Pharmaceutical companies frequently pay doctors, and research indicates that these payments have an impact on doctors’ prescription practices. Expressly, doctors may prescribe more expensive name-brand medications over low-cost medications, as well as more payer-company pharmaceuticals. How do these physicians receive “payments” from these companies?
The practice of providing everything from computers to expensive medical textbooks, seminar speaking fees, research funding, lavish trips, meals, and other incentives was supposed to have been capped at about $25 years ago. Now, research has uncovered a most disturbing place where this practice can have an enormous influence on the diagnosis and treatment of psychiatric disorders, and it relates to their holy book, The Diagnostic & Statistical Manual of Mental Disorders Disorders (DSM).
Industry money influences how doctors prescribe cholesterol medications, blood thinners, medications for multiple sclerosis and Alzheimer’s disease, and even which drugs are used to treat cancer. Perhaps most concerningly, it influences how many opioids doctors prescribe. This influence is consistent across all medical specialties and drug types.
I have been in physicians’ offices where prominent items related to specific drugs and the companies that make them are displayed. I’ve also been present when lavish breakfasts and hot, multi-item lunches were delivered to an office prior to a “detail” person from a pharmaceutical firm giving an “educational” seminar as the staff ate.
I’ve even been on a hospital ward visiting a friend when a physician came around to see patients, and in his hand was a medical bag with prominent lettering indicating a pharmaceutical company had supplied it. Was he naive, or didn’t he care? You decide.
I’ve also seen psychiatrists leave worksites for periods of time to provide seminars at hotels in the area. For their services, they were very well paid, and the most shocking part was that the individual had no special background in the drug and had received a script and a prepared PowerPoint presentation to be shown.
But the latest and most disturbing finding relates specifically to the panel on mental disorders, how disorders are added to the DSM, who is evaluating what should be added, and how they may, consciously or unconsciously, be influenced.
The AMA has clearly outlined a code of conduct that states:
“To preserve the trust that is fundamental to the patient-physician relationship and public confidence in the profession, physicians should:
Decline cash gifts in any amount from an entity that has a direct interest in physicians’ treatment recommendations.
Decline any gifts for which reciprocity is expected or implied.
Accept an in-kind gift for the physician’s practice only when the gift:
will directly benefit patients, including patient education; and
is of minimal value.
Academic institutions and residency and fellowship programs may accept special funding on behalf of trainees to support medical students’, residents’, and fellows’ participation in professional meetings, including educational meetings, provided:
a) the program identifies recipients based on independent institutional criteria; and
b) funds are distributed to recipients without specific attribution to sponsors.”
Are all physicians members of the AMA? No, it is not a requirement, but we have to wonder if non-members should adhere to this code.
Recent disclosures of the DSM committee members’ financial conflicts are a serious concern for everyone, and we have to wonder why conflicts weren’t readily admitted or were withheld from those responsible for placing members on the committee.
Investigations have noted there were a lot of conflicts of interest among the DSM-5-TR panel members. Since diagnostic and treatment guidelines have a big influence, there should be high standards for being on a panel that develops guidelines.
The Diagnostic and Statistical Manual of Mental Disorders should have a rebuttable presumption that prohibits conflicts of interest among its panel and task force members. In cases where there are not any independent experts, people with industry associations could consult the panels, but they should not be able to make decisions about revisions or the addition of new disorders.
How have these conflicts affected the resulting revised DSM-5-TR? We have no way of knowing and must depend on the integrity of the panel members despite any conflicts they may have had. If we think otherwise, the foundation for this essential book is shaken, and we can only surmise that patients may, in some way, be harmed.
No, patients will not die because of a faulty psychiatric diagnosis, but they may suffer self-esteem, work-related harm, or even insurance-related harm. The threads of harm spread far and wide.