The American Psychiatric Association (APA) is currently updating all its practice guidelines. According to a study recently released by Boston-based researchers entitled, “Toward Credible Conflict of Interest Policies in Psychiatry,” the latest clinical guidelines for how to treat depression, bipolar disorder, and schizophrenia were written by some psychiatrists who have financial ties to drug companies. Their study is the first to examine potential conflicts of interest in the APA panels that write the treatment guidelines widely used by practitioners.
The writers outline that the guidelines focus heavily on medications and give relatively little attention to non-drug treatments, this is largely because of the low reimbursement rate for non-drug treatments (counseling, bio feedback, etc.). Psychiatrist have migrated away from providing patient counseling which has been relegated to counselors and psychologists.
The APA now requires guideline writers to publish any financial ties along with the guidelines they work on, but at the time, the then-current guidelines for depression, bipolar disorder, and schizophrenia were published in 2004 and 2005, no such disclosures were required.
Dr. John S. McIntyre, Chairman of the Guideline Steering Committee of the APA, said the Committee that oversees the guideline-creation process has always screened proposed members of the groups who work on each set of guidelines for potentially troubling ties, including spouses who work for drug companies. The guidelines also go out to hundreds of psychiatrists and others for comment and review.
The APA further responded that its guidelines, which sum-up research and real-world experiences with treatments, receive a thorough vetting process and that people who obtain significant portions of their income from drug companies are excluded from the guideline panels. "We work very hard to ensure that the guidelines that we develop and publish are free of bias to the greatest possible extent," said Dr. McIntyre. Thus, it would be a mistake to disqualify everyone with drug company ties, because it would mean losing valuable expertise in research that must be evaluated, but the association is considering whether to set a limit on committee members' industry income and research support.
The study, scheduled to be published online this month in the Psychotherapy and Psychosomatics Journal, found that among 20 authors of the guidelines, 18 had at least one financial tie to drug companies. It also found that 12 guideline authors had ties in at least three categories, such as consulting, research grants, speaking fees, or stock ownership. But is that so shocking?
Of course, psychiatrists have ties to industry, as do the top software developers, the best engineers, the foremost accountants, and even attorneys. We want those with experience on interpreting clinical trials to serve on guidelines committees, in the same way the National Institutes for Health, the Food and Drug Administration, and other organizations use physicians with strong research track records in conducting clinical trials to do the same. But not all conflicts are necessarily bad conflicts, as is the ongoing case of lobbyists in Washington, D.C., especially within the Obama Administration. As of today, at least three waivers have been issued by the Administration to allow former lobbyists, whose potential for conflicts of interest are highly likely, to work within the White House.
The most important factor to consider when evaluating the recommendations that physicians and professional associations give are not the potential conflicts, but the experience and competence in a specific area these professionals have from working with industry and drug companies. By calling for more transparency to reveal these relationships, this will show the public that physicians are only acting in a manner that will lead to the best results for both healthcare providers, physicians, and pharmaceutical companies to come-up with more effective drugs and treatments.
With all the announcements at the APA cutting industry relationships and James Scully, M.D., the CEO, and Medical Director, condemning physicians with ties to industry serving on guidelines committees, it is refreshing to know that the volunteer leadership, as opposed to the paid bureaucrats within APA, understand the need for the use of experts, even those with ties to industry.