off-label is perfectly acceptable. Shame on you for saying otherwise.”
Shame on me???? Why would I be shamed for bringing to light that drugs are being used for situations, where they are not proven to work, based on someones opinion with financial ties to the manufacturer of that drug? Prescribing these drug without making the patient aware that they are NOT approved for use with their specific diagnosis? No shame here…just reality.
“1) How could his endorsement increase his OWN use of the drug? That doesn’t make any sense”
Now you are grasping at grammatical straws. Isn’t this where you demand full disclosure from anyone who posts here?
Like I said above…most doctors are very ethical in their prescribing habits. But I’m not naive enough to believe that all are. The two examples above are proof of that.
Carol, you hit it on the head. High prescribers get the fees….hence the claim that has been made here. This is the connection between the payments from pharma and prescription patterns.
Ernest
This article confirms again that psychiatrists are the bottom-feeders of the medical profession. They have such a rich history of treatments like lobotomy, leucotomy, shock treatment, LSD and now an epidemic of “off-label” prescriptions of dangerous anti-psychotics to kids under 18, prisoners, and the elderly in nursing homes. No other practice shares so much in common with torture and rendition. In Michigan, the Total Medicaid Reimbursement for Beneficiaries 18 Years and Younger for atypical anti-psychotic prescriptions in 2000 was $1,891,569.31. Just 7 years later in 2007 that total was $39,560,421.67. That’s a twenty-one fold increase in “off-label” prescribing of atypicals to just one group, 18 and under. Stuff like this is killing Medicaid. Senator Grassley, in leaving no rock unturned, is unearthing just the kind of creatures one expects to find under a rock–the lowest of the low. How much Medicaid money was denied to more successful and ethical fields of medical treatment for this to happen?
Nathan
Ernest - did it ever cross your mind that psychiatrists have been doing such “horrific” things because they have been dealing with diseases and disorders that have proven to be unexplainable by modern medicine and incredibly resistant to treatment? Sometimes trying something unproven is better than no treatment at all.
Hence off-label use of drugs. I wish we had so many great treatments for disease that there would be no need for “off label” use. But we haven’t reached that point in medicine and we don’t appear to be reaching that point anytime soon. Until then, doctors will keep on trying with whatever tools (proven or unproven) at their disposal.
Nathan
Two things seem to be getting mixed up in the last few posts: Off-label prescription and off-label promotion.
1) Off label prescription: Perfectly legal and medically acceptable. (unless proven NOT to work for a particular indication)
2) Off label promotion: Illegal and morally unacceptable. We (the pharma industry) can’t and shouldn’t PROMOTE products for uses other than their approved uses.
Thom
Two things seem to be getting mixed up in the last few posts: Off-label prescription and off-label promotion.
1) Off label prescription: Perfectly legal and rampant thanks to off label marketing practices under the guise of peer-reviewed publications and continuing medical “education.”
2) Off label promotion: Illegal, morally unacceptable, and industry’s Standard Operating Procedure. (PhRMA’s “catch me if you can!”)
Thom
Nathan, are you are PhRMA or Hill and Knowlton?
Lisa Van S
Nathan,
Take your children to a psychiatrist the next time sibling rivalry rears its ugly head. If your lucky the good ole psychiatrist will have written a script for a cocktail of meds that are off-label,.. or you can wait til they attend school and have a mental health evaluation and have your children sent home because they are diagnosed and labeled w/mental illness.
Young Man, your children are young now, wait til they become teens, and your government tells you that they are better capable of raising the children then you are. Teen Years are just around the corner, goog luck,.. you are going to need it!!
Lisa Van S
Thom,
He’s a Pharma Retort Reporter, disguised as a “Scientist”.
Chris
Dr. Sal,
What is wanted is true independence, not thinly disguised promotional efforts. Academic institutions and professional associations are not free from wanting additional funds from pharma. You present the information which makes the drug company happy which continues the flow of funds. And yes, I have seen this system in operation.
