I stood mesmerized as nearly 7,000 international psychiatrists herded through the streets of Florence, Italy, each toting a red canvas briefcase stamped boldly with the logo of one of the world’s most profitable pharmaceutical companies. Hesitantly, I merged with the pack, joining this vast swathe of red en route to this year’s World Psychiatric Association Congress.
Once inside the convention centre, I too was presented with my own ‘souvenir bag’, overflowing with industry-sponsored gifts and invitations to pamper and indulge under the guise of ‘education’.
Hoping to escape the flattery and enticing freebies of the well-polished drug reps, I navigated cautiously through the daunting labyrinth of industry display booths.
One drug company offered a gourmet espresso bar that flaunted international barista artists flown in for the event. Another displayed giant flatscreen TVs towering over eager participants as they tried their luck at game-show quizzes to win extravagant prizes.
As I caromed from booth to booth, I was met with a disconcerting variety of competing claims: Risperidal is better than Zyprexa, which beats Seroquel, which tops Zeldox, which trumps Abilify, which beats out Risperidal and Zeldox, which is really better than Seroquel which… well, you get the idea.
There is a glaring gap between Big Pharma and our healthcare ideals. The drug companies focus their energy on maximizing profits while contributing little to improving the care of patients
Outside, dozens of anti-psychiatry activists marched with banners announcing: ‘Psychiatry is a Pseudoscience’. I was flooded with discomfort. They were challenging a profession I’ve so optimistically pursued after more than a decade of training, years choosing the company of my beeper over that of my loved ones, and nights overtaken by my own tears as I failed to set aside the suffering that my patients entrusted to me. And now the protesters were attacking my calling. Yet, I couldn’t help but think that maybe I should join them.
The science of psychiatry clearly is in crisis.
Psychiatry is dependent on the pharmaceutical industry to distribute the medicines that are often essential and effective in the treatment of many mental illnesses.
Yet there is a glaring gap between Big Pharma and our healthcare ideals. The drug companies focus their energy on advertising, patent extensions and minute modifications to blockbuster drugs – maximizing profits while contributing little to improving the care of our patients. Even worse, billions of dollars supposedly targeted on ‘scientific research’ is wasted on deceiving doctors into favouring their products over those of the competition.
And the stakes are astronomically high – the net profits of the top 10 US drug companies exceed the total of the other 490 industries of the Fortune 500 combined.1 And footing that bill are our patients and already-overburdened healthcare systems.
I am reluctant to use the phrase ‘conflict of interest’ – it doesn’t capture the magnitude of the problem. I feel ‘scandalous’ is more fitting. The industry is not simply biased but deliberately manipulating scientific research to promote its products. Such tactics include suppressing negative test results, ghostwriting scientific articles and an impressive ability to spin any data into favourable results in their interest.
Repeated studies show that industry-funded research – the majority, as there is very little funding for non-industry sponsored research – is blatantly skewed towards their own products. Intentionally distorting study findings is a practice so ubiquitous that we need numerous lectures in medical school just to teach us the detective skills necessary to uncover all the sneaky tactics. But with the hundreds of articles being produced each month, such detailed scrutiny is an impossible task for any physician.
So we are left with the unsettling question: who can we trust to provide us with credible evidence to compare medications?
Can we rely on the information dispensed by ‘expert lecturers’ at medical conferences? With their extensive list of connections to the pharmaceutical industry, you might as well skip the lecture. You can easily predict their conclusions based on the mandated first slide requiring disclosure of industry ties.
And what about textbooks? It’s hard to be too confident when the author of our pharmacology ‘Bible’ is making a guest appearance at the Eli Lily booth to sign freebies.
Well, there are always national treatment guidelines – except that 90 per cent of the authors responsible for US treatment guidelines for depression, bipolar disorder and schizophrenia have financial ties, including investments, in the drugs that they recommend.2
It feels as if a force more powerful than ourselves is overtaking us. Yet, as doctors and patients, ultimately we hold the position of gatekeeper. As physicians we have a responsibility to protest the greed of Big Pharma, not merely grumble while pocketing personal benefits.
I strongly defend my profession for our ability to alleviate immense suffering. Mental illness strikes a quarter of all adults and ranks as the leading cause of disability in North Americans age 15 to 44.3 And mental illnesses are largely treatable. This is precisely why selling psychiatric drugs is such a lucrative business.
But this is also why the fight to protect our professional integrity is essential. We can’t let the influence of the market corrupt science and with it our faith in mental-health treatments. We need to prevail over this assault so we can focus on the larger battle of healing the billion people currently plagued by mental illness.
I refuse to surrender to the protesters who oppose psychiatry. Instead, we must fight to save medicine from being undermined by corporate dominance.
- The Truth About the Drug Companies: How they deceive us and what to do about it, Marcia Angell, Random House, New York, 2005.
- ‘Conflict of interest bedevils pyschiatric drug research’, USA Today, Marily Elias, 2009.
- ‘Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders’ in the National Comorbidity Survey Replication, Archives of General Psychiatry, Jun;62(6):617-27, Kessler RC, Chiu WT, Demler O, Walters EE, 2005.