It's time for psychiatrists to stop being so friendly with pharmaceutical companies

Psychiatry is "committing professional suicide" because psychiatrists are far too willing to accept gifts, food, trips, and free samples from the pharmaceutical companies that push psychiatric drugs, says psychiatrist David Healy. Worse, he says, those same drug companies have been caught hiding dangerous results from the FDA and doctors, covering up that malfeasance, and attempting to silence critics (including Healy himself). At Time's Healthland blog, Maia Szalavitz shows that Healy makes a persuasive case against the pharmaceutical giants and in favor of patients, doctors, and the federal government doing more to hold these companies accountable.
Discuss

21 Responses to “It's time for psychiatrists to stop being so friendly with pharmaceutical companies”

  1. penguinchris says:

    I was taken to a psychiatrist when I was 13 or so. I literally sat in his office (which was adorned with tribal and tiki art; was pretty cool actually) for the entire hour and neither of us said anything – it was some sort of bizarre staring contest. After that we left his office and he gave my mom, who had been waiting outside, several handfuls of free samples of Zoloft. He didn’t even try to diagnose me (I figured it out myself almost ten years later).

    Now, I know my anecdote doesn’t mean much in the big picture, but I’ll just say I’m not at all surprised at this.

    BTW Maggie I see you’ll be in Toronto; naturally after I’ve already moved back to California from Buffalo. I’m three down on meeting all the Boingers… come out to SoCal soon!

    • Tavie says:

       This is not at all atypical. Very similar to my experiences as a child.

    • Antinous / Moderator says:

      I literally sat in his office (which was adorned with tribal and tiki art; was pretty cool actually) for the entire hour and neither of us said anything – it was some sort of bizarre staring contest.

      Hey, that happened to my friend and me when we went into Boston at age 16 and visited the Church of Scientology!

      My psychiatrist, on the other hand, asked me a bunch of vague questions and then gave me a note to get out of gym class forever.

      • penguinchris says:

        Hehe, but why do I suspect you and your friend went to the Church of Scientology specifically to screw around?

        I must have been doing something wrong, I really could have used a note to get out of gym class! Damn.

  2. Cowicide says:

    Doctors of all kinds also get invited to “seminars” sponsored by pharmaceutical companies that happen to be located in resort areas like Hawaii, etc.  It’s a scummy, dangerous way to get all doctors to prescribe drugs as much as possible whether they are needed or not.

    ProPublica also has these damning stories:  http://projects.propublica.org/docdollars/

  3. Brad Gall says:

    I watched this and was in awe of how some Dr are doping up kids without any clinical proof that the drugs will help and are not harmful to the kids.

    http://www.pbs.org/wgbh/pages/frontline/medicatedchild/view/

    • TheOven says:

      I hilariously miss-read that as “Dr. Dre is doping up kids”.
      Can I get a hell-yeah? http://youtu.be/7PvJV9Lytes

  4. Joshua Ochs says:

    Doctors prescribing pills shouldn’t be too cozy with the industry – same thing as lawmakers who are too cozy with lobbies, or regulators and the industries they’re supposed to supervise. Gifts, food, trips – things unrelated to the direct practice of medicine – I see as harmful and blatant schmoozing. Free samples I rather like, as it allows doctors to try a few different therapies cheaply/for free, and ensure it’s working before making a long-term (and sometimes very expensive) commitment.

    That said, it doesn’t surprise me overmuch. The popular conception of psychiatrists has the big couch, and the doctor listening to your problems, taking notes, etc. In reality, psychiatry takes a much more clinical/biochemical view, focusing on symptoms and correcting them via medication. With that kind of focus, they’re prime targets for companies pushing new drugs. It’s therapists who will spend time in conversation, try to get at underlying issues and background, propose ways to change behavior, make plans, etc. To be fair – therapists will usually agree that if some people really need some medication just to establish a baseline from which therapy can work.

  5. RedShirt77 says:

    This is part of the reason I never pursued an advanced degree in psychology.  Pills are clearly sledge hammers when dealing with the delicate chemistry of the brain and even more so when you are talking about adjusting negative thinking.  Clearly they are an invaluable tool when people become a danger to themselves or cannot function in society, and maybe occasionally a helpful tool to help someone deal with problems more quickly and effectively than through counseling alone…. but obviously we are just putting people with short term issues on drugs without the support needed to get back off them.  Its disturbing. 

  6. BookGuy says:

    I don’t know about the “committing professional suicide” part, unless there is a significant uptick in psychiatrists losing their licenses over the relationships.

    And I say this as someone whose life has been saved by psychiatric medicine, so that’s my bias.

    • I think he’s referring to the entire profession losing credibility. 

