Unethical practices - drug industry

Ivan Goldberg psydoc at netcom.com
Sat Jul 29 16:51:45 EST 1995


Date: Thu, 20 Jul 1995 10:04:10 -0500 (CDT)
From: Sy Fisher <sy.fisher at utmb.edu>
To: psycho-pharm at netcom.com
Subject: Hanky-Panky in the Pharmaceutical Industry
 
       Hanky-Panky in the Pharmaceutical Industry
 
Does the pharmaceutical industry want clinicians
and patients to learn more about possible side effects of
newly marketed drugs?   I think the time has come to
make public just one egregious example of how individual
drug companies can influence the publication of clinical
research results that are not in their best financial 
interests. (I also have documented instances of how 
insidiously the pharmaceutical industry can influence 
publication of other manuscripts and even NIH support of 
research projects dealing with adverse drug reactions of 
newly marketed drugs.  But that's another story for, 
perhaps, another time.)    
          
First, however, for those who do not know me, I'd
like to point out that I have nothing to gain personally 
by going public with this issue.  I'm just about 70 years 
of age, and my academic credentials and career don't need
any embellishing (a brief resume can be found in Who's
Who in America).
          
Next, I urge you to read the article on "Postmarketing 
Surveillance by Patient Self-Monitoring: 
Preliminary Data for Sertraline versus Fluoxetine" in this
month's (July) issue of the Journal of Clinical Psychiatry
(1995;56:288-296).  This paper is based on large-scale
data indicating that many adverse reactions known to be
induced by fluoxetine (Prozac) were being  reported with
even greater frequency by sertraline (Zoloft) patients; 
the tables also includes suggestions to the clinician for 
age and gender patient types most at risk.  Zoloft is 
manufactured by Pfizer Incorporated (Roerig Division). 
          
The manuscript was accepted for publication on
May 12, 1994.  
          
On December 8, 1994 the Editor wrote me to say
that he had become "concerned that our largely clinician
readership might interpret the results more literally than
our investigator colleagues.  This apprehension led me to
draft the accompanying commentary, which I would like to
publish along with your article."  Although none of the
Journal's three reviewers who had originally
recommended publication voiced this apprehension, the
Editor's proposed commentary was entitled "What will
this drug do to me, Doctor?", and tacitly implied that our
results and conclusions might be spurious.     
          
I replied to this letter on December 20, showing
that most of the substantive criticisms he raised in his
proposed commentary were simply not valid, suggesting
instead that the research results along with the article's
carefully qualified discussion of the results should be 
able to speak for themselves.   
          
Letter from the Editor dated December 30:  "I have
revised and (I hope you will agree) 'softened' some of my
comments.  I hope you will be more comfortable with the
current draft."  His revised commentary included
sentences such as "It would be simplistic and premature,
however, to treat this report as gospel and conclude that
in reality sertraline produces a higher frequency of
unwanted reactions than does fluoxetine."  And the final
paragraph was to be: "The report by Fisher et al. is
thought-provoking and can frame hypotheses for
additional testing.  The actual incidence of side effects 
of these two SSRIs will become clearer with time and
additional study."   (Similar caveats were actually
included in the discussion section of the article, but
without the pejorative flavor of the proposed Editorial.)
          
By February of 1995, when we had not yet received page 
proof nine months after acceptance of the article, I 
phoned the editorial office for information.  I was told 
it was scheduled for the May issue.  However, in April 
when we had still not received either page or galley proof, 
and when a follow-up phone call elicited the information 
that the publication date was now postponed until July, 
I undertook a quickie "research project."  This led to a 
letter I wrote to the Editor on May 1, in which I expressed 
the view that publication of his proposed Commentary would 
be grossly unfair unless I was also given the opportunity 
to respond to the Editorial.  What follows was my proposed 
rebuttal:      
          
COMMENTARY ON "What will this drug do to me, doctor?"
          
