'No' to drug money Dr. Daniel J. Carlat wants to limit corporate sway over psychiatry

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'No' to drug money
Dr. Daniel J. Carlat wants to limit corporate sway over psychiatry
By Carey Goldberg, Globe Staff | May 7, 2007




But when he started to look around at the bigger picture of drug companies' influence on psychiatry, "I said, 'This is unbelievable! Our field as a whole is progressively being purchased lock, stock, and barrel by the drug companies: this includes the diagnoses, the treatment guidelines, and the national meetings."

Perhaps worst of all, Carlat said, drug companies have come to sponsor so much of continuing medical education -- the courses that doctors must take to retain their licenses -- that the companies can set much of the agenda




Instead of getting educated about psychotherapy, about how to better manage our practices, about epidemiology and the public health concerns of underserved populations, what we're getting is lecture after lecture about how to diagnose depression and use antidepressants to treat it; how to diagnose insomnia and use sleeping pills to treat it; how to diagnose bipolar disorder and use mood stabilizers to treat it," he said.

In particular, Carlat said, he is appalled that his prestigious former employer, Mass. General, has chosen to accept millions of dollars of drug-company money to sponsor its continuing psychiatry courses. MGH says that its pharmaceutical sponsors have no input on the courses.

By all indications, "psychiatrists are among the most conflicted of the medical specialties," said Dr. Jerome P. Kassirer , a Tufts University professor and author of "On the Take," a book about what he describes as medicine's complicity with big business. With new drugs available for common conditions such as anxiety and depression, the pharmaceutical industry has been recruiting armies of psychiatrists to market them in recent years, he said.

He has met Carlat, Kassirer said, and "I'd say he's the real thing. He honestly believes that psychiatry has gone too far, and by the way, so do I."




In 2004, the Report concluded that a new anti depressant, Cymbalta, offered no significant advantages over existing drugs, and that its maker, Eli Lilly, was massaging the data to make it look better than it was. The article and its headline, "Cymbalta: Dual the Reuptake, Triple the Hype," drew a lengthy complaint from Eli Lilly, replete with 24 footnotes that Carlat then published on the Report's website, with his own rebuttal.

The Report (online at thecarlat report.com) does carry interviews with psychiatrists who have financial ties with drug companies, Carlat said, but only because it is simply impossible to find prominent psychiatrists without such ties. He asks experts to disclose any financial ties in print.

Carlat seems to have struck a nerve. From a tiny 2002 start-up, the newsletter has grown to a circulation of 2,300 -- almost enough to begin paying himself a salary for his three days a week of writing and editing, Carlat said. Subscriptions range from $89 a year for individuals to $149 for institutions.

Dr. Steven Sharfstein , immediate past president of the American Psychiatric Association, the field's major professional group, said he believes that Carlat may be part of a larger movement, "a change in sensitivity and sensibility" about pharmaceutical industry involvement in psychiatry.

Sharfstein said he has no hard data, "but I believe there's a trend that people are moving away." His own hospital, Sheppard Pratt Health System near Baltimore, has stopped letting drug companies sponsor lectures.

"So now we just don't have fancy snacks," he said. "It just didn't feel right."