Is public health compromised as a result of financial ties between the drugs industry and healthcare professionals? CARL O'BRIENreports
WHEN RICHARD Patterson was diagnosed with a mental health problem, he was advised by a health professional to examine an information pack on dealing with bi-polar disorder.
“Solutions for Wellness” was emblazoned across the front of the pack, which contained information on nutrition, wellness and maintaining a healthy lifestyle.
Then he noticed the logo of a major pharmaceutical company which manufactures one of the main drugs used in the treatment of bi-polar disorder – he realised it had sponsored the pack.
Patterson, a critic of the “medical model” of psychiatry who feels drugs are not the answer, felt both dismayed and aggrieved.
“I didn’t have any problem with the material regarding the importance to general wellbeing of diet, exercise and stress management,” he says. “But, because pharmaceutical companies can’t advertise openly, it just serves as a marketing vehicle.
“The consultant wanted me to take a drug made by the company. But, like many people, I don’t believe in the unproven ‘chemical brain imbalance theory’ that underpins medical model-based psychiatry. Yet, I felt I was being coerced into taking this drug.”
The tensions and potential conflicts of interest between psychiatric care and pharmaceutical companies are due to come under the microscope at a conference later this week.
Mad Medicine: Do Conflicts of Interest Drive you Crazy?is the provocative title of a seminar being held at University College Cork, partly organised by the Critical Voices Network Ireland – a coalition of service users, professionals and carers who are opposed to the traditional "biomedical" approach to psychiatric care.
“The seminar is about promoting greater public scrutiny and debate about financial conflicts of interest in medicine and how these are handled by regulatory authorities,” says Dr Orla O’Donovan of UCC’s department of applied social studies.
By tracing the development of various psychiatric medicines, the conference will examine potential conflicts of interest at various stages including research, publication of research findings, licensing, promotion, public subsidisation, prescribing and monitoring of adverse side effects.
Some of the most revealing work into the extent to which professionals are potentially compromised by links to the drugs industry has been done by Lisa Cosgrove, a psychologist and associate professor at the University of Massachusetts.
Her study found that more than half of the psychiatrists who took part in developing a widely used diagnostic manual for mental disorders had financial ties to drug companies before or after the manual was published.
In all, some 95 – or 56 per cent – of 170 experts who worked on the 1994 edition of the manual, called the Diagnostic and Statistical Manual of Mental Disorders, had at least one monetary relationship with a drug maker in the years from 1989 to 2004.
The most frequent tie involved money for research, according to the study, an analysis of financial records and conflict-of-interest statements.
“The lack of biological markers – for example, there is no blood test for depression – render psychiatry particularly vulnerable to undue industry influence,” says Cosgrove, who is due to speak at the seminar.
There potential conflicts of interest can have serious public health implications, she says.
Patients may be assigned diagnostic labels that are not valid, or they be receiving imbalanced or even inaccurate information about their mental health treatment options.
These issues have also been bubbling to the surface over here. In one of his last reports as the Inspector of Mental Hospitals, Dr Dermot Walsh expressed his concern about the nature and influence of seminars and conferences organised by drug firms.
He said some of the events – often overseas – outlined latest research and other relevant information – but “others appear to present unscientific material aimed at influencing prescribing practice”.
The Irish Pharmaceutical Healthcare Association (IPHA) responded by saying its members had signed up to a code of conduct “that makes it very clear that hospitality can only be secondary to the main purpose of the event and reasonable in scale”.
Earlier this year, the European Parliament’s committee on budgetary control issued a stinging report over the European Medicines Agency’s poor handling of conflicts of interest.
It questioned the independence of the European Medicines Agency’s experts, who were involved in the evaluation of various medicines, and sought an explanation over why it took a decade to ban the slimming drug Mediator after being first alerted to dangerous side effects.
It’s not just the European regulator who has faced tough questions.
The State’s drugs regulator, the Irish Medicines Board (IMB), has been accused of being too close to the pharmaceutical industry.
In a report published in the academic journal Social Science Medicine, Dr Orla O'Donovan said senior people working in or with the IMB faced potential conflicts of interest as a result of past links to the pharmaceutical industry.
She said they “managed” rather than prohibited potential conflicts of interest and restricted public access to information on the issue.
The IMB rejected the claims, but has said it is planning to provide public access for the first time to the declarations of interest of its staff, board and committee members in pharmaceutical companies.
It maintains that rules prohibit staff or their families from having any financial interest in the pharmaceutical industry and from working on products that they may have had an involvement with in previous employment.
In addition, members of advisory committees are asked to confirm at each meeting that they have no conflict with matters under discussion.
The organisers of Saturday’s conference hope the seminar will refocus attention on a report by the Oireachtas Joint Committee on Health and Children into this area in recent years.
It recommended a number of changes to the Irish drug regulation system, including greater levels of disclosure over potential conflicts of interest that can arise in pharmaceutical industry marketing activities aimed at doctors.
“Many people were encouraged by the report because it gave official recognition for the first time of how conflicts of interest can arise in medicine,” says O’Donovan. “What we would like to do is to reignite that discussion and the implications for public health.”
Mad Medicine: Do conflicts of Interest Drive you Crazy?
takes place on Saturday, September 24th, at the Brookfield Health Sciences Complex, University College Cork. It is organised by Health Action International – Europe in association with the Critical Voices Network Ireland