Getting the Correct Medication From Your Psychiatrist

Deborah Gray Health Guide
  • Why is your psychiatrist prescribing a particular drug for you or someone in your family? Is it because it's the most effective? Or could it be because he or she just attended a conference at which a leading psychiatrist touted the benefits of the drug? Is is possible that your psychiatrist should be sending you to a psychologist for talk therapy instead? What influences his or her thinking when it comes to treatment?

    Your psychiatrist stays on top of the current medical research in a couple of ways. He or she reads medical journals and attends medical conferences. Let's say that at a conference, your doctor attends a talk by a leader in the field of child psychiatry, Dr. Joseph Biederman. Your doctor is confident that he or she can trust Dr. Biderman when he talks about treating children with psychiatric disorders using medication. Or your doctor might read an article that Dr. Biderman wrote for a medical journal about the benefit of psychiatric medication for children, even though that particular medication hasn't been approved for use in children.

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    It's hard to tell exactly what influences a doctor's reasoning when he or she recommends medication as a treatment. Do those pens and memo pads with a drug's name on it do anything? I'm guessing that they don't have quite as profound an effect as hearing about the drug's benefits from a leader in the field.

    It seems likely that the drug companies agree with me. A decade or more ago, they decided that they needed to expand their marketing efforts to target doctors more aggressively. Just giving doctors samples to pass onto patients, taking them out to lunch and giving them pens and notepads wasn't selling enough of the newer, more expensive drugs. So pharmaceutical companies recruited the leading psychiatrists as consultants and paid them to give lectures to their peers. Essentially, they turned them into high-priced salespeople.

    One reason psychiatrists have been a willing target is that they earn less than other specialists, according to a nationwide survey; half of what some other specialties earn. You can see why those consulting fees might be hard to turn down.

    But the gravy train, or the closure of the wage gap, may be coming to an end. Lawmakers are now investigating the most prominent psychiatric association, the American Psychiatric Association. Nearly 30% of the APA's $62 million budget comes from pharmaceutical companies. The current dust-up is over the lack of disclosure, and where disclosure policies existed, the failure to adhere to these policies. According to a New York Times article, some doctors apparently significantly under-reported the monies they were receiving from drug companies. I used Dr. Biderman as an example because he was one of two experts in child psychiatry at Harvard Medical School's department of psychiatry, who failed to report $1.6 million in consulting fees from drug makers that he earned from 2000 to 2007. That's an average of $200,000 per year each.

    In addition, a consumer watchdog group recently reported that more than half of the individuals overseeing the next edition of the Diagnostic and Statistical Manual of Mental Disorders have ties to the drug industry. Will these ties influence treatment recommendations? It seems like a distinct possibility that they will, at least subconsciously.

  • I personally don't think disclosure, or lack of it, is the problem. Let's be real. The information about these disclosures won't get to patients, and in many cases, not even to doctors. I think that doctors should have no ties at all to drug companies.

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    Hopefully, the current spotlight on the situation will bring that about. But here's an idea in the meantime. It's in the health insurer's best interests to curtail the out of control spending on drugs that is resulting from these partnerships between psychiatrists and the drug companies. Since a big part of this stems from the income gap that psychiatrists perceive, maybe the health insurers should hire psychiatrists as consultants to educate their members about their mental health care? Or to educate general practitioners on how to spot mental illness in their patients? Granted, this could be open to abuse also. But I think it's time to start thinking out of the box. The way things stand now, the drug companies have a nearly open line right to one of its most vulnerable set of customers.


    Psychiatric Groups Face Scrutiny Over Drug Industry Ties

Published On: October 16, 2008