Financial incentives are but one part of how doctors and academics are influenced by the pharmaceutical industry. The amount of money is important, influence can be exerted by the gift of a free pen or diary. In fact small gifts may be even more effective compared to large gifts of exotic holidays and large cash payment where acceptance can seem more readily to compromise.

The big problem is that articles are influenced by the pharmaceutical industry, in some cases written. Those who peer review articles may be influenced by commercial interests, so articles not favourable of particular drugs/treatments are not even considered for publication. Yes academics are judged by their articles, they publish or die. If they are cited by others great. So the result is that articles are put forward that have a chance of being published, ones that peer review will favour and that journals reliant on pharmaceutical advertisement are not afraid to publish are the ones most written. Articles critical of drug therapies are often not what gets published and if they are it may be the case that it is between competitors in industry vying for the top sales spot for their drug. As you say the thirst to publish is the drive but what gets published is not necessarily any good.

In turn articles have further influence on patient advocacy groups (or should that be marketing?), continuing medical education (or should that be brainwashing?), law, health policies, insurance and politics (in fact pretty much all pervading). The myth becomes fact and the status quo just is. Psychiatry is acutely influenced by the pharmaceutical industry and this is reflected in its main tenet the DSM.

Yes the patients want drugs, so why not give them what they want? First they want drugs because they are told they are effective, based on “facts” put across by the pharmaceutical industry or those attached to it, and of course those naïve and well intentioned patient advocacy groups fight tooth and claw for the newest and best wonder drug. Second should we get what we want or should we get what we need? Doctors have a duty to not prescribe where appropriate but they don’t seem able to do this if a drug is in patent.

None of the above would be a particular problem if the “evidence” presented in journals was above influence and reliable. What you put forward shows a system so corrupt that not even Sir William could fix. Rosencrantz and Guildenstern are not dead, they’ve melded into one.

Ghost written scientific articles!? Yeow!

That's about as weird as it gets for any discipline that would tacitly approve of the practice.

And the clowns that do it should not even be psychiatrists. Their values are so warped, they should be restricted to jobs in pathology or examining bodies in a morgue.

Of course fixing the problem should be easy. Have the primary author sign a statement affirming his/her leadership of the study. And then have his/her boss validate the claim. If it turns out they lied, they get blackballed.

But I guess the sticking point may be that the system is totally corrupt, so invites collusion. I.e., the department head has done it him or her self.

Hi, Dr Ghaemi. Another enlightening blog. An observation or two:

I drive a '92 old beater, but if it weren't for the industry ads on my website and another website I write for I would be sleeping in my beater. This is the world we live in.

My other currency is credibility. It is mine to lose if it looks like the drug industry is calling the tune. For that matter, it's mine to lose if it looks like my opinions are calling the tune.

Industry-academic partnerships are to be encouraged. My main complaint is that the industry does not make better use of academia. The impression I get from reading industry-designed, industry-written research is that they are using the best researchers in psychiatry as mere errand boys. From what I gather, too many great minds are forced to leave the field.

Back to the credibility issue. An industry trial can be the best-designed, most rigorous and scientifically valid study in the world, but unfortunately in too many the commercial interest far outweighs any legitimate research interests. Often, the "spin" in these studies contradicts the actual data.

Ironically, I find far more credible small (and perhaps flawed) underpowered pilot studies designed and carried out by independent academics passionate about going where their instincts lead them. If only they could get the funding to do the kind of studies that they would like to do

Perhaps in a future blog, you could talk about the issue of credibility vs validity.

I find it amazing that a past APA president and a Harvard luminary did not know what was going on - a full 9 years after 11 or 13 medical journals worldwide ran simultaneous editorials on the topic of ghost-written articles. Then again, I often get the impression that, when it comes to the color of money, psychiatrists can be extremely naive.

I find it less amazing that a department head mildly chastised you for your lack of "credits" for academic-fronted industry studies. (Don't tell me who it is; I can make an educated guess.) I hope one day soon that this situation is turned around - that you get commended for this accomplishment.

I appreciate the need for rational self-interest in industry and academia. A bit more enlightened self-interest, however, may prove in everyone's best interest.

If my research serves me, then diagnosis of Bipolar II was not identified until the 1970s. This of course correlates with the ascendancy of ADs for "depression"
Could this be an entirely iatrogenic disease born of the use of ADs which end up acting as mood de-stablizers.
Could it be that ADs merely push someone with a propensity into full blown Mania. Sort of like defining the road not taken.