Can You Trust Your Psychiatrist?

Pharmaceutical giant Eli Lilly will pay the largest penalty ever, over $1.4 billion, to the US Justice Department for marketing a medication, Zyprexa®, without proof of its effectiveness with certain conditions and plenty of reason to be concerned about its side-effects. Other recent media reports have revealed how a number of pharmaceutical companies, including Lilly, paid psychiatrist researchers small fortunes for developing and promoting medications for mental illnesses. If you can't trust big Pharma with its capacity to influence doctors then how can you trust your psychiatrist?

Psychiatrist researchers are hired by drug companies to study promising drugs in order to gain the FDA approval needed for a medication to go to market. These studies are called Clinical Trials and enable a medication to go from the laboratory to everyday use -- once it is determined that the drug works, for what condition, and with what risks and side effects. Payment to doctors to perform the studies -- and often additional handsome speaking fees -- is fraught with the prospect of drug companies wanting to see a good result from the studies since they have invested hugely (hundreds of millions to billions of dollars) in the product by the time it enters a clinical trial. Psychiatric researchers, as medical "thought leaders", are highly influential to their colleagues since the rest of the field typically follows their lead in diagnosis and treatment. What has been missing and what the public needs is absolute transparency so that all studies are reported (not just the positive results) as is the money paid to doctors. And we all should be skeptical about clinical trial results until they are replicated by different researchers.

Closer to home are the psychiatrists who prescribe medications once they come on the market. Like all doctors, psychiatrists are marketing targets where mind boggling amounts of pharmaceutical money are spent in two important ways. The first is advertising directed at psychiatrists in professional journals, at meetings and by "drug detailing" which is sending pharmaceutical representatives to doctors' offices. The second is kind of different because it is advertising directed at you because you can increase doctor prescriptions for specific products, and thus profits. This is called "DTC" -- direct to consumer advertising -- known to be far more effective than just working on doctors. DTC are the ads you see on TV, hear on radio and see in magazines. Drug companies have substantially redirected ad money from doctors to consumers because the returns are much greater. Think about the ads you have seen for depression, bipolar disorder, erectile dysfunction, and social anxiety (rivaled only by ads for gastrointestinal, heart and diabetes medications). If you go into your psychiatrist's office and say I want to try this or that medication the doctor is quite likely to give you what you want. Psychiatrists, thus, are targeted to prescribe by the Pharma companies and their patients -- a powerful duo. We psychiatrists have our work cut out for us if we are to better filter and manage these demands.

What can you do? First, be an informed consumer. Just like with a car or washing machine you can learn about medications and other treatments for mental health problems. Turn to websites like your state mental health agency or the National Institute for Mental Health, the National Mental Health Association and the National Alliance for Mental Illness. Google key words about what you want to know, as you would for breast or prostate cancer, diabetes, and heart disease. Ask others who have successfully navigated the mental health care system and taken medications. As has been said, caveat emptor -- let the buyer beware -- and be prepared.

Second, ask questions of your doctor and other health professionals. Rather than being a marketing arm of the pharmaceutical companies, be a prudent buyer. Don't be shy -- you are your best advocate. When you visit your doctor ask two questions: why are you suggesting this treatment for me and what alternatives do I have? When in doubt get a second opinion: any doctor who does not welcome a second opinion is not worth keeping.

Finally, recognize that medications for mental disorders often help but generally are not sufficient. Great reliance on medications has fostered inattention to individual and family therapy and skill building programs.

Trust is a precious matter. Pharmaceutical companies and some leaders in the psychiatric community need to regain it. That can start by responding to consumer and family expectations of transparency, ethical behavior and clinical decision-making where patient and doctor are equals solving problems together. When that happens trust will be built and sustained. That is the best protection of all.

Comments

[rolu]

Like with every other category there might be a Bernie Madoff of doctors out there, but I believe they are few and far between. Most of the doctors I know are really dedicated to do the best for their patients (they all welcome and encourage second opinions by the way), especially psychiatrists, who more often than not, must try many different drugs or combinations of drugs to find those that work better for each patient, because every patient reacts differently and there is no set standard or cure. Once they find what works best for their patient, rest assured they are not going to change the medications because a pharmaceutical company is throwing a few dollars at them to encourage them to use their drug rather than another.
And by the way, if all pharmaceutical companies promote their products and compete with each other, how would a doctor be influenced to prescribe more for one and less for another when all of them offer him/her the same perks?

