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Worrying About Greed

Worrying About Greed

I’ve been deeply worried about corruption and greed in psychiatry for a long time. In reading the new book from Wendell Potter, formerly head of public relations at CIGNA, my worry has escalated into panic anxiety. Before discussing Potter’s work, let me review some of the widespread greed-related corruption of recent years.

• The most awful are the revelations about pharmaceutical company tankings of pharma-sponsored clinical trials with negative results. The dozens of exposes issued by journalists in recent years cannot possibly be reviewed here, but a nice sample list can be found here. Browse the links at your own risk; you might need antidepressants afterwards, if you still believe they work! The significance of this for practicing clinicians is that (excepting NIH sponsored clinical effectiveness studies), everything we thought we knew about drug efficacy must be questioned - in psychiatric practice and elsewhere.

• In large part due to this greed-motivated corruption of the scientific enterprise, a multi-pronged response had been initiated by Congress, in passing the 1997 Food and Drug Administration Modernization Act, which established ClinicalTrials.gov as a public-access registry for clinical trials, though on a voluntary basis. An effort to mandate public registration of clinical trials, the Fair Access to Clinical Trials Act in 2005, was never passed. Pharma can, and still does, tank negative studies.

• The International Committee of Medical Journal Editors (ICMJE) [www.icmje.org ] issued a statement in 2004 presenting their policy for a mandatory registration of clinical trial results before the first patient is enrolled, as a condition for ICMJE-compliant journals to consider publication. This and other features of the ClinicalTrials.gov effort are summarized here.

• A set of 14 recommendations for tightened conflict-of-interest rules for psychiatrists’ relationships with pharma was voted down by the APA assembly last year. The recommendations were drafted by an 11 member APA panel headed by former APA President and ethics leader Paul Appelbaum. Interestingly, it was younger psychiatrists who most strongly advocated for the recommendations.

Psychiatric Times published a debate between Lisa Cosgrove, Harold Bursztajn, Darrel Regier, and David Kupfer concerning the role of pharma in influencing DSM-5 decisions.

One could go on, and many have, but I wanted to alert the Blog readers to Wendell Potter’s new book, Deadly Spin, which amounts to an insider’s expose of the very powerful industry influence not just on medicine but government as well. Potter goes beyond the facts of the nationwide lobby and propaganda efforts on the part of the medical insurance industry through describing the techniques he authored for industry. The primary focus of his discussion is the insurance industry’s systematic misinformation campaign regarding last years’ health reform bill; and the major target there was the (to the industry) dread public option (which would immeasurably aid the chronic mentally ill). Interested readers can get a short synopsis of Deadly Spin, as well as insight into why Potter decided to resign from CIGNA and pursue this expose, through Bill Moyer’s PBS interview. What is remarkable is that after all these years of secrecy, why should a courageous soul like Potter step forward now? (No doubt, spin persists in his own book, but Deadly Spin reads more like investigative journalism than PR.)

I can only worry about the behind-the scenes influence of pharma, and what kind of greed-motivated manipulation of “scientific” data is being promulgated by industry in the effort to shape industry-friendly diagnoses. DSM-5 authors are still subject to industry influence and biased interpretation of data. In the absence of DSM-IV-style comprehensive literature reviews and Source Books, the selection and interpretation of research to support DSM-5 categories is at the Work Groups’ whims. Denials of influence are not very convincing; show us the scientific rigor, please. We still don’t know what is going on behind closed Work Group doors, and all the DSM-5 draft indications point to the pharmaceutical market having another quantum-leap expansion in 2014 as new disorders are rolled out.

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