The Pharma-psychiatry tango: necessary evil or dance with the devil?

This is a follow-up to a recent post on why I think direct-to-consumer advertising of prescription drugs is wrong. This post is going to look specifically at marketing by drug companies aimed at health care professionals.  Primarily this marketing targets physicians, since they’re doing the majority of the prescribing.

There are multiple different forms this marketing can take. One example is the drug reps that go around to medical offices. They’ll schmooze with physicians and do things like provide written information about the drug, give samples, and hand out assorted merch like pens and notepads so that their product name is in front of the prescriber’s eyeballs more often.  While drug reps receive training on their particular set of drugs, in most cases they don’t have health professional training.

Drug companies will also sponsor educational activities. They may sponsor a hospital’s departmental grand rounds, providing free lunch for an event that would have gone ahead with or without sponsorship.  A drug rep would often be there, happy for the opportunity to schmooze.

A pharmaceutical company might also bring in a speaker, typically a psychiatrist, to give a talk about the company’ drug.  This might be a local psychiatrist who the audience will already know and presumably trust, or someone who’s brought in from elsewhere and has strong credentials.  Typically there is food involved, because who doesn’t love free food, right?

Another strategy is to sponsor continuing education activities that are geared at a broader audience, which may take the form of a free webinar.  All health professionals have some form of continuing education requirements they have to meet every year, and the opportunity to get free continuing education hours can be attractive.

There are pros and cons with all of this.  Health professionals do need to learn about new drugs that are on the market.  Just because a talk is being sponsored by  a drug company does not necessarily mean that the speaker will be heavily biased.  Sometimes the featured speakers at drug company sponsored events are widely recognized as experts in their field.

Sometimes health care organizations will put restrictions on sponsored activities occurring onsite.  I remember earlier in my career going to grand rounds at the hospital I worked at and munching on drug company-funded lunch.  A few years later the healthy authority I worked at put the kibosh on sponsored events at any of the health authority’s sites.  I’ve been to a couple drug company-sponsored dinners, one with a speaker they’d brought in from elsewhere, and one with a local psychiatrist I really respected.  I fairly regularly do continuing education webinars that are free because of drug company sponsorship.  I like to think that I’m enough of an informed consumer of information to be able to evaluate what’s being given to me, and recognize that, sponsored or not, one particular talk is never going to give me the whole picture on the topic.

This is pure speculation, but I wonder if the most potential iffy part of what I’ve talked about so far is drug reps going into family doctors’ offices.  Psychiatrists are only really keeping up to date about new psychiatry meds, and the same is true with other specialties. General practitioners often have little free time, and they have to learn about a much wider range of new drugs.  Chances are, they’re going to be relying a little more on what they’re getting from drug reps.  Still, a health professional should have the background information to put new info from drug reps into a proper context, something that’s just not possible when it comes to direct-to-consumer advertising.

All of this is small potatoes compared to the potential for corruption at higher levels.  Drug companies’ primary objective is to generate profit for their shareholders.  Yes, it would be nice if they were concerned about the wellbeing of the people taking their drugs, but that’s not the reality of capitalism.  It may not be very nice, but it is what it is, and there’s no point pretending otherwise.  The problem really comes if the drug companies are getting in bed with regulators or with major medical organizations.  In an ideal world, the drug companies would be at not just arm’s length from regulators like the U.S. Food and Drug Administration (FDA), but more like football field length.  Of course, we don’t live in an ideal world, and that kind of thing can be difficult to enforce.  What if John Smith worked at the FDA for years, and decides he’s ready to make some big bucks and takes a position at a drug company.  It’s pretty tough to regulate away that influence John Smith is still going to have with all his old buddies at the FDA.  It’s the old boys’ club at its finest.

Concerns have been raised about drug companies having undue influence with the American Psychiatric Association’s committee responsible for developing the most recent edition of the Diagnostic and Statistical Manual (DSM-5).  The fact that the people on the committee have received either research funding or speaking fees from drug company doesn’t inherently mean they’re biased.  Often, prominent figures within a specialty field are particularly sought after by drug companies for that kind of thing; it doesn’t mean they’re necessarily drug company flunkies.  Yet the old boys’ club appearance is still there.

