Psychiatrists Group Responds To Grassley Probe
26 CommentsBy Ed Silverman // September 8th, 2008 // 2:00 pm
Two months ago, the US Senate Finance Committee widened its probe into conflicts of interest involving drugmakers and federally funded academic researchers to include the American Psychiatric Association, since many of the academics already being investigated happen to be psychiatrists (back story).
Among those probed are Brown University’s Martin Keller, Harvard University’s Joe Biederman, Stanford University’s Alan Schatzberg and the University of Cincinnati’s Melissa DelBello. 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.
Today, the APA sent a letter to Chuck Grassley, the ranking Republican on the committee, defending pharma funding and how the APA handles the funds. At the same time, APA president Nada Stotland reminds members that a work group had already been formed to examine ways to lessen financial ties to drugmakers and, more recently, yet another group was formed to establish guidelines for interacting with industry. Here’s the e-mail to APA members.
From: APA
Date: September 8, 2008 11:02:00 AM EDT
To: ….ATTGLOBAL.NET
Subject: APA Responds to Senator Grassley
Reply-To: press@psych.orgAPA Responds to Senator Grassley
Subject Line: APA Responds to Senator GrassleyDear APA Members:
In July, I e-mailed to let you know that Sen. Charles Grassley (R-Iowa) had asked APA for detailed information about the revenue that APA has received from pharmaceutical companies since January 2003. The information was delivered to Sen. Grassley’s office, as previously agreed, on September 2. The letter that we sent the senator, which includes a summary and explanation of the information we provided to him, can be accessed at APA’s Web site at
by logging into Members Corner and then clicking on “Grassley Response.” Putting this information together was a major task for our staff. Our income from the pharmaceutical industry comes from many companies; it includes payments for advertising in APA periodicals, payments for exhibits at our meetings, support for minority and resident fellowships in leadership and research, funding for anti-stigma public education campaigns, and support for continuing medical education. Each specific case required an agreement or contract that we were asked to submit to Sen. Grassley; in each case we required a firewall between the source of funding and the content of the program. Indeed, because of the rigor with which we screen, rate, oversee, and evaluate the content of all our educational activities supported by pharmaceutical companies, we have received a commendation and a six-year accreditation from the Accreditation Council on Continuing Medical Education.
We expect that Sen. Grassley will also ask the pharmaceutical companies to produce detailed information about grants and other financial interactions with APA. We have informed Sen. Grassley that we anticipate that there will be discrepancies between their reporting and ours because of differing accounting methods. For example, a company may include all the expenses it has incurred in relation to an educational event it supported, even though much of that money won’t have been provided to APA; it will have gone to pay for expenses such as its employees’ travel. The APA has made every effort to respond accurately and fully to his request for information.
It is important to remember that relationships with medical industries are a challenge for the whole field of medicine. Long traditions and established practices are not only being questioned, but also criticized, across the board. Both the American Medical Association and the Association of American Medical Colleges have developed or are developing new standards that differ sharply from many decades of practice. An informal survey of medical specialty societies indicates that APA is more or less in the middle when it comes to the percentage of revenue received from medical industries (which includes not only medications, but also devices, equipment, tests, and so on). The numbers range from 2 percent to nearly 50 percent; APA has averaged about 28 percent of our yearly annual revenue.
It is also important to remember that APA has not been accused of any wrongdoing. We have been asked for information, and we have willingly provided it. Information about our pharmaceutical revenues, though not with the level of detail included in the report to the senator, have been available to our members through our members-only Web site for some years. Furthermore, information and articles about APA’s relationship with the pharmaceutical industry have appeared in Psychiatric News, which is available to APA members, the media and the public.
APA has been proactive in examining the pros and cons of our relationships with the pharmaceutical industry. Last March, months before the senator’s request, the Board established a work group, chaired by Dr. Jeffrey Geller, which was charged with producing a report detailing our pharmaceutical revenues and offering the Board options for decreasing or eliminating them. That group will produce an interim report at our October meeting and a final report at our meeting next March. Also before Sen. Grassley’s request, I wrote a column in the July 18 Psychiatric News addressing transparency and conflicts of interest. We have now established a work group, chaired by Dr. Paul Appelbaum, to develop guidelines for interactions between individual psychiatrists (in addition to our professional association, APA) and medical industries. Dr. Appelbaum and Dr. Laura Roberts, both national experts on medical ethics, will also co-chair a presidential symposium on this topic at our May 2009 annual meeting in San Francisco. We are developing a guide for discussing these issues with patients and an online educational program to assist you as well. You may send comments, suggestions, or information about any of these activities to me at APA at nstotland@psych.org. The times are changing, and we need to know how you feel about APA and potential conflicts of interest and what you are hearing about it in your offices, hospitals, and communities.