In this issue, an article by Fisher et al.(1) presents
data from more than 2,700 fluoxetine and sertraline
patients using a well-validated postmarketing surveillance
method developed to signal possible adverse drug
reactions (ADRs). The preliminary results indicated that
many adverse reactions known to be induced by
fluoxetine were being reported with substantially greater
frequency by sertraline patients.  The article is
accompanied by an Editorial Commentary(2), admonishing
readers not to "conclude that in reality sertraline 
produces a higher frequency of unwanted reactions than 
does fluoxetine."   Certainly this could be a premature
conclusion to draw.  But a legitimate question can be
raised as to why this particular paper is being singled out
when the implied "conclusions" in more than 90% of the
papers published in this Journal and in other psychiatric
journals are also generally subject to alternate
interpretations, not all of which may be equally plausible.   
          
The Editor notes that a bias could have been
introduced because we relied "on a comparatively small
percentage of volunteers [almost 20%] out of an
approached population."  But all postmarketing
surveillance studies use only a minute sample of the total
population of interest(3).  The more salient question is
whether there is reason based on empirical evidence to
believe that the final selected samples favor one drug
group over the other.  If selection causes a bias in our
method, we should not have been able to detect in our
validation studies so many of the commonly accepted
ADRs for various drugs(4,5).  However, it is always
possible in any postmarketing surveillance method that
volunteer subjects (including physicians who are urged to
report possible ADRs to the FDA) or even medical record
samples could introduce a bias.  Similarly, although the
Editor questions "whether this technique is well suited 
for comparing incidences of adverse events between a newer
and an older agent," he also acknowledges that results
from our past studies along with the statistical controls
used in the data analyses suggest that what we were
seeing in this sertraline study is not simply a "newer 
drug" phenomenon.      
          
So, again, why the red-flag editorial?  A review of
119 articles published in this Journal from July 1993
through April 1995 (excluding supplements, monographs,
and the October 1994 issue, which was unavailable)
offers some clues.  The mean article length was slightly
less than six pages (skewed upward by a few longer
papers); the mean publication lag, defined as the number
of months between the date of acceptance and the
published issue date, was eight months -- for which most
authors are grateful to the Editor.  Only two of the 119
articles were not published until 11 months after
acceptance, and none had a lag of one year or more. 
There was no relationship between the length of an 
article and the publication lag.       
          
While some issues of the journal included a
"commentary" on a specific paper, none of them were
signed by the Editor.  In fact, a cursory search through
issues dating back to 1990 found only one previous
Editorial, which also focused on adverse drug
reactions(6).  Yet, our sertraline paper not only 
prompted an Editorial, but publication was delayed more 
than a year after it was formally accepted on May 12, 
1994.
During the past four years of the 10-year development of 
our postmarketing method [continuously supported by the 
National Institute of Mental Health along with other 
funding sources], we have became acutely aware of the 
fact that, once a new drug has been marketed, many 
pharmaceutical companies clearly do not want their drugs 
to be carefully monitored for possible ADRs -- in 
particular, by any method that can systematically and 
sensitively compare possible ADR profiles.  The Editor 
of this Journal is to be commended for having the courage 
to publish our sertraline/fluoxetine paper, but one 
cannot help wonder to what degree external pressures may 
have contributed to both the publication delay and the 
need for a cautionary Editorial.   
            
Presently, the ultimate clinical preference for one
psychopharmacological agent over another is mainly
determined not so much by true differences in therapeutic
efficacy (most antidepressants in most situations are
about equally effective) but by presumed differences in
their ADR profiles(7).  Systematic health services
research carried out in the real world of postmarketing
pharmacotherapy is of paramount importance for
clinicians to be competent to practice empirically-based,
rational patient care.  The real bottom line here is that,
although publication of our paper could have an adverse
effect on company sales, sertraline appears to have a
more troublesome ADR profile than fluoxetine, particularly
in respect to those known ADRs that appear to be
common to the SSRI class.  But only continued astute
clinical observations and systematic research will judge
whether these preliminary results based on patient
self-monitoring indeed help provide more accurate
answers to the patient's question, "What will this drug 
do to me, doctor?"                                                
REFERENCES
1.   Fisher S, Kent TA, Bryant SG.  Postmarketing
surveillance by patient self-monitoring: Preliminary data
for sertraline versus fluoxetine. J Clin Psychiatry
1995;56:288-296
          
2.   Gelenberg, AJ.  "What will this drug do to me,
doctor?"  J Clin Psychiatry 1995;56:00-00 [subsequently
never published].
          