I think sometimes arguments in that area go a bit too far and throw the baby out with the bathwater, so to speak.  Sometimes GlaxoSmithKline, the makes of Paxil, are accused of inventing social anxiety disorder as a way to sell more Paxil.  Whatever role they did or did not play in the inclusion of social anxiety disorder in the DSM, there are many sufferers who would attest that social anxiety disorder is all too real and all too debilitating.

Of all of these areas, the relationships between drug companies and regulators like the FDA are most likely to cause damage, and that damage can occur on a very broad scale.  If alarming research results are being hushed up because the drug companies are too cozy with the FDA, that’s dangerous.  What is the answer, though?  I wish I knew.

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

16 thoughts on “The Pharma-psychiatry tango: necessary evil or dance with the devil?

  1. Liz says:

    I don’t know how many years ago it was now and what documentary made it, but I remember a documentary talking about what you discuss here. There was filming of the event of some places where there were free food going on for listening about drugs being discussed. I can’t remember if it was secret recording to show examples, or what, but I can remember doctors saying they were there for the food and that they don’t always take on medication what is being shown and talked to them. I think the programme was trying to highlight that it was happening and the concerns about it.

    Liked by 2 people

  2. Meg says:

    Great post! Very informative!! I can definitely see the possibilities of corruption and abuses of power here!!

    I think I must have the greatest psychiatrist in the world–Dr. Phlegm. I just now saw him. I no longer take Geodon, but when I did take it, he’d send me home with armfuls of free samples from the drug manufacturers. This was before I had Medicare Part D through disability, and it was also before Geodon had a more affordable generic. It was so nice of him to always do that! I guess that’s a plus-side to the schmoozing?

    You’re really smart at all this stuff!! I saw a movie several years ago. It had Jake Gyllenhall and Anne Hathaway (I think). But the movie didn’t make a whole lot of sense to me!!

    Liked by 2 people

  3. DV says:

    The FDA —> private move can bring benefits even when there isn’t overt corruption or even relying on relationships to ex-colleagues, but because of insider knowledge of loopholes, how to fast track applications, what sort of study is most likely to get approval etc. Same as any goverment/regulatory body to private sector move.

    My understanding of the issue with Paxil and social anxiety, and similar situations with other psychiatric drugs, is not so much that the companies are inventing the illness(es), but more that by being very selective about which scientific studies they publicise vs suppress, they are overstating the drug benefits overall plus downplaying the possibility of long term or even permanent neurochemical changes as a result of using the drug long term and the difficulty of withdrawal. So you get a situation where for some people, the drugs work marvelously and those people have no issue with staying on them forever; but in other people the drugs don’t seem to have a huge effect, or stop working, or intolerable side effects develop, or they work but the person just doesn’t want to take them any more – but whenever they try to go off them they get severe rebound symptoms which are similar enough to the original symptoms that the are diagnosed as “relapse” rather than “withdrawal” (sometimes are more severe than the original problem ever was, or in the case of post-withdrawal anxiety, weren’t actually part of the reason the drugs were prescribed in the first place and *only* develop post-withdrawal). And those people either accept the narrative promoted by the drug company via the doctor that this is in fact relapse rather than withdrawal, or they find that getting through the withdrawal phase is so hideously unpleasant and takes so long they just give up and go back on the drug even if it doesn’t work very well for them (that’s been my personal experience).

    So the anti-Pharma argument is not so much that the illness doesn’t exist at all, but that drugs can actually change the natural course of the illness in some people, taking an illness which may never have recurred, or was initially at least highly manageable with non-drug interventions, and turning it into a chronic, drug-dependent illness. And when you get enough people in this situation, it can be presented as evidence by drug companies that the *more common* variant of the illness is the chronic, drug-dependent form, and this becomes an even stronger argument to prescribe early or for milder symptoms, and it all becomes a catch-22. The thing is, it’s very hard to tell because many of the people who present this view on the basis of existing evidence are demonised as being “anti-psychiatry” overall (and there are a few who actually are), and there are strong financial disincentives to fund further research into the issue which might provide better quality evidence either way: drug companies because even without being evil or corrupt, at best they’d spend a heap of money money to have things stay exactly as they are already, at worst they’d lose business, and what business in their right mind does that?; governments because overall, funding drugs is (or at least appears) much cheaper than funding psychological interventions or social policy changes, and long term change also requires seemingly unachievable cooperation between political parties.

    Liked by 2 people

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