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Drug companies' influence in psychiatry
pervasive, experts say

by Timothy Kirn, Clinical Psychiatry News (July 1, 2006)


TORONTO -- Psychiatrists should be very concerned about the influence pharmaceutical companies wield in their field, and in medicine as a whole, two psychiatrists said in presentations at the annual meeting of the American Psychiatric Association.

The pharmaceutical industry has been encroaching with greater influence in continuing medical education, said Dr. Daniel J. Carlat, a psychiatrist in private practice in Newburyport, Mass., and editor of the Carlat Psychiatry Report, a newsletter that contains no advertising. Despite a decision last year by the American Academy of Continuing Medical Education to strengthen the rules governing industry support of CME, industry continues to increase its investment in accredited symposia and materials, he said. In 1998, industry provided $302 million worth of CME support, 33% of the total spent. By 2002, that figure had become $1.1 billion, 52% of the total spent. Currently, it is estimated that industry supports 57% of all CME. Dr. Carlat said he recently conducted an experiment with CME materials. He randomly selected 15 CME-accredited articles out of all the accredited materials received by his office between August 2005 and May 2006. He then counted the number of statements made that were favorable or unfavorable about a drug. Each article contained an average of 13 favorable comments about a drug made by the sponsoring company and an average of 2.2 favorable statements about
competing drugs, for a "pro-bias" ratio of 6. Rating the articles blindly, Dr. Carlat was able to guess the sponsorship of each publication in 14 of 15 articles.

In Dr. Carlat's opinion, these findings mean the CME providers "are out of compliance with ACCME standards. I think the drug companies and medical education companies need to get busy with something else or they are going to lose their accreditation."

Dr. Robert Kelly Jr., of Beth Israel Medical Center, New York, and his
colleagues found similar results in a comparison of major articles published in
the four leading psychiatry journals in 1992 and 2002. They collected 301
articles that described clinical studies mentioning 542 different drugs. Two
blinded raters then reviewed abstracts of those articles and decided whether
the report was favorable or unfavorable to a drug mentioned.
Overall, 57% of the articles published in 2002 described studies that had
some kind of industry sponsorship. That compared with 25% of the articles
published in the same journals in 1992, Dr. Kelly said.
When the drug trial was sponsored by a single company, the resultswere
deemed favorable to that drug in 79% of the articles. In contrast, articles
describing trials without company sponsorship were favorable only 48% of the
time. When trials were company sponsored and mentioned a competing drug, the
mentions were favorable only 29% of the time (see box).
No one wants to impede drug discovery and progress, Dr. Kelly said. But
as the situation stands now, something has to change or medicine will lose
credibility.

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Pharmaceutical Industry Donations & Continuing Medical Education
Pharmaceutical Industry Donations & Policy Think Tanks and Advocacy Groups
Pharmaceutical Industry Support for Patient Groups/Promotion of Prescription Drugs
Pharmaceutical Industry Donations & Charitable Conduits to Doctors
Pharmaceutical Industry Donations & Influencing Prescribing Guidelines

Pharmaceutical Industry Disclosure Practices