    • ocker3 says:

      I’ve been seeing a very good doctor over a few years, dealt with all kinds of problems. She can prescribe medicine, but prefers not to in most cases. Her focus is often on reconnecting people with what they are actually feeling, I know I’ve been cutting myself off from my emotional state for years as a survival mechanism. So rather than just bringing up the past and asking me how I feel about it, she encourages me to hold the memory (and not skip on like I normally do), experience how that memory makes me feel, where the emotion/feeling/tension sits in my body, and work on releasing it.

      In three years I’ve gotten rid of daily suicidal thoughts, realised how unhealthy a long-term co-dependant relationship was and moved on, learned how to connect with other people and my parents properly again, and a long list of other things.

      As you’ve probably experienced, drugs can be useful, but usually work best as a way of keeping a person on a relatively even keel while other problems are resolved. At some point the goal should be to remove or reduce them so you can function without chemical intervention (for example so you can enjoy travel to remote places).

  7. Daemonworks says:

    Normal MDs aren’t any better, unfortunately. Sadly, still not illegal or even officially unethical.
    And not likely to become so either, given how much money the companies can and will throw around to ensure that no regulations are ever put in place to limit their actions.

  8. wazmo says:

    And to add insult to injury, Teva was forced to pull their generic bupropion for not being bioequivalent. Now ask yourself how many other extended neuroleptic drugs aren’t 100% bioequivalent….

  9. Alan Olsen says:

     How is this any different than doctors that accept all sorts of gifts from pharmaceutical reps to prescribe whatever the new and expensive medication is this week? If you are in industry and you accept gifts from vendors you can run up against various corrupt practices acts. I don’t understand why these rules do not apply to the medical field.

    As for psychiatric medications…

    Most of the people who I have seen harping on the overuse of these medications are not qualified to do so.  They don’t understand why they are being prescribed, they just object that that is many times one of the first treatment options.

    I have a fair amount of experience with this. I have had a number of members of my family with mental illness. Talk therapy doe not work unless your head is clear. If your brain is lying to you and telling you that people are conspiring against you, breaking into your house, and other paranoid delusions, you are not going to be receptive to anything resembling talk therapy. In the case I had to deal with personally, it took a course of drugs to get that person stable and rational enough to get the other therapy to do any good.  Will that person ever go off those drugs? I hope not. Without them their view of the world is very very strange and makes my life a living hell.

    There are far too many people out there who NEED those drugs to be sane human beings, but because of this idea that people are better off without “artificial” medication (and that they are VERY expensive), far too many people go without. Without these drugs they either become a burden on their families or turn to weird forms of religion or politics that validate their insane world view.

    “Australia was founded as a penal colony.
     America was founded as an insane asylum.”

    • wysinwyg says:

      How is this any different than doctors that accept all sorts of gifts from pharmaceutical reps to prescribe whatever the new and expensive medication is this week?

      I don’t think anyone said it was any different, although I do think it’s a lot more insidious to overprescribe medication that actually changes someone’s personality than, say, prescribe a slightly-more-expensive-than-necessary cholesterol drug.  If you pay attention, Maggie’s been doing lots of stories about overprescription in medicine in general.

      Without them their view of the world is very very strange and makes my life a living hell.

      What an absolutely frightening thing to say.  Making your life a “living hell” doesn’t quite seem like justification for medicating someone into zombiehood.  Maybe you phrased that badly but that’s how it comes across.

      There are far too many people out there who NEED those drugs to be sane human beings,

      Frankly, I don’t trust anyone who claims to know the division between sane and insane — or worse, claims the authority to draw the line themselves.  You guys scare the shit out of me.  I’m an atheist and I’d rather talk to a Catholic priest or Muslim Imam about emotional or mental issues than a psychiatrist or psychologist.

      Without these drugs they either become a burden on their families or turn to weird forms of religion or politics that validate their insane world view.

      I bet you the majority of people in “weird forms of religion or politics” would not be diagnosable with mental illness if you guys weren’t working so hard to broaden the definitions of what constitutes “mental illness”.

  10. Will says:

    Doctors and psychiatrists, both, but they’re the symptom. Remember that GPs often don’t have the same level of training in psychopharmacology as psychiatrists, and just as often if not more prescribe drugs pushed on them from unbelievably powerful pharmaceutical conglomerates who care more about profit margins than treating symptoms. The focus should be on the conglomerates more than the doctors and psychiatrists, just as the militarization of the police is more a problem if the military hardware lobby than local police departments. 

    • zampino says:

      Doctors *AND* psychiatrists?  Psychiatrists are medical doctors in all senses of the word.

      That said, you are right…GPs don’t have the experience or training in this area.  By and far, GPs are prescribing psychopharms far more than any others and abusing them far more.  They really don’t know how these work and take the words of the pharm companies at the basest claim without understanding any further what is wrong.

      However, it is more of a health care / insurance problem than anything else.  As a trained therapist who chooses to do research psychology instead (and had interviews with med schools last month after a decade in this field with no intention of ever touching psychiatry), I can note that in the US most insurance companies give between 6 and 8 sessions a year.  Given this, talk therapy isn’t going to work.  

