This spring, the New York Post revealed that Columbia University
has been cashing in. Its Office of Clinical Trials generates about $10
million a year testing new medications--much of which is granted to the
Columbia Psychiatric Institute for implementing these tests. The director
of the institute was being paid $140,000 a year by various drug companies
to tour the country promoting their drugs. He also received payments of
nearly $12,000 from a drug manufacturer to head up a study on panic
disorders. How could he rate these drugs fairly when his livelihood was
dependent on the success of the drug manufacturer? The director resigned
in the aftermath of the article's publication.
At least one drug company, Wyeth-Ayerst Research, has spoken out
against offering cash bonuses and other incentives to researchers. But
company representatives admit it's difficult to stay competitive when
other groups so eagerly violate ethical concerns.
The APA Connection
The American Psychiatric Association--representing the majority of
psychiatrists in America, with about 40,000 members--is also unduly
influenced by pharmaceutical dollars. The association:
o receives substantial rent from drug companies for huge symposia
spaces at national conventions.
o derives an enormous percentage of its income from drug
companies--30% of its total budget is from drug company advertising in
its many publications.
o accepts a large number of unrestricted educational grants from
drug companies.
This relationship is dangerous because researchers and
psychiatrists then feel indebted to the drug companies, remain biased in
favor of drug cures, downplay side effects and seldom try other types of
interventions. And they know they have the unspoken blessing of the APA
to do so.
Collectively, these practices aggressively promote reliance on
prescription drug use-so much so that many people think drugs should be
forced on those who refuse to take them. The APA supports the National
Alliance for the Mentally Ill, which believes that mentally ill patients
should be coerced to take medication. I am appalled by this level of
social control. Mentally ill people should be given a choice to have
their illness treated in alternative ways.
Over the last decade, ! have written a number of letters bringing
my concerns to the APA's attention but have received no response. The
association claims that what it's doing is in the "best interest of
patients," but its strong ties to the drug industry suggest
otherwise.
Recently, it was dues-paying time for the APA, and I sat there
looking at the form. I thought about the unholy alliance between the
association and the drug industry. I thought about how consumers are
being affected by this alliance, about the overuse of medication, about
side effects and about alternative treatments. I thought about how
irresponsibly some of my colleagues are acting toward the general public
and the mentally ill. And I realized, I want no part of it
anymore.
Loren R. Mosher, M.D.
The Other Side
"Safe and Effective Drugs Have Improved the Lives of
Millions"
Dr. Mosher has seized onto the recent press interest in the
relationship between the pharmaceutical industry and biomedical
professionals as an opportunity to re-open a 25-year-old argument--one
that has long been settled by a mass of scientific evidence and by the
testimony of hundreds of thousands of patients, their families and their
caregivers. The availability of safe and effective psychoactive drugs has
dramatically improved the lives of millions of individuals with major
mental disorders such as schizophrenia, bipolar illness, clinical
depression, obsessive-compulsive disorder and panic disorder.
While Mosher apparently still sees the issue as a choice between
medications and psychological treatment (he says, "Schizophrenia can
often be overcome with the help of meaningful relationships rather than
with drugs"), the overwhelming majority of mental health professionals
now know that for the seriously mentally ill effective medication makes
it possible for psychosocial interventions to work. And work they do.
Many well-controlled studies have shown that psychosocial treatments
combined with medication can produce substantially better results than
medication alone.
It is now so well-established that illnesses such as schizophrenia
and bipolar disorder generally require medication, that many countries no
longer allow a placebo group in clinical trials with these disorders.
Incidentally, Mosher's 1970s "study" purporting to compare "meaningful
relationships" with medication was no such thing. A true scientific
inquiry would have required a single pool of patients randomly assigned
to either psychotherapy or drug groups. The report was simply an
interesting description of their experience with a group of patients who,
at least in the short run, did not seem to require medication.
Mosher would have us believe that the very broad consensus about
the importance of medications is somehow the result of drug company
money.
Tell that to the parents of a schizophrenic son who, following
treatment with a new, atypical neuroleptic drug, is able to hold a job
for the first time, to form meaningful relationships, in short, to
reconnect to life.
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