[rolu]

Every Industry Has convention and Fairs were members exchange information and get updated on the latest product. That does not mean that the doctor listening to a colleague talk about one medication is going to alter the way he/she treats his/her patients. Will he/she be unduly influenced by a few samples or some fancy dinners paid by the pharmaceutical companies? If that’s the case, then the doctor should be the one we should be focusing on, because the doctor is breaking his/her oath and should be disciplined. Like a lawyer who doesn’t adhere to certain standards is radiated from the BAR association, so a doctors should be radiated or their license revoked if they are found to have broken certain standard of behavior.
In the end the responsibility for the patient health, lies with the doctors! I think if I were a doctor I would be very offended by your low view of their moral and ethic!! Suggesting that they are unduly influenced and make decisions for their patients mostly based on what pharmaceutical companies offer them in the form of free pens, samples or even fancy dinners instead of on what’s best for their patients is in my opinion ludicrous. And by the way, if all pharmaceutical companies promote their products and compete with each other, how would a doctor be influenced to prescribe more for one and less for another when all of them offer him/her the same perks?

[rolu]

Yes I want to be able to question my doctor (I don’t have a mental illness, but I see plenty of other doctors), I want my doctor to tell me why he/she is prescribing one drug instead of another. It is a good practice to ask for second opinions but I think that the issue of trust has to be between the doctor and patient. Your statement that “... Pharmaceutical companies and some leaders in the psychiatric community need to regain it...” doesn’t mean anything. The trust has to exist between a doctor and a patient. The doctor is who should respond “..to consumer and family expectations of transparency, ethical behavior and clinical decision-making where patient and doctor are equals solving problems together.” But I don’t share your gloom and doom view of doctors. They take an oath to “prescribe regimens for the good of the patients according to their ability and their judgment and never do harm to anyone, and to keep the good of the patient as their highest priority.” Based on that I believe that my doctor has a duty to read as many “...professional journals...” and attend as many “..information meetings..” and listen to as many "drug detailing" speakers as possible, because without doing it he would not be doing his job which includes keeping updated on all the latest studies and drugs in order to make the best informed decision possible for my health.

[rolu]

And here lies the truth of the matter. You can accuse pharmaceutical companies of shady practices (which to me still don’t look any different than any other industry practices) and trying to unduly influence the doctors and the public (by the way why are you only targeting mental illness drugs??? When this happens for every drug marketed out there???), but what it boils down to is the relationship between the doctor and the patients. I want my doctor to be as well informed as he/she can be and I want to be as informed as I can be as a patient. I like your suggestion or making myself a better informed patient by consulting public agencies but the only way I would know what to look up is after I see the “direct to consumer advertising” on TV. Most of the time, that add is what allows me to start a conversation and exchange of information with my doctor about what is best for me. That doesn’t mean I want to take every drug I see on TV!

[rolu]

And how are pharmaceutical practices different from those of any other for-profit company? We live in a capitalist society, that’s what we chose. So, free market practices are not illegal, nor should there be, any industry, pharmaceutical or other.

You make accusations but do not offer any proof for these allegedly fraudulent practices.
You write: “…Eli Lilly will pay the largest penalty ever, over $1.4 billion, to the US Justice Department for marketing a medication, Zyprexa®, without proof of its effectiveness with certain conditions and plenty of reason to be concerned about its side-effects..” again your statement is slanted to prove your point. Eli Lilly paid 1.4 billion to settle a law suit that alleged they had encouraged doctors to prescribe Zyprexa® outside their labeled, FDA approved, indications. In other words, Lilly settled a suit, but that does not mean that Zyprexa® is not an incredibly effective drug for most conditions for which it is prescribed. There is no proof that anybody has been harmed by its correct use, and in spite of all the negative media, I’m convinced that like many other drugs, its effectiveness and impact on patients lives far outweighs the side effects. But that is also a decision that I or you should not make. That is a decision that doctors make when they write a prescription.

[rolu]

Pharmaceutical companies seem to have become the latest big bad monster, guilty of every possible sin. Especially those that market drugs for mental illnesses. I think that writing pieces like this post or some articles that came out in the NY Times does a great disservice to all of us and especially to the people suffering from mental illness. It could also be considered almost criminal because, as you probably know, one of the biggest problems with people suffering from mental illnesses is to convince them to take their much needed medications. Any doubt even unfounded that they might get in their head after reading slanted articles like this one and they could stop taking their meds with dire consequences for them and society. Let me clear up some things here. Without pharmaceutical companies paying for research and clinical trials we would not have many effective medications that are now commonly available. This is true for psychiatric drugs as well as all other drugs. One thing that you conveniently seem to forget in making your point is that after all the studies and clinical trials are done, all drugs are subject to FDA approval. In this country where everybody is always so proud of the checks and balances in place in the system, the FDA represents drugs’ checks and balances. The responsibility for making sure that the drugs they approve are effective and don’t have side effects lies with the FDA and not with the doctors and the pharmaceutical companies.