Tuesday, June 26, 2007

Top Recipients of Big Pharma Cash: Psychiatrists

Drug companies spend roughly 2.5 times as much on marketing as they do on research and development, and a large share of this promotional money is funneled directly to doctors in the form of "marketing payments," speaking fees, junkets, and so forth. In other contexts, the word bribery might come to mind, but because this is the medical profession we're talking about, the term is rarely invoked. Nonetheless, there is emerging evidence that the drug makers' massive investment in physician payments is paying off in the form of altered clinical practice, at least when it comes to the field of psychiatry.

In fact, according to a story in today's New York Times, psychiatrists are now the top recipients of drug company money (among all medical specialists). Psychiatrists in Vermont - the most recent state to make such data available - received an average of over $45,000 apiece in payments from Big Pharma last year* - more than double the figure for the preceding year. Moreover, individual psychiatrists who received the largest payments just happen to be the most likely to engage in questionable activities like prescribing expensive (highly profitable) anti-psychotic medications to children - an enormously controversial practice in light of the high potential of these medications to cause massive weight gain, debilitating sedation, insulin resistance, and cognitive slowing.

Most psychiatrists, of course, care deeply about their patients, and would never deliberately allow their practice to be influenced by drug company payouts. But psychiatrist are still human, and it's human nature to reciprocate as best we can when someone has given us something of value. Thus, psychiatry, now heavily indebted to the pharmaceutical industry - not just through payouts to individual psychiatrists, but also, for example, through millions of dollars spent each year on drug company advertisements in psychiatric journals - is a discipline that can no longer afford to ignore the looming scandal of drug company "promotional spending." Word is getting out, and the profession's credibility is now on the line.



*Many thanks to Dr. X for bringing my attention an apparent error in the NY Times' coverage of the story: the reported $45,000 average applies only to the subset of 11 psychiatrists who were among the state's top 100 recipients of pharmaceutical largesse. According to Dr. X's trenchant analysis, the average psychiatrist statewide received "only" about $4,000 in drug company handouts last year.

4 comments:

Dr X said...

I'm in sympathy with your concerns, but it looks to me like the Times made a serious error in reporting on this story. The $45,000 figure described as the average payment to psychiatrists represents only the average among the top 11 psychiatrists in the state. It is not a statewide average, as the Times article leads one to believe.

I did my own quick and dirty analysis based upon the report issued by the State of Vermont and it looks to me like gifts, education and payments totaling $1000 is probably much closer to typical.

Psych Pundit said...

Dr. X:

Thanks for bringing this reporting error to my attention. I went back through the original report, as well as your own trenchant analysis - and agree with your estimate of $4,000 as the average amount received by psychiatrists last year across the entire state. That's much lower than the figure reported in the Times, but still a nontrivial amount - certainly large enough to exert a potential influence on clinical practice.

Cheryl Fuller, Ph.D. said...

Glad to see you back again! You've been missed!

It seems to me that any amount of money received from drug companies creates a conflict if interest for potential prescribers; even trivial amounts will create bias, even if unconsciously.

Dr. Deb said...

Conflict
Conflict
Conflict.