Thom
I just wonder if Nathan’s billable hours are time and a half for weekend duty. Sunday work should be double time.
truthman30
Nathan Writes : Ernest - did it ever cross your mind that psychiatrists have been doing such “horrific” things because they have been dealing with diseases and disorders that have proven to be unexplainable by modern medicine and incredibly resistant to treatment? Sometimes trying something unproven is better than no treatment at all.
Nathan, did it ever cross your mind that psychiatry has gotten away with abusing and disposing of the mentally ill for decades because the “mentally ill” have been deemed as “useless to society” by governments? (these practices go all the way back to the nazi era, where psychiatry itself was born). And did it ever occur to you that maybe the reason why psychiatrists got away with such abuse was because most society’s don’t want to deal with a highly stigmatized, frightening and taboo subject such as “mental illness”. So in essence psychiatry was given free reign to do what it wanted.
You really should read up on the history of psychiatry Nathan, because it seems to me that you are absolutely clueless about it, so really you shouldn’t be making such ridiculous assumptions about a “practice” which you have in fact no knowledge of and no experience with.
If as you say these “illnesses” have been proven to be “unexplainable” then why is psychiatry allowed to perpetrate “cures” based on unprovable theories? …
Yes , mental distress and disorder can be complex, but a lot of it boils down to reaction to trauma , environmental factors, emotions and human nature. There is a sea of change in regards to mental illness happening right now and psychiatry is desperate to hold its power in the field of “mental illness” because it has become a highly profitable business based on the biological model…
Nathan
Thom writes: “I just wonder if Nathan’s billable hours are time and a half for weekend duty. Sunday work should be double time.”
I agree — I should be paid for this…
Lisa, let me get this strait: Your children were drugged up against your will? Your government has volunteered to raise your children? I’m not sure what you are talking about… Are you sure that you live in New Jersey? I’m in New York. Maybe my state isn’t quite so progressive.
Laurie
“Two things seem to be getting mixed up in the last few posts: Off-label prescription and off-label promotion.
1) Off label prescription: Perfectly legal and medically acceptable. (unless proven NOT to work for a particular indication)
2) Off label promotion: Illegal and morally unacceptable. We (the pharma industry) can’t and shouldn’t PROMOTE products for uses other than their approved uses.”
This is always interesting to me. The end result to the consumer of either is the same. Untested, unverified effectiveness and lack of scientific documentation/collection of results and adverse reactions.
So while one is illegal the other is perfectly acceptable, the consumer is still the unknowing guinea pig.
Ernest
Nathan, glad you aren’t a doctor. So it’s okay to resort to brutalizing a patient when you don’t understand what is going on with that patient? What crosses my mind is that psychiatrists continue to do horrific things because they are horrific people. A normal person regrets damaging somebody in the name of help and resolves not to do it again. Not so a psychiatrist.
The first thing a psychiatrist does is label a patient with a “disorder” that immediately stigmatizes and brands that person like a branded animal or the star Jews had to sew on their clothing in Nazi Germany. That makes it easy to dehumanize that person. It’s like psychological training of soldiers in boot camp. You wouldn’t want them thinking they were going overseas to kill somebody who was a father or mother with kids, a lover of dogs and gardening or in any way just like yourself. No, first you have to label the enemy as some type of subhuman, a terrorist, fanatic or someone infecting or diluting the purity of mankind, etc. The Nazis conducted a huge PR campaign in the press against the Jews before World War II. The Jews had to be seen as moneygrubbers and the cause of Germany’s depression. They had to be worse than dogs before the German public would accept rounding them up, gassing them and incineration. Nazis were to I.G.Farben (maker of Zyklon B cyanide gas) as psychiatry now is to companies like Lilly, maker of Zyprexa used primarily “off-label” on kids and the elderly.
Nathan, as Truthman says, you need to study history. And just so I have this straight “off-label” promotion is a no-no but “off-label” prescription is okay because it isn’t illegal yet? So it’s okay to abuse kids with harmful drugs but unethical to promote abusing kids with harmful drugs. It that it?