We psychiatrists are physicians who devote ourselves to the care of people afflicted with mental illnesses, and APA exists to help us provide that care. We are proud of what we do, and we are here to answer your questions.
Nada Stotland, M.D., M.P.H.
President, American Psychiatric Association
Lisa Van S
If APA truly believed in Transperency, they would have provided the American Public with the information they provided Senator Grassley on their website.
Hmmm,.. Members Only!
truthman30
“We psychiatrists are physicians who devote ourselves to the care of people afflicted with mental illnesses, and APA exists to help us provide that care. We are proud of what we do, and we are here to answer your questions.”
pfffffffffffff….
Hilarious…
Psychiatrists - physicians?…
Hmmm, but none of their “illnesses” can be proven?
If Bad science was esteemed , Psychiatry would be the masters of it..
If I was to practice voodoo and witchcraft then make incredible healing claims and benefits about the concoctions of potions I make in my cauldron , would I then be considered a “physician”? ..
Psychiatry is the art of the con man..
It is and always has been a a sham and a scam..
It has little to be proud of , but a lot to be shameful of..
Is 10 minutes to write a psychiatric drug prescription “dedication” or “exploitation”?…
“The APA has been proactive in examining the pros and cons of our relationships with the pharmaceutical industry”
The APA seems very confused here..
Either selling vulnerable peoples bodies , minds and souls to pharmaceutical industry is good or bad?..
There’s just not that many pro’s , but there is certainly a lot of “cons” going on..
“Delusions of grandeur” , is that listed in the DSM? ..
Matt
The APA has no shame…
Dan A.
A reminder that this speciality receives the most funding from the pharmaceutical industry.
And I agree with Truthman above. Psychiatry is a soft science, and should be treated as such.
Salmon
‘Truthman’ this is such a misnomer.
I have no love for those who would abuse, take advantage of and harm people with mental illness. For those who denigrate and attack anyone who raises questions about the efficacy or safety of psych drugs, and especially those who discard their professional ethics for self enrichment
But to claim that the entire field of psychiatry is a con and that there is no such illnesses is also a con.
We don’t need people on either side who are pursuing things for a personal agenda. What we need are people who are truly after the truth and want to find out what the true biological basis as well as risks and benefits of drugs are so that patients themselves can make an informed decision for themselves and not be conned. Or if they are unable to make that decision for themselves then they have a true advocate and not just be railroaded into commitment and forced treatment that may be worse than no drugs at all.
For anyone interested an organization that I like that supports people who are trying to protect themselves from abusive practices but still advocates self determination as to the role of drugs is mindfreedom. (www.mindfreedom.org).
Salmon
Christopher
The intransigent attitude of some here makes me hesitant to enter into this discussion. I don’t know what would convince those that mental illness is something that requires treatement by those specialising in helping patients with those needs. Seems to me that psychiatrists offer such help.
I happened to read a UK census form from the 1920s today that listed two categories: lunatic or imbecile-minded. Respondents had to select if those descriptions applied. Haven’t we moved on from there so that today we have at least somebody to go to for help?
What about the sad people on the streets whose illness is denied, otherwise categorised, or even shuuned because of lack of resources? Who is qualified to tend to those people and give them a professional evaluation of appropriate care? None of us I suggest. Not, it’s the anti-industry fervour yeat agin which taints so many replies.
Believe me I have dealt with psychiatrists in a professional relationship (100 at a time)and they can be as difficult as any other professional. Nobody is perfect but when I see such trite comments as those above it makes me despair.
Apart from industryphobia, and the resulting distaste for industry’s participation in this, who really is going to step up and help patients with psychiatric problems? It’s fine to call it a soft science: some are. It doesn’t negate the value of what it sets out to do and neither does it devalue the benefit to those patients who benefit from its intervetion.
It angers me that you who at every oportunity look to denigrate the industry overlook the wider benefits of their work. It’s about patients and care, not just the relentless (and indiscriminate) onslaught of the pharma industry.
Walk around any city or town and tell me it’s sorted; otherwise pipe down and let progress happen.
Christopher
Should have said that there were more categories in the 1920s UK census than lunatic or imbecile-minded! I listed those two to make a point. Sorry, but my other points remain.
truthman30
“But to claim that the entire field of psychiatry is a con and that there is no such illnesses is also a con”
I didn’t say there were no “mental illnesses” but I stand by my statement, I think psychiatry is a con…
“Mental illnesses” are intertwined with and originate from certain personality traits, environmental factors, self perception and behavior. mental illnesses are more emotional illnesses to begin with.
