Ethics, influence, and public perception
There are forces afoot that are undermining our credibility with the public and our relationships with our patients and their families. They have come at us from several sides. On one hand, antipsychiatry groups question our scientific integrity and portray us as greedy practitioners who lack a research base for our clinical decisions. They suggest that psychiatric disorders, for the most part, are a figment of our imagination and that child and adolescent psychiatrists pathologize what is within the bounds of typical development. On the other side, extraordinarily large marketing expenditures and controversial marketing practices by the pharmaceutical and medical device industries influence our clinical judgment and professional behavior.

Gifts and honoraria, large and small; biased Continuing Medical Education (CME) activities; kickbacks; and "free lunches" of various kinds have been designed to influence and reward physicians' specific decision making.14 Direct advertising to consumers also affects prescribing practices.15 Industry-supported clinical trials in academic medical centers, advertising in medical journals, and lavish exhibits at annual meetings all have contributed to the credibility gap with the public.16 Yet, how would many professional and advocacy organizations fare without such direct and indirect industry support? How much would subscription prices for journals need to be increased without such advertising? And how would physicians' competence and knowledge be affected without industry-supported CME programs and office visits by sales forces? These are complicated issues that affect all the specialties of medicine and certainly psychiatry and child and adolescent psychiatry.

The media have investigated these marketing practices and recently have begun to paint a grim picture of child and adolescent psychiatrists' diagnostic inconsistencies, individual ethical lapses, and clinical prescribing practices guided by pharmaceutical influence.^17-19 The public's perception of our professionalism has dimmed as a result of these media reports, as has its belief in the integrity of our research findings.

I believe that industry influence can and should not be eliminated. The pharmaceutical companies have successfully contributed to the success of our research agenda. Child and adolescent psychiatry as a field is better off because of that support. However, it is a good sign that at all levels, academic institutions, professional organizations, and individuals have begun to openly discuss the issues. Verbal and written dialogue among members of the AACAP and between industry leaders and the AACAP about acceptable ethical practices mirrors the discussions within other professional and academic groups. Similarly, the recent dialogue begun between the Journal of Child and Adolescent Psychopharmacology and its readership is laudable.²⁰ A similar effort has been mounted in the AACAP's newsletter. These efforts will guide us in our efforts to manage conflict. We will never be able to eliminate conflict, but we need to become more capable of managing it. I predict that 10 years from now, the management of influence and conflict will be significantly improved, resulting in significantly greater transparency through more pertinent and meaningful disclosure. The relationships among industry, practitioners, professional organizations, and academic centers will become more transparent and trusted, and the public's confidence in our skills, knowledge, and professionalism will be restored.

Conclusions
So how will the professional lives of child and adolescent psychiatrists change over the next 10 years? I expect that our practices will be largely unrecognizable in terms of current practice patterns. As specialists, we will be much more knowledgeable about brain and behavior mechanisms at both cellular and systems levels, and our treatments will be much more individually specific and effective. However, our numbers will continue to be inadequate, and direct care will be provided by a variety of professionals who will work collaboratively with us. Our roles will be as educators, consultants, and leaders of teams. Parent partnerships with professionals around advocacy and collaborative treatment will prevail as will strategies focused on prevention and early intervention. Parity and universal health insurance will reduce stigma and improve access. Finally, I am confident that the public's trust in our competence and professionalism will be restored. As a result, in 2018, children with mental disorders and their families will receive much better treatment than they do today.