The Pharmaceutical Industry, Psychiatric Drugs and Primary Care

An article last week in the New York Times, entitled Drug makers wrote book under 2 doctors names reported on a book that was written by two psychiatrists for an audience of primary care clinicians. The book, whose aim was to teach these clinicians about how to treat psychiatric disorders, was in fact ghostwritten by the drug company then known as SmithKline Beecham.

Robert Whitaker, author of Anatomy of an Epidemic, comments on his blog in a post entitled Ghostwritten book hints at much larger problem He offers a larger context, stating that

In fact, this ghostwriting revelation simply hints at a much larger, pervasive problem, which is that financial bias profoundly affects the authorship of psychiatric textbooks at every turn. And it is quite easy to document that this is so.

Most concerning to me, as a pediatrician, was a comment on Mr. Whitaker's blog from an MD who states

The Amer. Acad Child and Adolescent Psychiatry Psychopharm conference this November seemed to me to reflect commercial bias in a level I found unsettling -given that AACAP has long been a refuge where quality of care has tended to come first.

Last week, I wrote in a blog post about the possible influence of the pharmaceutical industry on the recommendations child psychiatrists give to primary care clinicians. I describe a supposedly successful program that aims to increase access to mental health care. The program in fact simply supports primary care clinicians in prescribing psychiatric medication to children.

The New York Times article, Whitaker's post, and the comment on it all confirm my fears of the heavy influence of the pharmaceutical industry on how psychiatry is guiding primary care clinicians in treatment of of psychiatric problems, in both adults and children.

An alternative paradigm is urgently needed. A primary care clinician has a long standing relationship with a family than can be put to great use in addressing mental health problems in a preventive model. With the enormous financial influence of the pharmaceutical industry moving the ship of mental health care in one direction, getting it to move in a different direction will take an enormous effort. Add to this a cultural expectation of a quick fix, and this seems an almost impossible task. But when it comes to supporting children's healthy emotional development, I believe we have no choice but to make the effort to change direction.