Psychiatric Group to Unveil Guidelines to Curb Conflicts
June 11, 2010

 Read it in WSJ online

By SHIRLEY S. WANG
 
The medical profession has been curtailing financial ties to drug makers in response to criticism over possible conflicts of interest. Now the bill is coming due: Doctor groups are facing budget shortfalls and cuts in services, and they are struggling to find new sources of revenue.
 
One influential medical society, the American Psychiatric Association, has seen a $7.5 million decrease in pharmaceutical-industry dollars over the past year—a more than 10% cut in revenue, which funds its research and education activities.
 
The decrease in revenue means having to cut back on some activities, such as lobbying on behalf of doctors and the mentally ill, and running educational programs in schools and for returning veterans, said Alan Schatzberg, immediate past-president of the APA, who convened a task force to develop conflict-of-interest guidelines that are expected to be unveiled today. The group also laid off more than 10% of its 200-person staff and reduced other administrative costs to cope with the shortfall.
 
The APA has made a number of changes in its practices in recent years, in part because it and several prominent psychiatrists have been scrutinized by the media and Congress for their financial ties with drug makers. Disclosure rules, codified in new guidelines expected out today, discourage doctors involved in APA policy decisions from accepting industry funds. In order to distinguish promotion from education, industry-sponsored symposia are on their way out and marketing at the group's annual meeting has been limited to the exhibit hall. And advertising by drug makers in the group's journals is down, in part because the industry faces its own pressures to avoid potential conflicts of interest.
 
The issue is playing out in doctors' offices, physician groups and medical schools around the country as the profession seeks to burnish its ethical image amid accusations by medical students, the media and lawmakers that taking money from drug makers could influence treatment decisions. Groups from the American Medical Association and the National Institutes of Health to the pharmaceutical-industry trade group have instituted tougher rules in the past two years. [APA]

 

Pharmaceutical spending on advertising dollars in medical journals—a key source of revenue for many groups—is down across most medical specialties, according to Kantar Media Professional Health, a market research firm. As a whole, drug-maker ad spending in health-care publications decreased to $626 million in 2009 from $865 million in 2005.
 
"All of medicine gradually came to realize [the problem of financial ties] and they really did need to take a look at it. We believed we needed to look at real and perceived conflicts," said James Scully, medical director and chief executive officer of the APA.
 
The Pharmaceutical Research and Manufacturers of America, the industry trade group, said in a statement that it "commends efforts taken by medical societies that help foster ethical relationships" with drug makers.
 
The biggest changes at the APA have come at its money-making annual meeting. Over the past three years, it has been phasing out industry-sponsored symposia—dinners and talks in ballrooms that often seated hundreds—of which there had often been dozens in past years. At this year's meeting in New Orleans last month, there were only two.
 
This translated to a loss of $1.8 million to $1.9 million in industry funding between 2008 and 2009, according to Dr. Scully.
 
The bulk of the group's loss of revenue was due to the decline in industry advertising in the group's medical journals as well, though some of that may be due to the economic downturn, according to Dr. Scully. The APA's policy doesn't have a specific guideline prohibiting advertising, except to say it should be made clear that advertising in an APA product doesn't constitute endorsement.
 
Response from APA members about the changes has been mixed. At the annual conference in 2008 in Washington, D.C., Dr. Scully recalled meeting a group of young residents and medical students at the bottom of an escalator who wanted to "express their outrage" at the industry influence at the meeting. At the top of the escalator ride, he encountered another group of doctors upset that there weren't enough seats in the industry-sponsored symposia. "A number of members liked those [symposia] and they liked that they got fed," said Dr. Scully.
 
The APA is hoping to make up for lost revenue, in part by offering more continuing medical-education courses on its website. Another service it will be offering—which should bring in close to an additional $2 million a year in revenue, according to Dr. Scully—will be to help doctors complete new requirements for certification that will be mandated by the American Board of Psychiatry and Neurology.
 
Drug companies can still donate some money to the APA's foundation that supports public education and to the group's institute on research and education, which funds public awareness of mental health and supports research projects. For those uses, APA will accept pooled money from multiple companies.