Conflicts of interest: psychiatry under the influence of big pharma?

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The President of the College of Psychiatrists of Ireland (CPI), Dr Lorcan Martin, received more than €20,000 in consultancy fees from the pharmaceutical industry between 2020 and 2022- despite the CPI’s own policy position clearly outlining conflict of interest issues that arise from such payments. 

Figures from the transparency database, Transfer of Value shows that Dr Martin, based on the specific search terms, ‘psychiatry and mental health’ is one of the top recipients for the kinds of payments captured by Transfer of Value, i.e. consultancy fees, registration fees and/or travel costs to attend events. (See table below)

The pharmaceutical companies named here, Lundbeck and Janssen, (recently rebranded as Johnson & Johnson) manufacture, among other things, psychoactive drugs known as antidepressants. The payments were disclosed the payments as per industry transparency rules.

Conflict of interest

It is understood that these kinds of payments aren’t restricted by the CPI’s policy – which states that the CPI itself no longer receives funding from the pharmaceutical industry. But they are a conflict of interest, as research in this area has overwhelmingly shown that clinicians are influenced by the industry’s marketing strategies, which in turn has an impact on prescribing practices.  

Other Irish psychiatrists and mental health care professionals who receive monies (set out below) from the pharmaceutical industry include: Dr Patricia Casey, Dr Timothy Dinan, Dr Malik Elahi, Dr Melissa Gill, Dr Zafrullah Hamzah, Dr Shane McInerney, Dr Henry O’Connell, Dr Paul Scully, Dr Thekiso Boitshoko Thekiso, Dr Servaise Winkel.

*This table is a snapshot based on certain search terms so may not reflect all of the payments received by those named. It is not exhaustive but reflects the most highly rewarded recipients based on search terms used.

Examples of high profile promotional work Dr Martin, a HSE consultant in general adult psychiatry, has undertaken with pharmaceutical companies can be seen here and here. It is also possible to find examples of work carried out by others listed, such as a Lundbeck funded talk on the ‘pharmacological management of depression’ by Dr Thekiso Boitshoko Thekiso, senior lecturer and consultant psychiatrist and the activities carried out by Dr Shane McInerney, general adult consultant psychiatrist, for Janssen.

CPI policy undermined?

The CPI is the professional body for psychiatrists in Ireland. The kinds of activities highlighted above appear to undermine the spirit of the CPI’s progressive policy – and it raises the question as to whether the CPI should expand its policy to prohibit college representatives from receiving pharmaceutical industry funding.

The CPI policy states that the College: “recognises the great benefits which have been achieved through advances in pharmacotherapy…however… the College is also aware of the risks of conflict of interests, and the importance for psychiatry to be able to form an independent appraisal of the value of specific drugs. Research in this area has overwhelmingly shown that clinicians are influenced by the pharmaceutical industry’s marketing strategies which have an impact on prescribing practices.”

The CPI policy document cites the Medical Council guide to professional conduct and ethics for medical practitioners, which states: “You are advised not to accept gifts (including hospitality) from pharmaceutical medical devices or other commercial enterprises. You should be aware that even low value promotional materials are offered by commercial enterprises with the intention of influencing prescribing and treatment decisions”.

The medical council guidance, which applies to all doctors including psychiatrists, further states: 

“If you receive financial support or other resources from pharmaceutical companies and/or related enterprises in connection with professional activities including lectures, presentations and publications, development of clinical services or conducting research you should address any potential conflicts of interest that arise. In these circumstances your patients and any other relevant party should be informed about any professional relationship you have with these companies.”

Mad in Ireland put a number of questions to the CPI:

  • can the college comment on the fact that data from TransferofValue.ie shows that many mental health professionals are in receipt of various kinds of funding from pharmaceutical companies in Ireland?
  • Can the college comment on the fact that the College president is in receipt of funding from pharmaceutical companies?
  • Does the college’s own policy position extend to senior representatives of the college, given the conflicts of interest that arise?

There has been no response.

Pharma industry influence 

Given that people rely on doctors for advice that is free from any kind of influence that might undermine their care, work carried out for or with the pharmaceutical industry is problematic. 

An Irish study looking at GPs’ perceptions of their relationship with the pharmaceutical industry stated that: “Pharmaceutical companies spend large amounts of money on promotion of medications, with most activities directed at physicians…However, information communicated by pharmaceutical representatives is often inaccurate, and physicians often underestimate the impact of these promotional activities on their prescribing behaviours.”

The Transfer of Value (ToV) database is a pharmaceutical industry initiative “to increase public and patient confidence in the integrity and independence of healthcare professionals and to promote a culture of integrity.”

In 2023, the HSE wrote to the Irish Pharmaceutical Healthcare Association, which runs the website, stating: “The HSE strongly believes that any ToV received by a HSE employee / HSE health care professional should be disclosed on the ToV platform i.e. www.transferofvalue.ie. The HSE would not, in general, support a request for non-disclosure.”

Yet despite this system being in place, it is not known how doctors who receive financial supports from pharmaceutical companies, as set out above, address conflicts of interest that arise, as the medical council advises. The advice is clear – healthcare professionals are advised not to accept gifts (including hospitality) from pharmaceutical commercial enterprises – and patients should be informed about any professional relationship doctors have with pharmaceutical companies.

What is also clear is that these kinds of links between doctors and pharmaceutical companies, whether disclosed or not, are not appropriate and could hamper important messages from reaching people on the ground. 

For example, although it’s long been reported that antidepressants work no better than placebo, they are still widely prescribed and many people still erroneously believe, as per industry marketing, that they correct a ‘chemical imbalance’. This is in no small part because of the kinds of activities highlighted here.

A 2017 systematic review investigating the association between physicians’ interactions with pharmaceutical companies and their clinical practices, concluded that there is a ‘consistent association’ between physician interactions with the pharmaceutical industry and ‘reduced prescribing quality as well as inappropriately increased prescribing rates.’  

According to expert in this field, Jonathan H Marks, partnerships and payments such as those outlined here, play into corporate strategies of influence, imperilling integrity as well as science and public health. 

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