companies' influence in psychiatry
pervasive, experts say
by Timothy Kirn, Clinical Psychiatry News (July 1, 2006)
TORONTO -- Psychiatrists should be very concerned about the influence
pharmaceutical companies wield in their field, and in medicine as a whole,
two psychiatrists said in presentations at the annual meeting of the American
The pharmaceutical industry has been encroaching with greater influence
in continuing medical education, said Dr. Daniel J. Carlat, a psychiatrist
in private practice in Newburyport, Mass., and editor of the Carlat Psychiatry
Report, a newsletter that contains no advertising. Despite a decision
last year by the American Academy of Continuing Medical Education to strengthen
the rules governing industry support of CME, industry continues to increase
its investment in accredited symposia and materials, he said. In 1998,
industry provided $302 million worth of CME support, 33% of the total
spent. By 2002, that figure had become $1.1 billion, 52% of the total
spent. Currently, it is estimated that industry supports 57% of all CME.
Dr. Carlat said he recently conducted an experiment with CME materials.
He randomly selected 15 CME-accredited articles out of all the accredited
materials received by his office between August 2005 and May 2006. He
then counted the number of statements made that were favorable or unfavorable
about a drug. Each article contained an average of 13 favorable comments
about a drug made by the sponsoring company and an average of 2.2 favorable
statements about competing
drugs, for a "pro-bias" ratio of 6. Rating the articles blindly,
Dr. Carlat was able to guess the sponsorship of each publication in 14
of 15 articles.
In Dr. Carlat's opinion,
these findings mean the CME providers "are out of compliance with
ACCME standards. I think the drug companies and medical education companies
need to get busy with something else or they are going to lose their accreditation."
Dr. Robert Kelly Jr.,
of Beth Israel Medical Center, New York, and his
colleagues found similar results in a comparison of major articles published
the four leading psychiatry journals in 1992 and 2002. They collected
articles that described clinical studies mentioning 542 different drugs.
blinded raters then reviewed abstracts of those articles and decided whether
the report was favorable or unfavorable to a drug mentioned.
Overall, 57% of the articles published in 2002 described studies that
some kind of industry sponsorship. That compared with 25% of the articles
published in the same journals in 1992, Dr. Kelly said.
When the drug trial was sponsored by a single company, the resultswere
deemed favorable to that drug in 79% of the articles. In contrast, articles
describing trials without company sponsorship were favorable only 48%
time. When trials were company sponsored and mentioned a competing drug,
mentions were favorable only 29% of the time (see box).
No one wants to impede drug discovery and progress, Dr. Kelly said. But
as the situation stands now, something has to change or medicine will