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|Clinicians Digest Sept/Oct 2008|
Clinicians Digest Sept/Oct 2008
Researching for Dollars
By Garry Cooper
In recent years, increasing evidence has accumulated about the pervasive impact of the millions of dollars flowing from pharmaceutical companies into the pockets of psychiatrists working on research, diagnosis, and treatment in the mental health field. This funding includes everything from the financial support for the presumably impartial clinical trials demonstrating the efficacy of new psychiatric medications to the huge consulting fees paid to noted figures in the field for speaking and writing about treatments that have the potential to generate enormous economic windfalls for the pharmaceutical corporations providing the funds.
This money flow has serious implications for the objectivity of drug-trial research. A metanalysis of 301 drug-trial studies in peer-reviewed psychiatric journals, published in the November 2006 Psychological Medicine, found that studies funded by pharmaceutical companies showed positive results for drugs 78 percent of the time, whereas trials without pharmaceutical company funding found favorable results only 48 percent of the time.
In May, an ongoing Senate investigation revealed yet other troubling details regarding the connection between pharmaceutical money and leading psychiatric advocates for the drug treatment of children. The Senate Finance Committee, chaired by Senator Charles Grassley (R-IA), found that noted Harvard psychiatrist Joseph Biederman, who's been extremely influential in popularizing the diagnosis and pharmacological treatment of pediatric bipolar disorder (PBD), underreported his income from drug companies in the last few years by at least $1.5 million.
Between 1994 and 2003, PBP diagnoses increased 40-fold: from 20,000 to 800,000 cases. At the same time, many critics have claimed that PBD is a loose diagnosis, given to a range of childhood behavioral problems, and has become a convenient justification for prescribing medications. While meds may quell the most disturbing symptoms, they carry side effects like weight gain, tremors, suicidal ideation, diabetes, and other physical and behavioral difficulties.
Grassley cross-checked the reported incomes from drug companies of two other Harvard researchers—Thomas Spencer and Timothy Wilens—who were investigating pharmacologic treatments for AD/HD and PBD, discovering that their combined incomes totaled $2.6 million, much of it unreported. Also in Grassley's sights is University of Cincinnati psychiatrist Melissa DelBello, who reported favorable results for treating PBD with Seroquel. She earned more than $180,000 in fees from the medication's manufacturer, not counting the funding for the original research.
Because underreporting violates both university and National Institutes of Health guidelines, Harvard is now conducting an internal review. However, more accurate income reporting isn't likely to solve the problem of the skewing effect drug-company fees have on research findings and prescribing practices. Study results have a long half-life, and disclosures of researchers' financial interests are usually short-lived stories, especially once desperate parents learn about promising research results for new treatments endorsed by noted figures in the field like Joseph Biederman.