Most psychiatrists who wrote clinical guidelines had financial ties to drug companies, study shows

Apr 5 2009

Most of the psychiatrists on the American Psychiatric Association panels who wrote the newest clinical guidelines for how to treat depression, bipolar disorder and schizophrenia had financial ties to drug companies, according to a study by Boston researchers scheduled to be published this month in the journal Psychotherapy and Psychosomatics, the Boston Globe reports.

For the study, Lisa Cosgrove of the University of Massachusetts-Boston and colleagues, including Sheldon Krimsky of Tufts University and Harold Bursztajn of Harvard Medical School, searched publicly accessible databases such as Medline and the records of the federal patent office to identify financial ties. According to the study, 18 of the 20 authors of the guidelines had at least one financial tie to drug companies. Twelve authors had ties in at least three categories, such as consulting, research grants, speaking fees or stock ownership, the study found. In addition, the study found that all of the authors of schizophrenia and bipolar guidelines had relationships with the drug industry, while 60% of the authors of the depression guidelines had such connections. According to the study, more than 75% of the authors received funding for research from drug companies. In addition, one-third of the authors served on the speakers' bureaus of drug companies, the study shows.

The study authors wrote that the guidelines focus heavily on medications and give little focus to nondrug treatments. The guidelines also do not focus on the time and process of removing mentally ill patients from prescription drugs, the study found. Three common diagnoses result in around $25 billion in drug sales annually, according to the study.

The psychiatric association now requires psychiatrists who write guidelines to publish their financial ties to drug companies, but the rule did not exist when the current guidelines for depression, bipolar disorder and schizophrenia were published in 2004 and 2005.

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Cosgrove said, "Most patients assume that when they're prescribed a drug, the decision is made on the basis of an objective review of the scientific evidence." She said that asking whether the guidelines actually are objective is "an important question because the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence." Krimsky said that guideline writers "should be totally transparent about their relationships with the drug companies so people reading a guideline might ratchet up the skepticism they might have about the use of drugs as the first line of therapy."

John McIntyre, chair of the association's guideline steering committee, said the association works to ensure the guidelines are "free of bias to the greatest possible extent." He said they screen members who work on each set of guidelines in order to avoid having people writing rules who receive more than roughly 5% to 25% of their income from pharmaceutical firms. In addition, the pharmaceutical industry defends its right to pay "thought leaders" in various fields to use their knowledge to aid drug development and marketing. The industry says that specialists' input benefits colleagues and patients, and that those specialists must be paid for their expertise.

Roy Perlis, a consultant on the bipolar guidelines, said, "The people who are most responsible for developing new treatments right now are the pharmaceutical companies. What is being lost in all this is that if I didn't work with them, I couldn't do my job as a scientist -- the part of my job that says we have people who are suffering that need new treatments" (Goldberg, Boston Globe, 4/2).