Monday, July 23, 2007

Ethical Dilemmas in Health Care: the special case of psychiatrists

The health care business in this country is full of conflicts of interest and insider dealing. It's rife with ethical dilemmas, however most healthcare professionals act as if they couldn't find an ethical dilemma if their lives depended on it.

Consider today's press release by the American Psychiatric Association. They have formed a national committee of experts to go through the DSM, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This manual is used by everyone in the mental health profession to diagnose a mental disorder and encourages best practices for treating diagnoses. Certain diagnoses encourage prescribing of certain very expensive medications. So there's lots of incentives for drug companies to influence psychiatrists and their diagnoses. So who would you want inventing the diagnoses? Somebody who isn't conflicted, correct?

According to their press release: "Of the 27 task force members, eight had no relationship with industry and 19 disclosed relationships with industry during any of the 36 months leading up to their nominations. The APA made all task force members' disclosures available during the announcement of the task force. Several otherwise highly qualified indivduals were ruled ineligible fortask force appointments due to their competing interests."The press release goes on to say "The APA Board of Trustees established limits on relationship with industry that are more stringent than federal agency limits," said APA President Carolyn Robinowitz, M.D."What makes the DSM powerful is its value in clinical practice. Patients deserve a diagnostic manual based upon the latest science and free of conflicts of interest."

So I took a look at the disclosures made by the committee members to see what they must attest to before becoming a committee member. They must disclose the last 36 months of connections to the pharmaceutical industry, and they must limit their income from the industry (excluding unrestricted grants) to $10,000 per year for the next year.

70% of these committee members are ONLY taking $10,000 a year from industry while they work on reworking the DSM-V. When I look at what they're getting from industry, it's really astounding to me. It includes things like: consulting fees, speakers bureau, honoraria, stock options, royalties and much much more. It makes me ask: who did they NOT accept on their committee?

One of the grantees for the AG program, Elissa Ladd (who signed a conflict of interest form which says that she has not taken - in the last two years - and will not accept for the duration of the grant any of this kind of funding from industry) has put together curricula in a movie format that you can watch to tell you why these kinds of conflicts are not good for consumers. Watch it, and weep for the psychiatrists. They evidently have no clue what a conflict of interest is and why people shouldn't trust them. For any reason, let alone medical reasons.

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