3.   Baum C, Anello C.  The spontaneous reporting
system in the United States.  In Strom BL (Ed) 
Pharmacoepidemiology.  New York: Churchill Livingstone,
1989. Pp. 107-118
          
4.   Fisher S, Bryant SG, Kent TA.  Postmarketing
surveillance by patient self-monitoring: trazodone versus
fluoxetine.  J Clin Psychopharmacology 1993;13:235-242
5.   Fisher S.  Patient self-monitoring:  A challenging
approach to pharmacoepidemiology. 
Pharmacoepidemiology and Drug Safety 1995, in press
          
6.   Gelenberg AJ.  Imperfect drugs in an imperfect world. 
J Clin Psychiatry 1992;53:39-40
          
7.   Gelenberg AJ, Schoonover SC.  Depression.  In
Gelenberg AJ, Bassuk EL, Schoonover SC (Eds) The
Practitioner's Guide to Psychoactive Drugs.     (3rd
edition)  New York: Plenum, 1991.  Pp.23-89
          
*   *   *   *   *
About two weeks after I had sent the above proposed 
Editorial Reply, I received a phone call from the Editor 
while he was attending the American Psychiatric 
Association meeting in Miami, saying he could not possibly 
publish my commentary in its proposed form. He agreed that 
I was entitled to space for rebuttal, but informed me that 
I would have to modify its contents.  I said I would 
consider this.  Then, just a few days later, he phoned 
again to say that he had decided to drop his proposed 
editorial, and that therefore I could forget about the 
rebuttal.  In our discussion, he admitted that this 
decision was made after conferring with Pfizer
representatives at the APA meeting.
          
So you will not find in the July issue of the Journal
of Clinical Psychiatry any Editorial Commentary or reply 
to accompany the Fisher et al. article -- finally made
available to clinicians (and their patients) a full 14 
months after acceptance. 
          
I would welcome your comments.          
- - -
Sy Fisher   (sfisher at utmb.edu)       | "The difference between intelligence
Ctr for Medication Monitoring        | and wisdom: Intelligence is knowing
Univ of Texas Medical Branch         | that 50% of all you read and hear 
Galveston TX 77555                   | is pure garbage; wisdom is knowing
409-772-3215                         | which 50%."    -- anon
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Date: Thu, 20 Jul 1995 19:08:34 -0700 (PDT)
From: "Ivan Goldberg, MD" <psydoc at netcom.com>
To: Sy Fisher <sy.fisher at utmb.edu>
Cc: psycho-pharm at netcom.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
On Thu, 20 Jul 1995, Sy Fisher wrote:
 
> Does the pharmaceutical industry want clinicians
> and patients to learn more about possible side effects of
> newly marketed drugs?   I think the time has come to
> make public just one egregious example of how individual
> drug companies can influence the publication of clinical
> research results that are not in their best financial 
> interests.
--------------------------- [ stuff deleted ] --------------------------
        Sy . . .
 
        Thank you so much for going public with your report on
        how drug companies exert massive effects on the literature
        of psychiatry.  I am probably "old fashioned" but I think 
        it is unethical for journals that publish reports on psycho-
        pharmacology to accept drug company money for anything. And,
        I think it equally unethical that the American Psychiatric
        Association allows drug company sponsored symposia as part
        of its annual meetings.
        If you ever hear that I have resigned as coordinator of this
        forum, it will more than likely be because the powers that be 
        at InterPsych have decided to accept drug company money. 
 
        Best regards . . .
 