      For quite a few ailments, talk therapy does work, but it takes a lot of face time with the client.  And often times, the psychopharms give an opportunity to break former habits and beliefs for talk therapy to work.  Without the appropriate therapy, the pharms are going to eventually need to be increased and eventually rendered as a useless dependence.  Most psychopharms are really intended to be used for a short amount of time and not to be used as they are today.  However, again, given the reality of the health care system, sometimes a dependance on these drugs are far more beneficial than nothing at all.

      It isn’t the drugs that are bad — although some can have lasting effects if given improperly — it is that a bad private insurance system is holding back bad treatment and physicians / therapists are caught in the middle.  Outside of the office, most will gladly rant against this system.  In the office…they make the decision between a system that delays the symptoms for the moment, or nothing at all.

  11. blendergasket says:

    When I was younger I wound up going to a psychologist. His basic perspective was that I had anxiety and ADD that would keep me from working well with him to get to the root causes of my anxiety and ADD so what I needed to do was medicate myself to a state of normalcy so I could work with him to get to the bottom of my anxiety. Like a fool I went along with him, took my referral to a general practitioner who was able to prescribe the “medicine”. I started taking it and lo and behold, it helped me get past my anxiety and the ADD medicine helped me focus. 

    The anxiety medicine helped me get past my anxiety by almost completely cutting off my ability to introspect so I because a caricature of my concept of myself. My personality started becoming really extreme and I started viewing people as flat, one dimensional toys to play with. I am pretty sure if I continued taking the meds I would be in jail now for committing some act of violence against someone I no longer viewed on the same plane as myself. 

    My ADD medicine helped me focus on stuff I really didn’t care about, which has always been super had for me and had the added affect of making me get angry and frustrated really easily. 

    It took an ex-girlfriend who happened to visit me to open my eyes as to what I’d become. She had a long talk with me and told me that I was not who I used to be and the change was not in any way good. 

    I started looking at myself and realized that this was in fact true and that the reason I hadn’t noticed the shift was because the way the “medicine” got rid of my anxiety is to cut off the feedback. 

    I tried to stop taking the anti-anxiety “medicine”, Effexor I believe it was, and started getting these lightning bolt sensations shooting through my body. I kept trying to find what this was but until I googled some combo like Effexor and Evil together I couldn’t find any results talking about the really negative reactions people have had to this. This was in 2003 or so, so hopefully google’s improved, but the pharma SEO people definitely did a good job sinking any negative info way down into the results of routine searches. 

    I finally was able to taper down off of it, tapering at 1/2 the recommended rate and weened myself from it completely. 

    I have friends whose personalities have been really damaged by these medications and they are afraid to get off of them. 

    In addition I feel that there is a big societal problem with these meds. They take society as being an unchangeable influence on people, who must be chemically altered so the parts that don’t fit in are dulled or ground off to the point where they can function successfully in the society. Drugging people into complacent acceptance of a broken system that no longer caters to the spiritual needs of the people living in it seems like a recipe for complete social disaster. 

  12. William Hurley says:

    The scope, scale and severity of the pharmaceutical industry’s problems is truly astonishing.  The Payola-like symbiosis between industry reps and dispensers must be cleaved many reason, first among them to reorient the skewed relationship that is today’s diagnostic/prescriptive function. 

    That said, the structure of health care delivery at-large needs to be remedied.  Using the example of diagnosing then prescribing psychoactive medications, one hardly needs to scratch the surface of the patient/diagnostic process to see big dangers.  Big dangers such as over-worked, under-compensated, under-informed primary care providers taking on the primary responsibility of prescribing these medications.  The pressures applied by the payor-side and delivery facilities themselves put PCPs in a difficult spot, a spot which is then exploited by pharma marketing which provides CPE look-a-like conferences and seminars to PCPs.  That’s, of course, in addition to the hired-gun MDs who act as the informed friendly face ensuring the seminar attendees that they’re doing the right thing by being there and in prescribing the meds they’re “learning” about over other alternatives.

    That said, the track record of pharmas’ products resulting in improved QoL for patients is astounding.

    One aspect of this cluster-f that’s not discussed in the Time piece is the abysmal state of the general public’s understanding of and familiarity with the scientific process.  Patients, their families and non-clinical care-givers suffer from misapprehension of and/or misinformation regarding the efficacy of a given course of treatment – to include the meds and the meetings/sessions.

    Pursuing the thought at the end of the above paragraph, it is important to note that a patient is likely to see one medical professional for on-going care or treatment and another for the prescription management process (e.g.: social worker/psychologist and PCP or NP).  The fork in this delivery path requires that the patient herself (or himself) act as general contractor to her/his own health care – which is fraught with danger as its  practiced in service of mental health care.

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