A Bad Mix: Psychiatric Drugs, Money, and Children

I gripe about the poverty of postdoctoral scientists, but I'd rather be poor and keep my professional integrity than be lavishly paid by drug makers and lose my conscience. The NY Times has a story about psychiatrists who receive payments from drug makers, and who also just happen to have a tendency to frequently prescribe 'atypical drugs' for children. (Atypical here means prescribed for an unconventional use or patient population, one for which the drug was not initially designed. Atypical prescriptions are not necessarily bad - physicians are allowed to use their professional judgment to write such prescriptions.) This isn't a new issue by any means, but the NY Times story reemphasizes its importance.

The story described physicians who are paid thousands of dollars by drug makers to lecture on or write about (in other words, promote) potentially best-selling anti-psychotic drugs. Those same physicians just happen to prescribe these drugs much, much more frequently than physicians who are not paid by pharmaceutical companies. Often the patients receiving these prescriptions are adolescents or children - populations on which these drugs have not been well tested.

Amazingly, these physicians think that this massive conflict of interest can be dismissed simply by denial. According to the NY Times:

"Doctors... maintain that payments from drug companies do not influence what they prescribe for patients."

Yeah, right.

Even without any malicious intent, a conflict of interest can exert an influence on someone's behavior. The NY Times quotes Dr. Steven Hyman, the provost at Harvard:

"There’s an irony that psychiatrists ask patients to have insights into themselves, but we don’t connect the wires in our own lives about how money is affecting our profession and putting our patients at risk."

If a drug works well for a certain class of patients, it should be promoted by physicians who give lectures because they are leaders in their field, not because they have been selected by marketing executives to push the drug. These physicians should show some integrity and not accept lecture fees or other honoraria from drug makers.

No matter how fervently these physicians believe that their professional judgment is not affected, at the very least they should care about maintaining the trust of their patients. Would you be concerned if your child's physician was being paid thousands of dollars to promote an anti-psychotic drug, not officially approved for use in children, that had just been prescribed for your child? I sure as hell would.