Top psychiatrist calls for ethics cleanup around ‘Big Pharma’
CHICAGO (AP) American psychiatrists need to
break away from a “culture of influence” created
by their financial dealings with the drug
industry, the head of the National
Institute of Mental Health said in a leading medical journal
Dr. Thomas Insel stops short of calling
researchers corrupt or asking them to stop taking
money from drug companies. But he highlights a
“bias in prescribing practices” that favors brand
names drugs over cheaper generics and non-drug
treatments. And he says the situation must change
with new standards for transparency and full
disclosure of psychiatry’s collaborations with industry.
“We can show the rest of medicine how to clean up
our act,” Insel told The Associated Press. His
commentary appears in Wednesday’s Journal of the American Medical Association.
His efforts got a boost Tuesday with the signing
of the health care overhaul legislation which
requires drugmakers and others to file annual
reports to the government on their financial ties
to doctors. The law requires reporting of gifts,
entertainment, food, research money and other
fees and grants. Consumer advocates applaud the
“sunshine” provision because it also requires a
database the public can search for their own doctors’ ties to industry.
“Transparency is the first step toward giving
patients and the public the tools they need to
evaluate those relationships, ” said Allan
Coukell, director of the Pew Prescription
Project, a consumer health project of the
Institutes of Health rules on financial
disclosure are confusing, Insel said. They allow
researchers seeking federal funds to make their
own judgments about what constitutes a
significant financial interest, which they must
report to their academic or research
institutions. The rules also exempt disclosures
of anything below $10,000 annually or 5% equity
interest in a company. Insel is helping oversee a
revision of the
rules, which date back to 1995.
Industry pays for much of the medical research in
the United States and many scientists have
financial relationships with drug and device
makers. Researchers at many institutions are
expected to fully disclose those ties to their
universities, to the NIH and to the medical
journals that publish their research.
Beginning in 2008, an inquiry by Sen.
Grassley, R-Iowa, uncovered millions of dollars
in unreported fees paid by drug industry to
prominent researchers. The investigation prompted
universities and NIH to reassess their conflict-of- interest policies.
When the Grassley inquiry accused seven
psychiatrists of failing to report payments they
received from drug companies, Insel, himself a
psychiatrist, said he tried to determine whether
psychiatrists were being targeted unfairly.
He found, instead, evidence that psychiatry may
have more drug ties than other medical
specialties. In Vermont, for example, which
requires public disclosure of industry payments
to doctors, psychiatrists receive more money from
drug companies than do other types of doctors.
Psychiatric journals report slightly higher rates
of industry funding of published studies than
other medical journals. And one study found that
90% of the advisers who help write American
Psychiatric Association guidelines had
undisclosed financial ties to industry, Insel writes in JAMA.
Meanwhile, antidepressants and other drug
treatments rack up multibillion- dollar annual
sales while non-drug treatments such as therapy
are “woefully underused,” Insel writes.
Insel said he has no financial ties with the drug industry.
Insel’s commentary will be influential, said Dr.
Emil Coccaro, psychiatry department chairman at
of Chicago and a recipient of NIH grants.
“It’s important that our potential patients and
their family members know we’re above reproach in
terms of undue influence by Big Pharma,” Coccaro said.
That’s why he threw away all the coffee mugs and
pens given to him by drug companies and is
careful to report any payments he receives as a
board member of a start-up biomedical company, he said.
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