There are a variety of complex relationships between academic medical centers and the pharmaceutical industry. Before exploring issues related to industry support of basic and clinical research performed at academic medical centers, we want to clearly state our opinions regarding financial relationships between academic faculty members and industry. We are unequivocally opposed to academicians being paid to help industry market medications or medical devices. We are opposed to academicians being paid directly by the pharmaceutical industry to give talks about medications, and we are opposed to academicians receiving any gifts from industry. We want to commend non-profit organizations such as the American Psychiatric Association and the American College of Neuropsychopharmacology for efforts to diminish conflicts of interests in their financial relationships with industry, and we encourage these organizations to develop even more rigorous standards.
What about partnerships between industry and academic medical centers involving basic and clinical research? Can such collaborative efforts benefit society or do they mainly benefit the bottom line of the pharmaceutical industry without benefiting the public?
When a pharmaceutical company has a medication that has been shown to be effective in treating a certain condition, it is often in the company's best interest to support research involving the condition that their medication treats. For example, if a company has a product that decreases the risk of panic attacks, it may support basic science and clinical research into the nature of panic and anxiety disorders. Similarly, if a company has a drug that might help people with social phobia, it might be interested in supporting studies elucidating the nature of shyness and social phobia. Why? We suspect there are many reasons, however, from a business perspective, it is likely that scientific advances pertaining to an illness increase physicians' awareness of both the illness and treatment options related to the illness, including the medication that the company produces. As an example, we can look at research into the prevalence of depression. Before the 1970s, clinical depression was thought to be relatively rare. With the establishment of research criteria in the 1970s, epidemiologic studies demonstrated that various forms of depression are, in fact, quite common and very disabling. Because of this new knowledge, the market for antidepressant medications expanded and so did support for research. From research over the last few decades, it is now known that even milder forms of depression are associated with significant medical and social disabilities. It is also now known that people with depressions have increased death rates from accompanying medical illnesses such as heart disease. Also, depression is the major illness associated with completed suicides.
As a result of the knowledge that depressive illnesses are common and are associated with poor medical and social outcomes, the use and sales of antidepressants have skyrocketed. Medications together with supportive medical follow-up and psychotherapy can help alleviate symptoms in the majority of depressed people. Some forms of depression can also respond to specific types of psychotherapy without the use of medications. Unfortunately, many people with clinically significant depression are not diagnosed and, therefore, do not receive potentially lifesaving treatment. It is also true that some people are incorrectly diagnosed with depression and are unnecessarily prescribed medications.
In similar fashion, research supported by both the federal government and industry has helped to establish that conditions such as panic disorder and social phobia exist, are common, lead to disabilities, and respond to treatment, including medications. Once again, one can argue about whether these disorders are under-diagnosed or over-diagnosed.
People can also debate where the boundary lies between normal and mild illness. Where does shyness end and social phobia begin? How can one tell whether someone has a mild depression or is overreacting to a stressor? Part of the answer to such questions may be determined by the degree of disability associated with the condition and the effectiveness of treatment in diminishing the disability. Despite issues related to definitional boundaries, there is no doubt that severe forms of illnesses such as panic disorder, depression, and social phobia exist and that research supported by both the federal government and the pharmaceutical industry has contributed to increased knowledge about these conditions.
Thus, we believe that research support from industry can help to advance basic and clinical sciences. True scientific collaboration between academia and industry is in the public's best interest. However, it is critical for academic health centers to make certain that any basic and clinical scientific research supported by industry is unhampered by any preconditions that limit academic faculty's research independence.
In summary, we strongly believe that academicians should avoid any personal financial support from industry that is derived from marketing activities that are designed to enhance the sales of drugs. These activities include giving talks for companies and accepting gifts from companies. On the other hand, we believe that it is in the public interest to encourage basic and clinical scientific collaborations between academic medical centers and industry in order to enhance our knowledge about psychiatric disorders and to promote the development of new and more effective treatments.
This column was co-written by Eugene Rubin MD, PhD and Charles Zorumski MD.