Psych’s perfect storm: A conversation with Dr. Joseph Sokal
With headlines about Sen. Chuck Grassley’s investigations into industry payments to psychiatrists rolling in as predictably as, well, payday, PostScript thought it would be good to get a little perspective from someone in the field.
So we talked last week with Dr. Joseph Sokal, an associate professor of psychiatry at the University of Arkansas – Little Rock, and chair of the ethics committee at the National Physicians Alliance.
Here’s what he had to say about the industry’s footprint on the field and what Grassley’s inquiry means for his work.
PS – Do you think your field has special need for pharmaceutical collaboration or, conversely, a special susceptibility to pharma influence?
JS – To date the data indicates that psychiatrists often lead other specialists in taking money from the pharmaceutical industry.
There are a number of forces at play here. One is psychiatry’s movement towards a more biological, brain-based model of psychiatric illness and a correspondent emphasis on pharmaceuticals to correct underlying, “chemical imbalances.” This has naturally led to closer relations with the pharmaceutical industry who play a critical role in developing the treatments that most in the field rely on.
Pharma also heavily funds research that helps advance many an academic career. It is too much to say that philosophy only follows funding in this case, but it is naïve to think that philosophy has not been effected by this funding source. Psychiatry is one of the most poorly paid specialties in medicine, making money from the pharma industry that much more attractive.
Add to that the emergence of relatively safe antidepressants in a culture very interested in happiness but not necessarily so interested in reflection, and a healthy pharmaceutical industry that has championed those diagnoses that lead to greater profit, and you have the environmental conditions for a perfect storm.
Clearly, psychiatry needs to clean its house. With that said, it is clear that this is a major problem for medicine as a whole, and focusing exclusively on psychiatry would be significant mistake.
PS – So you’ve already talked a bit about the changes you’ve seen in the field over the last thirty years—do you see that the awareness is changing also?
JS – I do think that there is an increasing awareness that this is a meaningful problem that must be addressed.
PS – Does Grassley’s inquiry into the financial statements of the American Psychiatric Association (and his earlier inquiries into Dr. Biederman and Dr. Schatzberg) have impact on your work, and if so, on what level?
JS – Yes. When the major professional organization for my field is being critically evaluated it affects the public’s view, which ultimately affects the work I do with patients.
PS – As a member of the University of Arkansas medical faculty, have you seen your institution take steps on these issues?
JS – UAMS does have guidelines for interacting with Pharma reps. The NPA ethics committee is also working on guidelines to address several aspects of medicine/pharma relations.
PS – Do you have the sense that these will be stronger than many med schools?
JS – Yes. At the NPA, we are fundamentally committed to strengthening the public’s trust in the integrity of medicine. This means actively addressing and sanctioning behaviors that undermine physicians’ fiduciary relationship with patients or give the impression of doing so. Because of this, we intend to set the highest possible standard. It is worth noting that the NPA does not get any of its funding from the pharmaceutical industry.