Monday, June 9, 2008

Research, drug companies, and income reporting...

Has anyone else seen this article* about some eminent US child psychiatrists failing to fully report income from drug companies?

"A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators."

It's not clear at this stage whether Dr Biederman and his colleagues' research has actually been compromised, but given the subjective nature of psychiatry in general, this is very concerning - especially given that this involves treatment of children with powerful psychiatric medications. Many children all over the world have been prescribed medications because of these doctors' work, and now we find there is a possibility that the research on which these decisions were based was invalid, or that the conclusions were invalid. Critics certainly believe this may be the case:

"The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.

Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said."

I'll be clear here - in general, I am pro-psychiatry. I think the work they do is vitally important, and that it can genuinely improve people's lives.
But I also think that medicine generally, and psychiatry in particular, has come to rely too heavily on pharmaceuticals, and often fails to see people as whole people. Oftentimes we need to think harder about the implications of our treatments, and how we deal with the adverse effects/side effects.  This story also highlights some issues about the relationships between doctors (and medical students) and drug companies.

At best, this is a blow for the credibility of psychiatry, and especially child psychiatry, a speciality that has already faced a lot of controversy and can ill-afford this kind of bad press. At worst, it brings the validity of much of the field into question. It certainly highlights inadequacies in the reporting of researchers' income and checking in the accuracy of this reporting.

*props to the education rep who posted this on the student discussion board, & for getting on his own soap box about the matter.