Nathan
Laurie writes: “The end result to the consumer of either is the same” (for off-label promotion vrs off-label prescription)
Absolutely not. Many, many cancers are treated off-label due to the fact that the particular drug has not yet received approval for that indication – but the patient will likely die by waiting for the said approval. Enbrel is being given off-label in order to treat Alzheimer’s. (Ed wrote a nice story about it last week) Off-label prescriptions serve a key medical need - they serve as an important link between the “idea” stage and spending tens of millions of $ for a full clinical study.
The end result is not the same: Off label promotion is essentially lying. It’s saying that a drug is effective for treatment of condition “XZY”. Off label prescription is a doctor saying “Well, we don’t have any good treatments for your condition at the moment, but there is some literature that indicates that this drug may be effective for the treatment of XZY.”
I don’t know what the laws for off-label prescription are, but I would hope that the doctor indicates to the patient when the use of the drug is currently unapproved. I’m sure we can at least agree on that statement.
truthman30
“Nathan, as Truthman says, you need to study history”
Thanks Earnest , I can tell you are knowledgeable about the history and practice of Psychiatry and the pharmaceutical industry..
Great to have you around…
:)
Doc
Shine the light Sen. Grassley!!! And watch the rats run for cover!!!
Ernest
Thanks Truthman, I will try to check in and comment more often.
truthman30
Doc
July 13th, 2008
9:29 pm
Link to this comment
Shine the light Sen. Grassley!!! And watch the rats run for cover!!!
Rats is too good a word…
Psychiatrists are down so low on the food chain, even Amoebas look upon them with utter contempt and disdain…
Ernest
July 13th, 2008
10:17 pm
Link to this comment
Thanks Truthman, I will try to check in and comment more often.
Please do Earnest, It is nice to have reasoned dialogue with those who actually get the subject matter.. :)
Dr. Sal Giorgianni
My, my. Whatever happened to civilized dialog?
This is a serious situation and name calling and, as we used to call it on the tough side of the tracks in NYC, “ranking the other kid out” will not help birng resolution to any of this.
I do hope the Good Mr. Silverman does not endorse any of this. A good and useful e-publication such as this one can quickly end up having no use if the debade continues to be debased.
Laurie
“I don’t know what the laws for off-label prescription are, but I would hope that the doctor indicates to the patient when the use of the drug is currently unapproved. I’m sure we can at least agree on that statement.”
Nathan, if this was happening we wouldn’t be having this discussion. Out of the thousands of parents that I’ve talked to about ssri’s in kids, not one was informed that the drug that was being prescribed was an “off label” use.
This is my whole argument.
If the patient knows that they are being prescribed a drug off label, and they are OK with taking that risk, then there’s no problem. It’s when they are left in the dark that the problems come up.
Lisa Van S
Nathan,..From NYC, huh. Are you sure about that?
Nathan
Laurie — it looks like we found some common ground. I agree — for the most part, doctors should be telling patients when drugs are prescribed off-label. Obviously, there would have to be some exceptions (incompetence, emergencies, etc) — but overall, I agree wholeheartedly with you.
However, I’m not so sure that telling a patient about off-label use will change their mind — generally patients trust thier doctors. Otherwise they wouldn’t be going to visit the doctor in the first place. It’s easy for these parents to disagree with the doctor after-the-fact. But when the doctor recommends the ssri for the child, even though it is unapproved, are they really going to disagree? Maybe a few will — but I suspect most will defer their judgement to that of the expert.
Lisa
It is like advertising, companies do it because it works, if the payments to doctors didnt work Pharma would not do it. There is a reason for these budgets.
MarthaBeal
Nathan, it’s interesting that you should ask for a direct connection between prscribing patterns and “gifts” to prescribers. As you wrote that would prove the “gifts” were kickbacks. Where have you been? Pharmaceutical companies actually pay companies which monitor prescribing patterns based on pharmacy records from across the US. The companies track prescribers through their license numbers which are required in order to fill prescriptions.