        -- Ivan --
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
.np
Date: Fri Jul 21 1:02:27 PDT 1995
From: montgome at ohsu.edu
Cc: psydoc at netcom.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Ivan,
 
Thank you for your comment about your ethics.  I appreciate and respect 
your 
position.  Made reading my mail at 1 AM quite rewarding.
 
Mary Montgomery
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Date: Fri, 21 Jul 1995 08:02:08 -0500
From: Larry Goldman MD <larry at yoda.bsd.uchicago.edu>
To: "Ivan Goldberg, MD" <psydoc at netcom.com>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
     Ivan - I'm old enough to agree with you completely and young enough 
to 
say, "Right on!" I sent the following to Sy:
 
 Fascinating...and very troubling. Thank you for posting this. Do you 
have 
an eager-beaver med student who could do a count of the drug ads in J 
Clin 
Psych by manufacturer? Might be interesting data (esp if there were a 
comparison w/AJP, J Clin Psychopharm, etc).  Wonder if could show that 
JCP 
is tighter than others w/Zoloft.
 
     Unfortunately, as money gets tight in research, teaching, and 
clinical 
arenas, the temptation to cozy up to the drug companies increases, and 
there 
are more and more "alliances" which are troubling in appearance if not in 
outright substance. While this is a problem in all of medicine, it is 
especially appalling in psychiatry where we have trumpeted ourselves as 
especially sensitive to image and ethical nuances!
 
     Keep up the good work.
 
Larry S. Goldman, M.D. (larry at yoda.bsd.uchicago.edu)
 
Dept of Mental Health
American Medical Association
515 N. State Street
Chicago IL 60610
312-464-5067  FAX: 312-464-5841
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Date: Fri, 21 Jul 1995 10:45:38 -0500 (CDT)
From: Sy Fisher <sy.fisher at utmb.edu>
To: "Ivan Goldberg, MD" <psydoc at netcom.com>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
>
-Ivan
 
I'm especially appreciative of your kind words.
If you agree that this kind of tampering with research and publication 
from the "ethical" pharmaceutical industry is a serious issue, please let
your voice be heard. 
 
In our systematic research on measuring the frequency of adverse 
reactions for newly marketed drugs, this is not the first time 
my colleagues and I have obtained evidence of drug companies 
exerting pressure upon journal reviewers and editors.  Nor is It just 
one company, Pfizer.  Lilly did essentially the same thing when we 
first attempted to publish our fluoxetine vs trazodone paper (which 
was subsequently published more than two years after we had first
written it). 
 
And recently, after 10 years of continuous funding from the 
National Institute of Mental Health, further support was abruptly
terminated, when at least two members of the original study 
section -- one being the chairman (!), another being the primary 
reviewer -- had been conducting numerous company-supported drug 
studies, substantially contributing either directly or indirectly 
to the reviewers' overall income.  Incredibly, NIH claims 
there was no conflict-of-interest in the review since "Research 
that focuses on other than assessing the efficacy of a particular 
pharmacologic agent(s) do not represent financial conflict of 
interest situations" (grammar exactly as written).
 
You rightfully play an extremely influential role in the psycho-pharm 
newsgroup, and occasional "editorials" from you would be particularly 
persuasive.  Please  let it be widely known that, while we admire and are 
grateful for the industry's many therapeutic accomplishments, 
we will not tolerate their placing dollars before truth.  If I sound 
a bit sanctimonious about all this, so be it.
 
My best regards.
-
Sy
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Date: Fri, 21 Jul 1995 09:26:46 -0700 (PDT)
From: "Ivan Goldberg, MD" <psydoc at netcom.com>
To: Sy Fisher <sy.fisher at utmb.edu>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Sy . . .
 
One of the things we are working on is an "Electronic Journal of 
Psychopharmacology."  As this ejournal will accept no advertising it 
would be an ideal place for reports of the sort that other journals are 
not likely to publish.  The reluctance of authors to publish in ejournals is
slowly decreasing as their value is coming to be appreciated.  You may 
have seen my editorial for the InterPsych News where I criticized the 
editorial in the NEJM which took the position that ejournals have no 
place in medicine. (I'll bet that within 10-years they will publish an 
electronic edition)  In physics things have changed so rapidly that 
ejournals are now the chief way in which recent discoveries are announced 
to the profession.
 