There is no child that is born pre-destined to suffer from depression, psychosis or Bi-polar. It is the “illnesses” themselves which influence the biological reactions. And the “illnesses” themselves manifest from the individuals reaction to trauma. The trauma and trigger needs to be addressed before the biology, which is is just a symptom of the condition. This can only be done with intensive talk therapy. Psychiatry ignores the fundamentals of mental distress and why it happens, instead it focuses on “providing” drugs for the biological symptoms of human life crisis. This is what I mean, when I say that Psychiatry is a con.
Supremacy Claus
Truthman is a denier. He has the credibility of 9/11 conspiracy theorists. Nor will any fact dissuade him. He seeks to impose his denier false ideology on patients deriving great benefit from their life saving medications.
The APA should have told Grassley to go jump. He is a paid off, unseemly agent of the insurance companies. They do not want brand names prescribed to Medicaid patients with dark skins. Grassley is a racist and a liar. Many of these generics, you would refuse to give to your dog.
truthman30
“I don’t know what would convince those that mental illness is something that requires treatement by those specialising in helping patients with those needs. Seems to me that psychiatrists offer such help”
The operative word here being .. “seems” ..
Let me put it this way, say for instance somebody has a rough childhood, they then have a rough marriage and lose their job, they become depressed. They go to see a psychiatrist , the psychiatrist diagnoses a depressive episode based on the individual exhibiting “depressive symptoms” , the depressive symptoms are occasional thoughts of suicide, despair, fatigue etc etc.
The psychiatrist then tells the patient that it is a “chemical imbalance” which has caused his depression and this imbalance can be fixed with a pill like Paxi.
What the psychiatrist is effectively doing is dismissing completely the reasons why the individual has become depressed and reaching straight for the psychiatric drug script. What is needed in these situations is guidance, empathy and an understanding of what trauma’s has led to the person being depressed not drugs. People in crisis need a caring, humanistic and holistic approach. You can’t drug away the memories of a crap childhood, the realities of a broken marriage or the pain of low self esteem from unemployment. Psychiatrists need to empower people, but instead they numb them with drugs.
Most “mental illnesses” develop and manifest from poor coping skills. Psychiatrists do not provide talk therapy. This is a huge disservice to the patient.
truthman30
Supremacy Claus
September 9th, 2008
8:24 am
Link to this comment
Truthman is a denier. He has the credibility of 9/11 conspiracy theorists. Nor will any fact dissuade him. He seeks to impose his denier false ideology on patients deriving great benefit from their life saving medications.
Oh shut up Supremacy Claus…
What do you know about psychiatry , mental illness and medications?..
Have you experience with these things?..
I doubt it..
“life saving medications” ..
Are you referring to drugs like the anti-psychotic Zyprexa which causes diabetes or the SSRI anti-depressant Paxil which causes people to kill themselves and sometimes kill their familes? ..
Would you call these medications “life saving” ? , if so then it seems you have a very twisted view of saving lives..
I know the facts Mr Claus ..
I’ve lived the facts…
Have you? ..
Christopher
truthman disparages psychiatrists who numb patients with drugs that deal with ‘chemical imbalances’. Fact is that biochemical changes do affect behaviour and there are drugs that modify such changes. Agreed drugs shouldn’t be the only treatment approach but let’s not deny their role in therapy. No dispute that depression results from some of the events you describe truthman but knowing the cause of a condition doesn’t negate the need for effective treatment which, again, will include pharmaceuticals alongside other forms of care.
truthman30
“Fact is that biochemical changes do affect behaviour and there are drugs that modify such changes”
Ok Christopher, get me some sound, unbiased, independent research and opinion about this then..
Biochemical changes? ..
Well that’s a broad term isn’t it?..
What exactly are these miraculously wonderful and deeply mysterious “biochemical changes” which psychiatrists and their avid followers like to blabber on about?
How can we measure and test for these amazingly elusive biochemical changes? I’d sure like to know the answer to that question.
And when you prove and explain to me the proven scientific research solidifying without a shadow of a doubt the existence of these “biochemical changes” , could you then perhaps tell me how the SSRI drugs and Anti-psychotics work in “modifying” these changes? ..
And when you’re finished doing that, maybe you could bring me to see the flying pig which you keep in the UFO which crash landed in your garden….
Christopher
Truthman - that reaction is exactly why I should not have addressed your earlier comments with what was intended to be a sensible remark. I have no intention of prolonging this because it’s never going to be a discussion is it? And the thought of taking time to provide you with sound, unbiased independent research and opinion (sic) just so you can slosh more bile around is a non-starter.
