Industry Role in Medical Meeting Decried
Symposiums Sponsored by Pharmaceutical Companies Trouble Some Psychiatrists
By Shankar Vedantam
Washington Post Staff Writer
Sunday, May 26, 2002; Page A10
PHILADELPHIA -- In the days leading up to the American Psychiatric Association's annual meeting here this past week, pharmaceutical companies mailed attendees hundreds of free phone cards, as well as invitations to museums, jazz concerts and fancy dinners.
As thousands of psychiatrists streamed into town, they were greeted by a highway billboard advertising AstraZeneca Pharmaceuticals's anti-psychotic medicine Seroquel. Each of the 19,000 attendees was given a gray bag with the insignia of the meeting and the orange logo of GlaxoSmithKline PLC, the maker of the antidepressant Paxil. Outside the giant convention center, curb signs for buses ferrying doctors to their hotels advertised Eli Lilly and Co., the maker of Prozac.
In one part of the convention hall, companies erected 20 foot-high monuments to their medicines and handed out promotional material, candies and gifts. Company executives hailed passing physicians, imploring them to stop and pick up information. And in several dozen symposiums during the weeklong meeting, companies paid the APA about $50,000 per session to control which scientists and papers were presented and to help shape the presentations.
The perks, freebies, handouts, promotions and corporate sponsorships are not unique to the APA's meeting or to psychiatry. But many psychiatrists increasingly feel that the industry's aggressive promotional activities are particularly troublesome in their field, potentially swaying psychiatrists into writing prescriptions for the products of companies that woo them, raising health care costs and tilting the profession away from insight-oriented psychotherapies to a near-total focus on medications.
"A line has been crossed in terms of pharmaceutical company marketing," said Henry Levine, a psychiatrist from Bellingham, Wash.
Officials at the APA defended the sponsorships and symposiums, and said the money helped pay for a vast range of educational activity and advocacy on behalf of the mentally ill. They said the bottom line is that no physician would ever mistreat a patient whatever the inducement.
"Of course, it's going to bias us -- the question is whether the bias is benign," said David McDowell, a Columbia University psychiatrist who helped monitor industry sponsorships for the APA. Without industry money at the gigantic Philadelphia Convention Center, he said, "we'd be sitting in the basement of the YMCA."
Jeff Trewhitt of the Pharmaceutical Research and Manufacturers of America said ties between companies and doctors have led to more informed medical practices and better knowledge about how drugs work. He said new guidelines taking effect on July 1 will ask companies not to give doctors tickets to sports and entertainment events, and to offer them only modest meals.
The industry-sponsored symposiums at this conference are unusual -- most major medical associations do not allow them -- said James Thompson, the APA's deputy medical director. If companies want to take advantage of the conferences of those other groups, they have to set up their own "satellite symposiums."
Thompson and other APA officials said allowing the symposiums to be part of the convention permits doctors to first screen the studies for scientific accuracy. Drug companies then select the papers they want to sponsor, and APA officials monitor the proceedings for signs of bias or marketing.
The diagnosis and treatment of mental illness have risen sharply in recent years. While studies show that many patients are still untreated, pharmaceutical marketing has raised fears that others are getting prescriptions they do not need.
Concern over psychiatry's ties with industry was widespread enough to be the focus of several panels at this year's convention. Some psychiatrists said the association should simply sever all ties with industry. Harvard Medical School psychiatrist David Osser suggested that companies pool symposium money into a common fund, which could then be used to conduct sessions chosen exclusively by mental health professionals. Andrew Ho, a University of California at Los Angeles psychiatrist, said the extent of industry involvement -- and the dependence of the association on the money -- raised questions about who was controlling the association and the profession.
"Let's face it -- they make the money back" through greater sales and prescriptions, said Robert Eilers, a psychiatrist in the state Office of Mental Health in New Jersey, in a session where several doctors assailed top APA officials. "It's totally out of control."
Levine told APA officials that even patient organizations such the National Alliance for the Mentally Ill had been shunted to the "far, far corner of the auditorium" as funding companies got center stage in the exhibitors' hall.
Officials at the APA warned, however, that there were no simple answers to questions about industry influence in psychiatry. "There are strings attached," agreed Stephen Goldfinger, the APA's top monitor of industry sponsorship at the conference, at a session discussing potential conflicts of interest. "When you dance with the devil, you can't control all the steps."
Led by Columbia University psychiatrist Philip Muskin, APA officials said that doctors were very much in control of the convention and that the idea of setting up a common pool of money for symposiums was "naive." Industry would never sponsor symposiums they have no control over, said Muskin, and warned that the critics were forgetting the many important educational and advocacy services that would be slashed if the money was refused.
"Are you willing to pay $3,000 a year for membership dues if we didn't take drug company money?" asked Anand Pandya, a psychiatrist who helps the APA evaluate new research presented at the conference. "That's how much you would pay."
The APA's 31,000 psychiatrists -- who account for three in four American psychiatrists -- currently pay about $540 in dues to the national association, and between $200 to $500 in state dues, said the APA's Thompson.
Part of the APA's dependence on industry sponsorship is because the association has been ailing financially, and revenue from the annual convention represents about 22 percent of all funding. That money is becoming increasingly important, as revenue from dues has dropped in recent years from $11 million in 1998 to $9.9 million last year, and is expected to drop further. The association has run at a loss for three out of the past four years.
Thompson said that it is ultimately the responsibility of physicians to evaluate what they hear for scientific accuracy and signs of bias. Goldfinger said that observers and evaluation sheets at the symposiums rated each session and that warning letters were sent to researchers whose presentations fell short or who had shown biases for particular medicines. If a pattern of bias is observed, said Goldfinger, scientists would be barred from presenting research at the APA for five years.
In the three years the policy has been in place, he said, nobody has been so sanctioned.
In the end, the appearance of a conflict of interest may be more harmful than any actual conflict itself. Several doctors noted that it may even keep good treatments from receiving the attention they need.
Jeffrey Levine, chairman of psychiatry at Bronx-Lebanon Hospital Center, an affiliate of the Albert Einstein College of Medicine in New York, said he had once been approached by a marketing representative who complained that a particular drug was not being made available in Levine's hospital. Levine said he thought the medicine was effective, and would likely have recommended that it be added to the formulary, but hesitated because he was worried that others might think he was in the pocket of the drug industry.
"There isn't a simple headline or a bottom line," he said. At his panel discussing the ethics of industry influence in education, Levine dubbed the meeting "the American Psychiatric Association GlaxoSmithKline Convention." Still, he noted that the psychiatric residents who had presented data about the dangers of conflicts of interest would not have been able to attend without industry funding. Saying that a company marketing representative he knew had helped arrange a grant, he added: "It has paid for our residents to come here today. Now you all don't know that, but it's got to be said."
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