Psychiatrists become drug firms' targets
Ellen Barry, Boston Globe Staff, 5/28/2002
- Ivonne Munez Velazquez, a psychiatrist from Mexico, rooted through
her goody bag like a child on Halloween.
a reward for attending the American Psychiatric Association's
annual meeting, she had received a small egg-shaped clock from
the makers of the antidepressant Prozac; a sleek thermos from
Paxil, also an antidepressant; and an engraved silver business
card holder courtesy of Depakote, an anticonvulsant. She got a
neat little CD carrying case from Risperdol, an antipsychotic;
a passport holder from Celexa, an antipsychotic; a neat green
paperweight from Remeron, an antidepressant; and a letter opener,
representing what drug she could not remember.
the duration of the weekend, though, Velazquez's loyalty belonged
to Pfizer, which had paid her airfare from Mexico City (along
with 30 of her colleagues and her 18-year-old nephew) and put
them all up in hotels near the APA meeting. That night, also courtesy
of Pfizer, she would attend a glittering banquet at the Philadelphia
Academy of Fine Arts. Asked whose products she prescribes the
most, Velazquez giggled, looked around and whispered, ''Lilly.''
psychiatry, as in all branches of medicine, this extravaganza
of marketing has become so familiar as to be almost invisible.
Nearly every specialist attending a conference can expect to receive
a portion of the $13 billion to $15 billion that pharmaceutical
companies are likely to spend on marketing this year. With central
nervous system medications now making up almost a quarter of sales,
and newly defined illnesses such as social anxiety disorder calling
for a new round of prescribing, psychiatrists have become a particular
surgeons, however, psychiatrists are in the habit of examining
behavior, including their own, and several sessions last week
were devoted to the issue of free gifts. A Brooklyn psychiatrist
presented a new paper titled ''Attitudes of Physicians Towards
Gifts from the Pharmaceutical Industry: A Pilot Study.'' A symposium
asked ''Psychiatry and the Pharmaceutical Industry: Where Is the
Boundary?'' and the APA's Committee on Commercial Support invited
dissidents in for a discussion called ''The Pharmaceutical Industry
and the APA: Controversies and Approaches.'' As his colleagues
lined up to express their outrage at the influence of industry
on the meeting, Stephen Goldfinger, chairman of the committee,
my politics are such that I would nationalize the health-care
system and switch to a single-payer system,'' Goldfinger said.
''This country has said we believe in the entrepreneurial model,
in capitalism. The pharmaceutical companies are an amoral bunch.
not a benevolent association. So, they are highly unlikely to
donate large amounts of money without strings attached. Once one
is dancing with the devil, you don't always get to call the steps
of the dance.''
with APA dues proceeds falling every year, dancing they were.
Drug companies paid between $200,000 to $400,000 apiece - plus
a $60,000 direct payment to the APA - for each of 50-plus ''industry-supported
symposia,'' in which doctors ate in banquet halls and listened
for three hours to industry-sponsored speakers, Goldfinger said.
The shuttle buses to and from hotels were underwritten by AstraZeneca;
Pfizer brought in Sylvia Nasar, author of ''A Beautiful Mind,''
and passed out free copies of her book; and a relaxing Zen garden
was paid for by Solvay Pharmaceuticals.
the drug company money, officials said, the annual meeting would
lose educational benefits along with amenities.
much are you willing to pay for that, if we don't accept drug
company money?'' said Anand Pandya, who reviews new research for
the APA meeting. ''Are you willing to pay $3,000?'' Dues are now
of the gift-giving in evidence last week will actually be prohibited
next year under new regulations self-imposed by the pharmaceutical
industry. Starting July 1, it will be illegal to offer doctors
pure entertainment - such as a Forest Pharmaceuticals-sponsored
concert by the blues artist Keb' Mo' - or pay travel expenses
for nonfaculty health-care professionals. Branded golf balls will
be prohibited, as they ''do not primarily entail a benefit to
patients,'' and drug representatives will no longer be allowed
to pay to fill doctors' cars with gasoline.
within medicine, however, would like to see the restraint coming
from the doctors.
would sort of expect it from orthopedic surgeons, all those former
athletes, but psychiatrists are supposed to be the philosophers
of medicine, the thinkers,'' said Bob Goodman, a New York internist
who founded the organization, No Free Lunch, which urges doctors
to refuse freebies of any kind. ''You don't expect to see them
fighting over those cheesy little gifts.''
those psychiatrists who have taken up that gauntlet, the convention
can be an uncomfortable place. Richard Roston, a fourth-year resident
in New Mexico, attended the APA convention for the first time
two years ago, and was astounded at what he described as a ''pharmaceutical
then, he has taken Goodman's pledge of complete abstinence from
free gifts. This has resulted in a degree of isolation, he said.
you don't eat lunch, you're thought of as being holier than thou,''
Roston said. ''But that's how all social movements start. They
ignore you and they ridicule you and then they start listening
to you. This is somewhere between ignore and ridicule.''