Supremacy Claus
Psychiatrists do not treat failed marriages, crappy childhoods, nor unemployment with medications. The resulting moods of those stresses are normal reactions. They do not respond to medication. Normal reactors to stress get side effects. The proper response is to cope.
It is those patients with inimitable physical changes in their functions that get medications.
truthman30
Christopher
Truthman - that reaction is exactly why I should not have addressed your earlier comments with what was intended to be a sensible remark. I have no intention of prolonging this because it’s never going to be a discussion is it? And the thought of taking time to provide you with sound, unbiased independent research and opinion (sic) just so you can slosh more bile around is a non-starter.
Supremacy Claus
Psychiatrists do not treat failed marriages, crappy childhoods, nor unemployment with medications. The resulting moods of those stresses are normal reactions. They do not respond to medication. Normal reactors to stress get side effects. The proper response is to cope.
It is those patients with inimitable physical changes in their functions that get medications.
To both of you, I think I have explained to you my stance on psychiatry and SSRI medications . I am willing to discuss my opinions yes, but when I read the absolute garbage that people write about psychiatry and the way it does “business” , then I am sorry, but yes I am cynical about it , and it is for good reason.
Try a few years on an SSRI and then come back to me , try 4 years in the mental health system and then come back and tell me what you think! Then try 6 years of researching the industry , psychiatry and psychiatric drugs in an attempt to understand what the system works the way it does, then I would like to see just how much your opinions change.
Supremacy Claus , you say : “It is those patients with inimitable physical changes in their functions that get medications”
That is absolute horse shit and you know damn well that a huge proportion of people reeling from failed marriages, losses , grief, disappointment and all other life stresses are prescribed psychiatric medications. As a matter of fact most people in primary care who are prescribed these medications because they cannot cope with what life is handing them in one way or another.
Supremacy Claus
Truthman: You seem smart. Do you have a job? How do you get time to finance the private study of industry, and psychiatric drugs?
truthman30
Truthman: You seem smart. Do you have a job? How do you get time to finance the private study of industry, and psychiatric drugs?
It is none of your business how I spend my time Supremacy Claus, I’m not going to discuss my private life on pharmalot , that’s for sure. It doesn’t take any financing to read about psychiatry and the pharmaceutical industry. There are book shops, the library and the internet and I have had a keen interest in all this stuff over the last 6 years. I just wish I educated myself about them before I went on meds 10 years ago. I would have saved myself a lot of pain, heartache, headaches and hassle.
AA
Supremacy Clause, you might want to read the story on this NY Times link about depression being overdiagnosed:
http://tinyurl.com/5jecye
But the American Psychiatric Association’s diagnostic manual does not specifically exclude people experiencing deep but normal feelings of sadness, unless they are bereaved by the death of a loved one. And an increasing number of school districts and health clinics use simple depression checklists, which do not take context into account, the authors said.
“Larger and larger numbers of people are reporting symptoms on these checklists, and there’s no way to know whether we’re finding normal sadness responses or real depression,” said Jerome C. Wakefield, a professor of social work at New York University and the study’s lead author.
Christopher, you said:
sound, unbiased independent research and opinion regarding meds.
This is what I have found. Sorry I don’t have a link but somewhere on the NIMH site, it says that antidepressants work 50% of the time and relieve 50% of the symptoms. That isn’t a stellar record.
The Star D study came up with a 33% success rate. And no, according to a statistician I know, it is not correct to call it a 67% success rate as some people do.
If you chose to respond and I will understand if you don’t, I would appreciate respectful posts and sticking to the points.
Just so you know my biases, I am tapering off of psych meds as one of them caused a hearing loss, cognitive symptoms and a horrific apathy that has led to my condo being unsuitable to have guests over. I will spare the details.
That is not my idea of life saving medication.
Since I told you my biases, I would appreciate hearing yours so I know where you are coming from.
AA
truthman30
Just so you know my biases, I am tapering off of psych meds as one of them caused a hearing loss, cognitive symptoms and a horrific apathy that has led to my condo being unsuitable to have guests over. I will spare the details.
That is not my idea of life saving medication.
Since I told you my biases, I would appreciate hearing yours so I know where you are coming from.
AA
Thanks AA..
It is difficult to get through to supremacy claus about these meds..
Even when it does come from the horses mouth (so to speak) ..