There are many ways in which Internet can make material available.  With 
little difficulty long articles containing large amounts of data can be 
made available to anyone who has Internet access.  I am sure that you can 
think of other ways in which electronic publishing may be useful when it 
comes to the publication of material too long or too controversial for 
the usual journals.
 
I am about to leave for 5-weeks of teaching, vacation and working on my 
other career as a landscape photographer . . . look for my stuff in the 
Biblioteque Nationale, the next time you are in Paris.
 
I hope the rest of your summer goes well.
 
Best regards . . .
 
-- Ivan --
 
P.S. I'm old enough, 61, that I am not afraid of upsetting the drug 
companies, Chairpersons of Depts. of Psychiatry, editors of psychiatric 
journals, etc.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Date: Fri, 21 Jul 1995 08:50:40 -0500
From: Jay Burke <jdb1353 at tam2000.tamu.edu>
To: Sy Fisher <sy.fisher at utmb.edu>
Cc: psycho-pharm at netcom.com, Sy Fisher <sy.fisher at utmb.edu>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
re: Your message "Hanky-Panky in the Pharmaceutical Industry"
Personally, I have always held both you and the Editor in the highest 
regard, so I found your account very important.  I want to thank you for 
raising the problem.
 
I have always assumed that the drug manufacturers act in their own 
short-term interest, so I would not be surprised at any report that the 
companies try to suppress bad news.
 
However, of much greater interest in my view is the problem of knowing 
how 
best to assess effectiveness (after efficacy has been established) and 
how 
to assess adverse drug effects etc in clinical practice.  From that 
perspective,  I wish that both the Editorial commentary and your reply to 
it 
had been published so we could see the arguments about these 
methodological 
issues laid out in an articulate manner.  
 
I wonder about suggesting that you organize a symposium at next year's 
APA 
or NCDEU meetings to review the state-of-the-art in methods for this 
aspect 
of health services research?  While I was at NIMH, I would have been 
enthusiastic about trying to support a thoughtful discussion of how to 
keep 
advancing this essential area of research.
 
Perhaps Bob Prien or Bob Hirschfeld could help engineer such a discussion?
 
     Jay Burke MD  Dept of Psychiatry and Behavioral Science
       Texas A&M - Scott & White   1-817-724-5852
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Date: Fri, 21 Jul 1995 19:35:42 -0700 (PDT)
From: "Ivan Goldberg, MD" <psydoc at netcom.com>
To: psycho-pharm at netcom.com
Cc: Sy Fisher <sy.fisher at utmb.edu>, Jay Burke <jdb1353 at tam2000.tamu.edu>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
On Fri, 21 Jul 1995, Jay Burke wrote:
 
--------------------------- [ stuff deleted ] ------------------------------
 
> I wonder about suggesting that you organize a symposium at next year's 
APA 
> or NCDEU meetings to review the state-of-the-art in methods for this 
aspect 
> of health services research?  While I was at NIMH, I would have been 
> enthusiastic about trying to support a thoughtful discussion of how to 
keep 
> advancing this essential area of research.
> 
> Perhaps Bob Prien or Bob Hirschfeld could help engineer such a discussion?
 
        Jay . . .
 
        Maybe I am more cynical than I like to think, but with the
        important role played by "industry" at both the APA and
        NCDEU, I'll bet you $100 that no matter how hard any of
        us push, that no symposium on drug company influence over
        the funding and publication of post-marketing studies of
        psychopharmacologic agents will be scheduled at APA or
        NCDEU.
 
        -- Ivan --
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Date: Fri, 21 Jul 1995 19:48:32 -0700 (PDT)
From: Joseph Mccreery <mccreery at u.washington.edu>
To: "Ivan Goldberg, MD" <psydoc at netcom.com>
Cc: Sy Fisher <sy.fisher at utmb.edu>, psycho-pharm at netcom.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Bravo!!!!!
 