The prescribers license numbers are matched to medical association member lists to the prescribers’ names. Every pharmaceutical company knows exactly, right down to the last pill, which doctors are prscribing their products, when, in what doses and how many prscriptions are written in any given period. Wake up, this is common knowledge.
MarthaBeal
I’ll find the articles which give the exact details about drug companies monitoring of prescribing practices and their corresponding “quid pro quo” payments to prescribers. This is really old news so I’d prefer not to spend my time proving this but if Nathan needs a teacher to keep him informed I guess someone has to do it.
Nathan, the Alliance for Human Research Protection provides this type of information on a regular basis. They don’t exclusively report on psychiatric drugs though. They report on the entire drug industry.
MarthaBeal
Pharmaceutical company salespeople prize doctors’ information because it profiles prescribing habits - they can learn which doctors favor brand names or generics, and who is more willing to prescribe new drugs - and steer their strategies accordingly. Associated Press, Concord Monitor (NH) July 28, 2006
The companies which provide the prescribing data to the drug companies who then pay the kickbacks to prescribers opposed a New Hampshire law banning the disclosure of prescribing practices. The law is the first of its’ kind in the US.
The companies who provide the data to drug comapnies are paid tens of millions of dollars for this info. Without it, how would the drug companies know which prescribers get the biggest kickbacks and bribes? Drug comapnies just can’t trust prescribers to tell the truth about the amount of prescriptins written. They want to know they’re getting their moneys worth for the kickbacks.
Which boy scout troop did you say you belong to, my sweet, naive little one? Welcome to the real world were there’s no such thing as free money from drug companies to needy innocent doctors.
MarthaBeal
“Ok, if I’m so naive, then please give me a straightforward answer to the following question. I’ve asked this before (other threads) and never gotten a strait answer: Pay-for-prescription is obviously very, very illegal.
So where is the connection between the payments from pharma and prescription patterns? How would prescribing a particular brand of medication benefit bring a future financial benefit to a doctor?”
The drug companies know when virtually every prescription in the US is filled and which doctor wrote the script.
Have you heard of Google? Its so easy. You just type in keywords such as: kickback, prescribing patterns, corruption, doctors, pharmaceutical comapanies, etc. Any questions?
Understanding the Lucrative Business of Selling Medical Records By Gloria Bulter Baldwin:
http://acadiana.medicalnewsinc.com/news.php?viewStory=886
The drug comapnies pay top dollar for accurate info so kickbacks are targeted and effective:
“According to a 2005 Intelligent Manufacturing Systems (IMS) Health annual report, operating revenue of $1.75 billion was derived from sales to the pharmaceutical industry. Forty-eight percent was from “sales force effectiveness offerings,” which include “sales territory reports and prescription tracking reports.” In 2005, the AMA received $44.5 million in revenue — about 16 percent of its total revenue — from the sale of database products.”
“In the June 29, 2006 issue of The New England Journal of Medicine, Dr. Robert Steinbrook addressed the lucrative business of buying physicians prescribing data and the growing rebellion of physicians against the companies using the information as marketing tools.”
An average of $57,000 per year was paid in kickbacks from the drug companies directly to the top prescription producing psychiatrists in Vermont. I think that was the New York Times. Don’t you read anything?
Jesus Christ Nathan, are you really that lazy that you can’t look this up on Google and read it yourself. It’s been on the internet for years. If you really are a child and belong to a boy scout troop, I apologize for making you cry. Otherwise…what’s your issue? Don’t you have a clue? How could you not know this? Do you really expect others to spoon feed information to you without having to make any effort.
It’s not exactly hidden information when it’s reported by the Associated Press, the New England Journal of Medicine and a thousand other places such as the House Committee on Oversight and Government Reform. Put down the comic books! Read something worth reading! Educate yourself, instead of asking others to do it for you. I won’t do it again. That would only encourage your laziness. Even McCain and that moron Bush have heard of “Googles” and “The Internets.”
