Thursday, June 30, 2011

Guest Blogger SG on How the Pharmaceutical Companies Have Damaged Psychiatry

SG put a comment on our last post on The Chapter I Wish We'd Written on Bad Psychiatrists.  With permission, I'm making part of those comments their own post.  I gotta tell you, SG, we shrinks aren't so happy about these issues either.

Per SG:

I don't think the issue is so much a few bad shrinks but bad psychiatry. What I object to most is the pervasive compromising of science by pharmaceutical companies and all-out advertising.

This toxic influence is so pervasive that one comes to the forlorn conclusion that evidence-based medicine as it is currently practiced is really just a way for pharmaceutical companies to generate new revenue streams. The companies are so savvy they realized if they own the evidence through biased studies and suppressed trial data (failed studies, nasty side effects), they would have physicians eating out of their hands and prescribing their pills for whatever they wanted. I really think this dynamic is similar to state ownership of the media by totalitarian regimes.

Of course this is endemic in all of medicine, but psychiatry is uniquely vulnerable to this phenomenon because it has become so rigorously based on medical therapy (read: pills) since the DSM III ushered in the new "biologically based" model of mental health.

I refer the posters on this thread to the 1boring old man website in which a retired psychiatrist has been relentlessly examining internal emails between pharma execs, presentations by prominent psychiatrists like Madhukar Trivedi, seriously compromised studies like STAR-D, and various political infighting between powerful psychiatrists.

It's all very vertiginous and one comes away with the conclusion that the last 30 years of psychiatric "breakthroughs" are largely built on sand.

I think it is imperative that psychiatry look at ALL the evidence in evidence-based medicine, even if it provokes cognitive dissonance.

We must remember this about evidence-based medicine: it works on paper, but when you factor in human bias, fear, greed, and stubborn attitudes, you could have the most air-tight science (or evidence) in the world, but if it doesn't tell us what we want to hear, then the medical community automatically thinks it's flawed. How is that true evidence-based medicine?

It's time for psychiatry to come to some harsh truths and own up to them so ALL psychiatrists, even the good ones (and yes there are some good ones!) can practice at a higher standard. Even if a psychiatrist does everything right these days, I know they could do far better if they had a more honest and transparent evidence base to draw on.