The Pharmaceutical Industry and the Psychiatric Profession

 

This statement was prepared by the Standing Committee on Ethics of the W.P.A., in response to a request from the WPA Executive Committee.

 

Increased awareness of the pharmaceutical industry’s (henceforth referred to as “industry”) influence on the profession has led  to a range of concerns and the  need for guidance, supplementing the WPA Guidelines concerning support from external sources for activities of the WPA (1).

 

I.          Purpose:      1) To clarify  ways in which industry and               

                                         the profession interact.

 

2) To identify actions which may : undermine the agreed                    

     upon values of the profession,

     exert a negative effect on its autonomy

                                     and interfere with a commitment to care optimally

                                     for patients, based on well-grounded

                                     research evidence.

 

3) To provide guidance to assist Psychiatrists

     to maintain constructive links  with industry at the

     same time maintaining their autonomy.

                                                                                                   

II.         Historical context

 

            The growing association between industry and psychiatry has  its  roots not only in a deeper  understanding of the nature of biological   factors relevant to mental illness but also in the parallel   expansion of pharmacological options available  to the practitioner to limit suffering and disability.

 

 

            Accompanying these developments has been the regular  publication of peer-reviewed articles  drawing  attention to the   multi-layered and complex relationship between industry and psychiatry and the ethical issues inherent in this relationship. 

 

           Industry is certainly committed to developing safe, effective drugs with fewer side-effects but it also has to satisfy its  shareholders who    

 

 

(1)     Guidelines concerning support from external sources for activities of the World Psychiatric Association. Approved by the WPA General Assembly in Hamburgh on August 8, 1999. WPA Information Guide 2005 - 2008

 

 

 

naturally wish to see a maximum return on their investment. Therein lies a potential problem, as prescribers come under continuing pressure from a range of sources (including, more recently, informed patients and their families) to choose specific  medications

 

 

IV.               Brief review of what has been learned about the links between industry and psychiatry.

 

 

·        Industry’s influence begins during  psychiatric training  through such features as token gifts, free meals  and colleagues lecturing on behalf of  a company, as well as through  role-models.  Many academic centers have instituted  guidelines to address these influences but their  number and distribution are relatively unknown.

 

 

·        Clinicians, including psychiatrists, are significantly influenced, and over an extended period, in their prescribing patterns by industry practices such as free samples, free meals, industry-sponsored attendance at, and help with travel expenses to scientific conferences  and participation in what is presented as a research presentation  but is little more than a marketing exercise. Industry-sponsored symposia speakers, are more likely to prescribe  the sponsor’s drug.    

 

 

·        Academic and research centers are also subject to industry’s influence, not only financially, e.g. funding of studies, but also in an indirect manner, through peer pressure, academic promotion etc. Government and the public have, hitherto, allowed the profession to practice self –regulation concerning these influences. However, demands from these sources for greater accountability are steadily growing in many countries.

 

 

IV.     Specific concerns for professional bodies, training programs, researchers and clinicians.

 

·        Advocacy for a complete severance of psychiatry’s relationship with industry is impractical. Prescribers must learn  about available pharmacological options that will enable them to make informed choices. Failure to take the opportunity to gain new knowledge in this way, may deprive patients of treatments that could benefit them considerably. This could well be tantamount to providing negligent care. 

 

 

 

·        At the organizational and research levels, it is difficult to envision alternative sources of support for many activities that are essential to further the understanding of mental illness and its treatment. Many professional journals could not survive without industry or other external support.  Governmental and non-industry sources of support are less likely to be made available for clinically-based research.

 

·        Planning quality scientific conferences on the basis of participants’ registration fees alone is difficult to imagine. Additional sources of support, such as from the State, are unlikely, particularly in countries which are struggling just to provide basic services. 

 

 

 

V.        Suggestions

 

           

·        Training programs should encompass a specific module to cover  the ethical issues that arise  in psychiatry’s relationship with  industry.

·        Trainee and qualified psychiatrists should keep abreast  of  scientific knowledge concerning the  potential influences of industry on prescribing practices. 

·        Academic and consultant psychiatrists  should be sensitized to the influence of  role modeling on trainees as it relates to links with  industry.

·        Psychiatric services and especially academic centers should develop clear ethical  guidelines regarding psychiatrists’ links with industry,  including monitoring and auditing of joint activities.

·        The industry should be encouraged to make unrestricted educational grants, so allowing  recipients total freedom over choice of speakers and topics.

·        Financial support from the industry should be given to institutions, such as psychiatric associations, university departments and research centers, rather than individuals,

                      in the form of unrestricted grants. These institutions

                      should be responsible for the allocation of the

                      funds in a  transparent way.

·        Free meals, gifts and services to individual psychiatrists should be eliminated

·        Organizations should maintain a policy requiring industry- sponsored educational activities to be vetted for balance and objectivity  by an authorised scientific program committee, as is the case with any other component of the program.

·        The psychiatric profession should campaign  against patient-direct advertising  and assist relevant governmental departments  to adopt corresponding policies.

 

 

                               

This Draft was prepared by the WPA Standing Committee on Ethics.

Prof. Werner Pankratz prepared the original draft, Professors George Christodoulou and Sidney Bloch edited it and the members of the Committee reviewed it and contributed to the subsequent drafts.

 

 

Submitted on 15 August 2008 on behalf of the WPA Standing Committee on Ethics.

 

 

Prof. George Christodoulou

Chair, WPA Standing Committee on Ethics