Piper
Truthman: Blaming your problems on psychiatric medications is a sham. Your intense hatred for the institution of psychiatry is just a reflection of the improvement you have not been able to achieve in yourself. I hope you are not “tapering off” your meds yourself and hope you have been seeing a psychotherapist to discuss the reason you were taking them in the first place. No two drugs are alike. If at first you don’t succeed, scrap it and move onto another. Don’t like SSRIs? Try an SNRI. Not working? Maybe Wellbutrin. You can take it with the others as well. Feel tired/ feel wired? Adjust the doses. That’s the value of a psychiatrist - he/she works with you to figure out what works for YOU. In a trial of one type of drug, it should not work 100% of the time. Because 100% of the patients will not have the same chemical deficiency (unless it is the third day of the third month in the third year of…..). Not everyone is lacking in serotonin receptors, hence the reason everyone won’t benefit from an SSRI. Some people may be more receptive to a dopamine enhancer like Wellbutrin.
Psychiatrists are just like any other doctor that specializes in a certain field of MEDICINE. A gastroenterologist focuses on medicines that treat the digestive tract, while a psychiatrist focuses on medicines that treat the brain…..
If a drug doesn’t make you FEEL better, don’t take it. But if your symptoms resemble depression, ask yourself if you might not be better of switching meds…..NOW.
- The Horse Mouth
Piper
I meant The Horse’s Mouth :)
Matthew Holford
Hmmm. DSM-IV is the key diagnostic tool, wherein one finds that various disorders are identified by the behavioural traits, which somebody or other has decided are typical of any given disorder. A disorder, then, is a collection of behavioural traits, at least superficially.
I agree with Truthman: the chemical imbalance business is completely unproveable. One may only measure brain chemistry post mortem, and, as I’m fast tiring of pointing out, even that only gives one an indication of brain chemistry at the point of death. Even assuming that we’ve looked at a lot of dead brains, and decided that we’ve seen a trend, and can claim what amounts to “normal,” in terms of chemistry, we still don’t know for sure that it is the chemistry of the brain that impacts mental illness. In fact, it’s not even worth discussing, seeing as we can only ever assess the superficial appearance - wouldn’t it make more sense to ask the person, when they were alive?
Anyway, back to the point, which is that shrinks appear to ask crap questions, give shite information (based upon preconceptions as to what is “normal”), and have crap solutions for the issues that they imagine they’ve found. The unwillingness of the “profession” to discuss its methodology is the thing that I find most worrying.
Matt
truthman30
“Truthman: Blaming your problems on psychiatric medications is a sham. Your intense hatred for the institution of psychiatry is just a reflection of the improvement you have not been able to achieve in yourself. I hope you are not “tapering off” your meds yourself and hope you have been seeing a psychotherapist to discuss the reason you were taking them in the first place. No two drugs are alike. If at first you don’t succeed, scrap it and move onto another. Don’t like SSRIs? Try an SNRI. Not working? Maybe Wellbutrin. You can take it with the others as well. Feel tired/ feel wired? Adjust the doses. That’s the value of a psychiatrist - he/she works with you to figure out what works for YOU.”
Piper..
You are obviously extremely stupid, delusional or a complete and utter moron…
Or possibly all three?..
I do not “hate” psychiatry..
I just intensely dislike it..
Particularly since I have been through it, along with 4 years on Paxil, and researching it all for 6 years I think my point of view is more than valid. I have also had access to information about the pharmaceutical industry and psychiatry which would make your hair stand on end..
The “faustian pact” between the industry and biological psychiatry is destroying peoples lives everyday, I choose to speak out against it, my opinions are informed and experienced, yours are just ridiculous..
AA
Piper,
I told this board my biases so I would appreciate knowing your perspective.
Anyway, the chemical imbalance theory has been totally refuted:
http://chemicalimbalance.org/?p=6
And it is a myth that SSRIs just act on the Serotonin system as they affect many systems which can end up causing alot of side effects.
I know your post was addressed Truthman about withdrawing from drugs by yourself but I wanted to address that. Most psychiatrists and doctors advocate a way too fast tapering schedule which causes withdrawal symptoms so bad that people are forced back on the drug.
I have no doubt that I would have been one of these people if I had done it my psychiatrist’s way. But by tapering slowly, (5 to 10% of the current dose every 3 to 6 weeks), I have been very successful. The WD symptoms have still been tough but would have been alot worse under an MD’s schedule
I would be careful about making judgments about people’s situations. You have no clue as to the destructive nature of these meds.
They have destroyed my life. Even though I suffered a hearing loss and a worsening of learning disability symptoms, that wasn’t the worst thing they did. They caused apathy that destroyed many areas of my life.
The problem is that I was so spellbound that I didn’t realize what was going on until I started tapering off the meds.
truthman30
“The problem is that I was so spellbound that I didn’t realize what was going on until I started tapering off the meds.”
Spell bounding..
That’s it right there, that’s what these meds do..