Touches all the bases. Great job.

I have a few things to say about the sub-topics. But first generally, I think the problem (on the marketing side) is not as complex as it seems. Simply leverage information technology.

Say the APA passed a resolution strongly recommending that psychiatrists refuse to meet with pharma detailers. Instead, the PI would have to produce webcasts about a drug's properties, side effects and relative clinical value(infomercials so to speak). They could be real-time interactive with Q's and A's and then available for download or streaming.

But a webcast would have to be scientifically focused and validated by the FDA (and better yet APA) as accurate and unbiased. If it does not have the APA seal of approval, the content should be viewed as suspect by default. BTW, tell the drug companies that they have to pay APA for the approval effort.

Then set up drug specific blogs for med professionals that allow them to trade clinical outcomes and observations related to the molecule. Let the PI provide forum oversight to blog questions posted by the docs. But the docs could offer competing opinions too if they want. So every question and answer posted is out in the open.

In other words, take the soft selling completely out of the process. Drug reps? Who needs them? Remove them from the sales calculus and the stupid give-aways and boozy meals go away too.

And forget about the paid seminars. The internet makes them superfluous. A web focus would be on clinical outcomes and side effects, not domain personalities or suspect Harvard “big hitters”.

Of course professional conferences with personal face time will always be important and necessary. But if content validation was made strictly web centric, the impetus to stuff cash in someone's pocket for a conference pitch would disappear.

I have to think about the other good stuff mentioned here...

Pharma sales and marketing issues are easy to solve. What is not easy is modifying the normative overuse of psycho-pharmaceuticals. And that is because dispensing CNS drugs is driven by both Supply (physician ineptitude, greed or laziness) and Demand (patient demand for a quick fix).

One of the biggest travesties of trade publishing was Peter Kramer’s Listening to Prozac. That best seller convinced millions that CNS drugs could be dispensed like pixie dust leading to a new era of collective mood elevation. And Kramer positioned himself as the wisest of all pixies.

Well he was wrong. SSRI’s ruin sex lives and offer up a host of other lousy side effects. Cymbalta withdrawal symptoms are ravaging thousands as I type this. Prescribing Zoloft to kids? Does anybody take the time to query them as to what makes them anxious in the first place? And then help them address their childish root causes rather than dope them up?

Kramer can declaim no financial interest all he wants. What drives him from retreating from his be all and end all of CNS drugs is ego. Money has nothing to do with it. And he has plenty of similarly arrogant academic pals who drink the same bathwater. They may occasionally talk alternative therapies but at the end of the day, they are writing scripts for brain bombs like Cymbalta without hesitation. And increasing time spent with patients will provide little therapeutic value if the “brilliant” psychiatrist is socially retarded.

The only way that problem is going to get fixed is if the APA delegitimizes psycho-pharmaceutical carpet bombing as a primary method for treating mood disorders. And the FDA steps in and re-regulates drug advertizing. But that ain’t gonna happen because the Kramer’s and Eli-Lilly’s of the planet won’t let it.

Say no more. :)

Dear Dr. Ghaemi:

I am grateful for your generosity. Though I am still taking my "first steps" into Psych, I have came across with practices I feel unhumanitarian and selfish.

Some fellow colleagues have asked me why "do I treat patients so nicely", and advice me on the contrary.

I felt devastated. How can't they understand pain?.

To read points of view like yours and to feel compassion, empathy, humbleness and love in them fills my soul and my mind with a peaceful felling.

Thank you for teaching and sharing you experience and knowledge.

Regards,J.