Profession

Psychiatrists scrutinize APA's revenues from drug industry

Concerned about conflicts of interest, the specialty society is pondering a move away from pharmaceutical funding over a five-year period.

By Kevin B. O’Reilly — Posted Aug. 18, 2008

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The American Psychiatric Assn. has appointed a work group to identify the industry money it receives, what the funds pay for and whether to go without them. The Ad Hoc Workgroup on Adapting to Changes in Pharmaceutical Revenue was appointed last spring and is set to report to the APA's board of trustees in October.

The move comes on the heels of intense news media and congressional scrutiny of potential conflicts of interest posed by drug- and device-makers' support of clinical researchers, medical education programs and practicing physicians.

Pharmaceutical revenue accounted for 28%, or $14 million, of the 38,000-member APA's 2007 budget, according to James H. Scully, MD, the group's medical director and CEO. The revenue comes in the form of journal advertising and grants for continuing medical education and fellowships.

APA President Nada L. Stotland, MD, MPH, said she hopes the work group can help the association get a better handle on exactly what industry money supports and what, if anything, should be cut.

"People tend to have a different feeling about ads in journals than industry-supported symposia or minority fellowships or even the exhibit area, free pens and other things that are made available," Dr. Stotland said. "When people complain and say they want the APA to not accept pharmaceutical revenue, they've not done it head on in the sense that we would have to cut some activity. Nobody wants to say, 'Let's cut something.' "

Most of the criticism has focused on industry-supported symposia, but APA officials said the association has set up stringent firewalls to prevent bias from creeping in.

Questioning firewalls

Some argue the firewalls have failed.

"Many people who go to these symposia can guess very, very quickly -- based on the title of the symposium and based on the speakers that are hired -- which company funds them, even without looking at the logo that the company has to display to disclose that they're funding it," said Daniel J. Carlat, MD, a member of the APA work group and assistant clinical professor of psychiatry at Tufts University School of Medicine in Boston.

"My sense of the mandate of the work group is that everything is on the table," he said.

The Pharmaceutical Research and Manufacturers of America did not respond to requests for comment about the APA initiative. The APA is not alone in comprehensively examining the consequences of industry support of physician organizations.

At its June Annual Meeting, the AMA House of Delegates referred for further study a Council on Ethical and Judicial Affairs report recommending a gradual end to industry funding of medical education.

The Institute on Medicine as a Profession, funded primarily by a $7.5 million grant from George Soros' Open Society Institute, is working on a set of guidelines to help medical societies reduce potential conflicts of interest. In 2006, a similar IMAP proposal aimed at academic medical centers was published in the Journal of the American Medical Association and led many institutions to change their policies. IMAP aims to finish its work by year-end, said David J. Rothman, PhD, IMAP's president.

He said the APA could "set the gold standard" for how organized medicine groups reduce their financial dependence on industry. "It's wonderful and crucial that they're even taking on the assignment."

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External links

The Carlat Psychiatry Blog (link)

Institute on Medicine as a Profession (link)

"Health Industry Practices That Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers," abstract, Journal of the American Medical Association, Jan. 25, 2006 (link)

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