Doctors And Drug Companies – Too Close For Comfort?

The nexus between doctors and hospitals who prescribe brands of medication manufactured by companies they have links with, is well known. Often the links are above board and completely ethical. But there is always the chance of undue influence entering the field, as is seen from what has been revealed about the psychiatrists who wrote the latest guidelines on the treatment of depression, schizophrenia and bipolar disorder.

A study on the links between the American Psychiatric Association (APA) panels that write these guidelines for medication used in psychiatric treatment and the pharmaceutical companies reveals a potential for large scale conflicts of interests, biased research and recommendations that may favor the use of specific medication beyond needed levels.

Dr. Roy Perlis, who is a consultant on bipolar treatment guidelines, is associated with the Psychiatric Genetics unit at Massachusetts General Hospital. Dr. Perlis recently revealed that he has received speaker and consultancy fees from major drug companies. Dr. Perlis, while admitting to the payments, says that his association with the drug companies gives him access to the latest medical breakthroughs, which enable him to do his job better and does not conflict with his responsibilities.

Whatever the truth may be in Dr. Perlis’s case, the fact that doctors and drug companies have financial ties opens the door to a medical minefield. There is a growing backlash against such ties and eminent doctors and researchers are now pushing for a change in the system. Their argument is that, even if a medical guideline appears to be fair and advocates the best medical practices, any financial ties between the drug companies and those who created the guideline, opens up the question of bias. A full disclosure of the links between the writers of the guidelines and the drug companies must be made so that those who use the guidelines are aware of the potential of bias.

The pharmaceutical companies defend their use of medical specialists to help in their research and development work, and say that all such guidelines are subject to such extensive review that the chances of even any unwitting bias coming through are remote.

However, the fact that the authors of the bipolar and schizophrenia guidelines all have pre-existing relationships with the drug companies, as did 60% of the authors of the depression guidelines, raise a host of ethical issues that needs to be addressed.

The APA, according to news reports is now considering setting a limit on the income that committee members derive from drug companies. But will this be enough?