I congratulate you on your ethical standards.
 
How long will it be before insurance companies and managed care companies 
become major stockholders in drug companies as they also strip away any 
forms of psychotherapy and relegate psychiatrists to the limited category 
of Prescribers??  Or is this perchance already occurring??
 
                                        Joseph M.McCreery, MD
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Date: Fri, 21 Jul 1995 20:34:37 -0700 (PDT)
From: "Ivan Goldberg, MD" <psydoc at netcom.com>
To: Psychopharmacology Forum <psycho-pharm at netcom.com>
Cc: Sy Fisher <sy.fisher at utmb.edu>,
    Joseph Mccreery <mccreery at u.washington.edu>
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
On Fri, 21 Jul 1995, Joseph Mccreery wrote:
 
> Bravo!!!!!
>
> I congratulate you on your ethical standards.
>
> How long will it be before insurance companies and managed care 
companies 
> become major stockholders in drug companies as they also strip away any 
> forms of psychotherapy and relegate psychiatrists to the limited 
category 
> of Prescribers??  Or is this perchance already occurring??
> 
>                                       Joseph M.McCreery, MD
 
        Joseph . . .
 
        Drug companies have already become major players in
        the managed care debacle.  I have heard of plans that
        do not allow for psychiatrists to prescribe one of the
        SSRIs, because the managed care company is owned by
        the manufacturer of another.
 
        Also, in some plans all psychiatrists are authorized
        to do are 15-minute medicine checks with patients.
        Psychologists and social workers are suffering too,
        as the managed care companies are paying low fees
        and are pushing for psychotherapy to be conducted by
        poorly prepared "counselors" with a bachelors degree.
        I am prepared to abandon the practice of psychiatry
        if survival as a private practitioner outside of 
        managed care becomes impossible.
 
        -- ivan --
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Date: Fri, 21 Jul 1995 13:54:28 -0700
From: "Dr. Raymond W. Lam" <rlam at unixg.ubc.ca>
To: Sy Fisher <sy.fisher at utmb.edu>, psycho-pharm at netcom.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Dear Sy,
 
I too thank you for airing this story. I have participated in and
coordinated clinical trials and have always found that the companies I have
been involved with have been completely above board when it came to the
science and the publication of results. However, I think your story shows
how vigilant we need to be about the (great) influence of the pharmaceutical
industry. 
 
Regards,
 
Ray.
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Date: Sat, 22 Jul 1995 11:27:55 -0400
From: RamGardner at aol.com
To: psydoc at netcom.com
Cc: DonaldK737 at aol.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Ivan,
 
Congratulations on taking a stand on this matter.  
 
We are now at great peril to the field:  Now that Government funding for
research is drying up we will inadvertently  become much more dependent on
other sources of funding for research.  Perhaps it is time for CLINICAL
psychopharmacologists to assert themselves in that field (i.e., new drug
development, and research) The psycho-pharm and ASCP start answering another
neglected field: The creative thoughtful treatment of psychiatric patients.
But I think when it comes to directions and evaluation of research
applicability to the clinical arena our field is still submitting  of
progress to people who view patients, mental illness and medications as an
isolated interaction between some receptors and transmitters floating in an
imaginary oversimplified brain. (That is why a highly flawed theory like the
dopamine one has such incredible longevity).  It may be too simple a
suggestion but making progress in psychopharmacology in total disregard to
the patients, the actual clinical arena is IMHO mutually exclusive.  I do not
want to belabor this issue but I want to propose that some of us possibly
under the guidance of Don Klein as president of ASCP could come up with some
guidelines for objective  independent appraisal of new (and old) drugs,
promotion of creative thinking in psychopharmacology (already happening in
psycho-pharm) and the crucial role of clinical psychopharm as opposed to
merely theoretical one (and unfortunately money and pharmaceutical companies
driven)  It is extremely important at a time when most research money is
bound to become corporate based. 
 
