[NYAPRS Enews] BG: Rx Firms Tied To Creation of Psychiatric Treatment Guides

[Matt Canuteson]

NYAPRS Note: A soon to be released study led by Lisa Cosgrove of the
University of Massachusetts at Boston has found that almost all of the
psychiatrists who wrote the latest clinical guidelines for how to treat
depression, bipolar disorder, and schizophrenia had financial ties to
drug companies. The study also found that the guidelines focus heavily
on medications and give little attention to nondrug/alternative
treatments and how and when to phase out drugs prescribed for people
with psychiatric disabilities. This report comes at a time when many are
pushing for adoption of tougher policies against industry influence in
the creation of treatment guidelines.

 

Firms Tied To Some MDs Who Set Policy

Treatment Advice Focuses On Drugs, Researchers Find

By Carey Goldberg Boston Globe April 2, 2009

Virtually all the psychiatrists who wrote the latest clinical guidelines
for how to treat depression, bipolar disorder, and schizophrenia had
financial ties to drug companies, according to preliminary findings by
Boston-based researchers.

Their study is the first to examine potential conflicts of interest in
the American Psychiatric Association panels that write the treatment
guidelines widely used by practitioners, the paper's authors said.

The guidelines focus heavily on medications and give relatively little
attention to nondrug treatments and how and when to phase out drugs
prescribed for mentally ill patients, the authors wrote. They said three
common diagnoses generate some $25 billion in drug sales per year.

"Most patients assume that when they're prescribed a drug, the decision
is made on the basis of an objective review of the scientific evidence,"
said the paper's lead author, Lisa Cosgrove of the University of
Massachusetts at Boston. "However, our study raises the question: Is
that decision based in science, or is there a financial incentive behind
it? This is an important question because the lack of biological tests
for mental disorders renders psychiatry especially vulnerable to
industry influence."

The psychiatric association responded that its guidelines, which sum up
research and real-world experiences with treatments, go through a long
and elaborate vetting process and that people who get significant
portions of their income from drug companies are excluded from the
guideline panels.

"We work very hard to ensure that the guidelines that we develop and
publish are free of bias to the greatest possible extent," said Dr. John
S. McIntyre, chairman of the guideline steering committee.

The study, scheduled to be published online this month in the journal
Psychotherapy and Psychosomatics, found that among 20 authors of the
guidelines, 18 had at least one financial tie to drug companies. It did
not name names or specify sums, but found that 12 guideline authors had
ties in at least three categories, such as consulting, research grants,
speaking fees, or stock ownership.

To find financial ties, Cosgrove and her colleagues, who included
Sheldon Krimsky of Tufts University and Dr. Harold Bursztajn of Harvard
Medical School, searched publicly accessible databases such as Medline
and the records of the federal patent office.

Dr. Roy Perlis, listed as a consultant on the bipolar guidelines, works
in psychiatric genetics at Massachusetts General Hospital. In published
papers - including one that examined financial conflicts of interest in
clinical trials of psychiatric medications - he disclosed having
received consultant or speaker's fees from five major drug companies:
AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmith Kline, and
Pfizer.

But Perlis noted that the guidelines for bipolar disorder make two main
points, neither of which benefit drug companies: that lithium, which has
long been available as an inexpensive generic drug, is still the
"gold-standard treatment" and "that certain kinds of talk therapy are a
very important part of treatment."

"My job is to find better treatments for my patients. These are awful
illnesses. People really suffer," he said. "And the people who are most
responsible for developing new treatments right now are the
pharmaceutical companies. What is being lost in all this is that if I
didn't work with them, I couldn't do my job as a scientist - the part of
my job that says we have people who are suffering that need new
treatments."

The pharmaceutical industry defends its practice of paying "thought
leaders" in various specialties to lend their expertise to drug
development and marketing, saying that their input benefits both
colleagues and patients and that they must be paid for their work.

But there is a growing backlash against conflicts of interest in
medicine. A posse of those pushing for change in the medical culture is
centered in Boston and includes Drs. Marcia Angell and Jerome Kassirer,
former editors of the New England Journal of Medicine, and researchers
such as Cosgrove and Krimsky. These critics contend that financial ties
introduce the potential for bias, and at the very least, all such ties
must be disclosed.

"What we're saying," said Krimsky, is that guideline writers "should be
totally transparent about their relationships with the drug companies so
people reading a guideline might ratchet up the skepticism they might
have about the use of drugs as the first line of therapy."

This week in the Journal of the American Medical Association, a group of
influential medical leaders went further, calling on medical specialty
groups to adopt tough policies against industry influence, including
appointing "only individuals who have no ties to industry" to committees
writing treatment guidelines. Among the leaders, who specified they were
not acting as representatives of their organizations, was the medical
director and CEO of the psychiatric association.

The psychiatric association now requires guideline writers to publish
any financial ties along with the guidelines they work on, but at the
time the current guidelines for depression, bipolar disorder, and
schizophrenia were published in 2004 and 2005, no such disclosures were
required.

McIntyre, of the psychiatric association, said the steering committee
that oversees the guideline-creation process has always screened
proposed members of the groups that work on each set of guidelines for
potentially troubling ties, including spouses who work for drug
companies. The idea, he said, is to avoid people who get more than
roughly 5 percent to 15 percent of their income from pharmaceutical
firms, especially when from one particular company.

It would be a mistake to disqualify everyone with drug-company ties, he
said, because it would mean losing valuable expertise in research that
must be evaluated, but the association is considering whether to set a
limit on committee members' industry income and research support.

The guidelines - the psychiatric association has produced 16 - also go
out to hundreds of psychiatrists and others for comment and review,
McIntyre said. "When you subject a document to that kind of review, by a
large number of people, a single voice that might unwittingly be biased
gets diluted," he said.

The new paper found that all of the authors of the schizophrenia and
bipolar guidelines had relationships with the drug industry, and 60
percent of the authors on depression did. More than three-quarters
received research funding from drug companies, and more than one-third
served on the speakers' bureaus of drug companies.

In an editorial, this month's American Journal of Psychiatry singles out
speakers' bureaus as the clearest example of conflict of interest,
noting that they supply prominent psychiatrists "to deliver
company-approved presentations that market their drugs to their clinical
colleagues in the guise of medical education." 

http://www.boston.com/news/local/massachusetts/articles/2009/04/02/some_
who_set_policy_tied_to_industry?mode=PF

 

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