Assembly Addresses Relationship Between APA, Drug Companies
APA's relationship with pharmaceutical companies was the focus of several papers discussed at last month's meeting of the APA Assembly in Washington, D.C.
Elizabeth Henderson, M.D., of Ridgeland, Miss., shows evidence for Assembly members of how badly Hurricane Katrina devastated her state, particularly its mental health services.
David Hathcox
The Assembly voted, for example, to include information on APA revenue that comes from drug companies in all future reports of the APA secretary-treasurer along with a description of activities that APA conducted with these funds. This is an effort to make the relationship between APA and the companies more“ transparent” and less subject to speculation or questions about possible conflicts of interest. This also responds to a concern spotlighted by APA President Steven Sharfstein, M.D., in his address to the annual meeting in May.
Assembly members also voted to have APA explore starting an initiative with the Pharmaceutical Research and Manufacturers of America (PhRMA) “to expand access to psychiatric care and treatment.” The Assembly actions addressed problems caused by managed care companies as they reduce access to some psychiatric medications and other treatments in their zeal to save money. The proposal emphasized that any advovacy effort arising from the joint initiative must be “consistent with APA's Practice Guidelines.” This was an attempt to ensure that psychotherapeutic treatments are part of any broadening of access, a concern for Assembly members since PhRMA represents companies that manufacture medications.
In addition, representatives called for appointment of a task force comprising representatives of the Board, Assembly, and pharmaceutical industry to “explore matters of mutual educational interest and develop a mechanism to manage areas of conflict.”
Representatives also voted to give those attending the APA annual meeting beginning in 2007 the option of purchasing a book bag, at APA's cost for the bag, if they did not want to carry their annual meeting books and other material in the free bag with a drug-company logo that all registrants receive. Supporters of the measure maintained that this is an example, emblazoned for all to see, of APA's dependence on funds from the pharmaceutical industry. Opponents countered that no one is forced to tote these bags since attendees can opt to use their own bag or briefcase.
Participating in Interrogations
The Assembly voted to endorse a modified version of a position statement on psychiatrists' participation in detainee interrogations passed in October by the Board of Trustees (Psychiatric News, November 4).
The Assembly chose different wording to characterize parameters for psychiatrists' participation in such interrogations. The Board's version said,“ Psychiatrists should not participate in the interrogation of persons held in custody by military or civilian investigative or law-enforcement authorities, whether in the United States of elsewhere.” It also said that psychiatrists should not provide information that could affect the way officials conduct interrogations of detainees.
The Assembly, in contrast, approved language that says that psychiatrists should not participate or assist in “coercive interrogation,” which it defined to include “degradation, threats, isolation, imposition of fear, humiliation, sensory deprivation or excessive stimulation, sleep deprivation, exploitation of phobias, or intentional infliction of physical pain such as use of prolonged stress positions.”
Because the versions differ, the proposed statement will have to go back to the Board, which will decide on final wording at its meeting this month.
Additional Actions
In other actions, the Assembly voted to:
Consider providing monetary support and technical assistance to district branches and state associations that want to develop or advocate for legislation barring the practice of holding civilly committed persons in jail until a hospital bed becomes available for them. | |||||
Create a voluntary, Internet-based listing of psychiatrists available to accept patient referrals. Access to the listing would be restricted to APA members only. The estimated cost for the new project is $97,000. | |||||
Develop a new list serve for chief residents and member-in-training (MIT) leaders at APA. | |||||
Address the problem of retaining MITs as APA members once they complete their residencies. The Assembly recommended that each district branch make an effort to procure lists of graduating MITs who are moving to an area included in another district branch and provide that branch with contact information on the graduating MIT. | |||||
Urge APA to adopt as official policy that states should have the option of receiving a federal exemption from the Institution for Mental Diseases exclusion for state hospitals and all nonprofit [hospitals and other treatment programs] with more than 16 beds.” At its July meeting, the Board of Trustees voted against having APA take such a stance, in part because of a concern that the change would threaten the financial health of nonprofit general hospital psychiatric units, which would end up in pricing wars with for-profit psychiatric hospitals. The Board will revisit the issue at its meeting this month. | |||||
Adopt a position statement concerning mentally ill prisoners on death row. | |||||
Make the Association of Gay and Lesbian Psychiatrists the 18th allied organization with representation in the Assembly. | |||||
Create a Corresponding Committee on Group, Couples, and Family Processes in Psychiatric Practice. Its proponents envision that such a committee would be able to educate psychiatrists about “group and family processes and therapy in relationship to a range of specific conditions.” | |||||
Defeat a proposal to support the Minnesota Psychiatric Society's Integrated Care Project, which its creators planned to use as a model that other district branches could adopt. Project leaders advocate for integrating psychiatric and other medical care with legislators, employers, health plans, and others. The Assembly agreed that the proposal left too many unanswered questions to warrant endorsement. | |||||
Reject a proposal to change APA's procedures regarding adoption of official position statements. When the Assembly would face a position statement proposal, the authors wanted the Assembly to first vote on whether APA should even have a position on the topic in question before it debated the merits of a statement's suggested wording. Representatives agreed that this would make the process “unnecessarily cumbersome” and that adequate checks and balances were in place during the long development process these statements go through. | |||||
Assembly representatives also received an extensive update from Irvin“ Sam” Muszynski, J.D., on the status of the upcoming Medicare Part D prescription drug benefit, in particular rules affecting beneficiaries who need psychiatric medications. Muszynski is the director of the APA Office of Healthcare Systems and Financing. He reminded members that APA has posted substantial information about Medicare Part D on the Web site<www.mentalhealthpartd.org>.
They also heard first-hand accounts of the havoc hurricanes Katrina and Rita wreaked on the Gulf Coast. Assembly members from the affected states described the devastation of many psychiatric practices and training programs in the region and predicted a long and difficult road to recovery.
A summary of actions from the Assembly's November meeting will be posted in the Members Corner section of APA's Web site at<www.psych.org/members.index.cfm> under “Assembly.” ▪