Please tell me your thoughts in the matter. 
 
Rami Kaminski
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Date: Sat, 22 Jul 1995 08:57:37 -0700 (PDT)
From: "Ivan Goldberg, MD" <psydoc at netcom.com>
To: RamGardner at aol.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Rami . . .
 
I doubt that you will see much leadership from an individual or an 
organization that accepts a good deal of drug company money.
 
Best regards . . .
 
-- Ivan --
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Date: Sat, 22 Jul 1995 14:19:33 -0400
From: Whit Garberson <jwgg at world.std.com>
To: psydoc at netcom.com
Subject: Re: Hanky-Panky in the Pharmaceutical Industry
 
Ivan Goldberg wrote:
 
>       Psychologists and social workers are suffering too,
>       as the managed care companies are paying low fees
>       and are pushing for psychotherapy to be conducted by
>       poorly prepared "counselors" with a bachelors degree.
 
It's not just managed care companies, either.  Here in MA, there is a new 
piece of legislation being drafted called "The Sunset Act" which proposes 
to 
do away with many licensing boards in the state Division of 
Registration.  
As originally drafted, this bill would simply have eliminated social work 
licensing.
 
NASW's Mass. chapter organized a letter and fax campaign and as of 
yesterday, the word is the bill survived, but Governor Weld took social 
work 
out of it.  I don't know the licensing status of other disciplines, but  
this is dangerous business.
        -wg
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Date: Sat, 22 Jul 1995 11:14:50 -0500 (CDT)
From: Sy Fisher <sy.fisher at utmb.edu>
To: psycho-pharm at netcom.com
Subject: Re: Hanky-Panky 
 
On Fri, 21 Jul 1995, Ivan Goldberg wrote:
>
>       Maybe I am more cynical than I like to think, but with the
>       important role played by "industry" at both the APA and
>       NCDEU, I'll bet you $100 that no matter how hard any of
>       us push, that no symposium on drug company influence over
>       the funding and publication of post-marketing studies of
>       psychopharmacologic agents will be scheduled at APA or
>       NCDEU.
>
>       -- Ivan --
 
Ah!  How perceptive!   If Dr. Goldberg could find enough takers for such a
bet, he could buy out Bill Gates.
 
Most of the key psychopharmacology players at APA and NCDEU also have power
roles in the American College of Neuropsychopharmacology (ACNP).
 
 At its 1993 meeting the ACNP had scheduled a luncheon meeting on the very
subject mentioned by Ivan.  However, at the last minute the topic was
changed to something much more important, like "Can SSRIs be used to make
bassett hounds act like German shepherds?"
 
For its 1994 meeting the ACNP Council was considering having the editors of
a number of psychiatric and psychopharmacological journals participate in a
study group.  The topic was to be a discussion of the ethics of journal
reviewers notifying drug companies of submitted  manuscripts with content
inimical to a company's interests.  As a corollary, the group would also be
expected to discuss advertisers' pressures upon journal editors.  This
proposed study group was never held.
 
Can anything constructive be done about this "nasty little" issue?
 
Sy
- - -
Sy Fisher   (sfisher at utmb.edu)       | "The difference between intelligence
Ctr for Medication Monitoring        | and wisdom: Intelligence is knowing
Univ of Texas Medical Branch         | that 50% of all you read and hear 
Galveston TX 77555                   | is pure garbage; wisdom is knowing
409-772-3215                         | which 50%."    -- anon

-- 
--                                                         \\\\           
                                                           (@ @)          
||-----------------------------------------------------ooOo-( )-oOoo----||
||                          Ivan Goldberg, MD                ~          ||
|| ikg1 at columbia.edu                                  psydoc at netcom.com ||
|| V: 212 876 7800  /  1346 Lexington Ave NYC 10128  /  F: 212 737 0473 ||
||               http://avocado.pc.helsinki.fi/~janne/ikg/              ||
||----------------------------------------------------------------------||




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