Someone needs to kick your lazy “please give me the answer” ass, and it may as well be me. I’m sick of suffering fools gladly and doing their work for them.
Nathan
Marthabeal - thank you for your information-loaded posts. Unfortunately for you, you wasted your time. Your insults and surly attitude caused me to skip right over them. While we disagree with each other frequently on this site, most of us attempt to remain cordial to one another. Please refrain from further commenting until you can comply.
American Psychiatric Association
The American Psychiatric Association is a leader in promoting disclosures of financial relationships and will comply fully with Senator Grassley’s request. We are proud of our tradition of transparency in reporting. Our strict rules of disclosure for advisors to the updating of the Diagnostic and Statistical Manual (DSM) have been unprecedented. Even though Cognress has focused on psychiatry, the issue of industry funding and its possible impact is one that affects the entire field of medicine. There is little doubt that accepted rules of practice are in flux and will continue to change for some time.
truthman30
Nathan writes— generally patients trust thier doctors. Otherwise they wouldn’t be going to visit the doctor in the first place.
Well unfortunately because of greed within the industry which leads to suppression of negative data, the doctors can’t even trust what is printed in the patient information leaflet anymore?..
It is a great shame that patients can no longer trust their doctors because of the pharmaceutical industry’s continual deception in regards to the efficacy, safety and effectiveness of medications…
The APA writes : - The American Psychiatric Association is a leader in promoting disclosures of financial relationships and will comply fully with Senator Grassley’s request. We are proud of our tradition of transparency in reporting. Our strict rules of disclosure for advisors to the updating of the Diagnostic and Statistical Manual (DSM) have been unprecedented. Even though Cognress has focused on psychiatry, the issue of industry funding and its possible impact is one that affects the entire field of medicine. There is little doubt that accepted rules of practice are in flux and will continue to change for some time.
Well, first of all, psychiatry itself is a sham science and psychiatry wouldn’t be in business if there were no medications..
And unfortunately the medications which the APA endorses are for the most part, ineffective ,dubious efficacy, intolerable side effects and questionable effectiveness..
When the APA is done medicating the “human condition” and ceases to rely on pharmaceutical companies for the continuation of its agenda then I myself might give it some benefit of the doubt..
But from what I know about psychiatry , the stakes are too high now, much profit is being squandered off the backs of the “mentally ill” and i doubt if that gravy train is going to come to a sudden halt any time soon…
And don’t get me started on the DSM..
It’s a “drug pushers handbook” , nothing more and nothing less..
That said, I look forward with glee to the new “disorders” which psychiatry has invented for inclusion in the DSM 5…
One thing is for sure, psychiatrists sure have active imaginations..
Shame that the practice of it damages so many people..
Lisa Van S
Dear A.P.A,
It appears that we have your attention! On March 3rd 2008, your organization testified before the NJ State Assembly Consumer Affairs Committee in opposition of Assembly bill A378.
Please enlighten Pharmalot Readers as to why “YOU” believe Parents shouldnt be informed that Psychotropic Drugs carry a Black Box Warning, their lack of efficacy, and increased risk for suicide and violence, and please no anecdotal evidence that they are effective. The APA is an organization that lacks ethics!!
Monday March 3rd 10 am approx.1 hr. in APA, APA oppose Parental Informed Consen;
http://www.njleg.state.us/media/archive_audio2.asp?key&session=2008
Lisa Van S
Look out Senator Grassley!! APA Will be accusing you of being a “Scientologist!!!”
truthman30
Look out Senator Grassley!! APA Will be accusing you of being a “Scientologist!!!”
Oh they always use that line to discredit people who speak out against them..
Quite ironic really considering psychiatry is a much more dangerous cult than scientology could ever be..
And I’d rather be called a scientologist than a psychiatrist…
But just for the record, I have no connection to either..
Thom
If the APA is the leader in disclosure, then why do they keep Schatzberg around after it was discovered that he has been hiding all his financial interest in Corcept Therapeutics?