The ranking Republican member of the Senate Finance Committee has asked APA
to provide detailed information about its relationships with the
Sen. Charles Grassley (R-Iowa) last month requested in a letter addressed
to APA Medical Director James H. Scully Jr., M.D., "an accounting of
industry funding that pharmaceutical companies and/or the foundations
established by these companies have provided" to APA, "including
but not limited to grants, donations, and sponsorship for meetings or
The request covers the period from January 2003 to the present.
Grassley's request is the latest instance of the rapidly escalating public
interest in—and scrutiny of—financial relationships between
medicine and the pharmaceutical industry. Similar letters were sent by
Grassley in January to the American College of Cardiology and the American
Separate from the request for information from APA, Grassley has also asked
Stanford University for information on its conflict-of-interest policies and
on disclosures made by APA President-elect Alan Schatzberg, M.D., about his
involvement with pharmaceutical manufacturers. In a detailed response,
Stanford said that all of Schatzberg's earnings have been properly disclosed,
and Grassley's staff later acknowledged that at least one charge he leveled
against Schatzberg about undisclosed income was in error (see Schatzberg Met
Disclosure Requirements, Stanford Says).
In response to the request to APA for information, APA President Nada
Stotland, M.D., M.P.H., said APA has nothing to hide.
"We intend to comply with the letter and spirit of Senator Grassley's
request," she told Psychiatric News. She added that Grassley's
letter, dated July 10, had asked for the information no later than July
24—a deadline she said had been impossible to meet to collect all the
information he requested. APA asked for, and received, an extension of the
deadline until September 2.
Upon receipt of Grassley's letter, Stotland disseminated a memo to the APA
membership. It read, in part: "[R]ecent public focus on relationships
between medicine and the pharmaceutical industry is a challenge for the whole
field of medicine. APA fully endorses the concept of transparency in our
relationships with pharma and other entities and has been in the forefront of
the disclosure process.... We are proud of what we do."
Speaking to Psychiatric News, Stotland reiterated those points,
saying that in the area of monitoring conflicts of interest, "APA is in
many ways way ahead of the curve." She especially cited the processes
and policies in place for vetting potential appointees to the DSM-V
Task Force and for monitoring the content of industry-supported symposia at
She also noted that in March the Board of Trustees empanelled a work group
charged to review all APA pharmaceutical revenues, sort them into categories,
and provide the Board with options for ending pharmaceutical support in each
category and the implications for the activities they currently fund.
Grassley, in his letter to APA, requested that all information be produced
in a table detailing pharmaceutical income by year, company name, amount of
funding, and reasons the funding was provided. He also asked for a description
of "policies for accepting industry funding and whether or not the APA
allows companies to place restrictions or provide guidance on how funding will
A press representative for Grassley told Psychiatric News that the
senator's investigation was not solely focused on psychiatry. "His focus
is on transparency in the relationship between medicine and the pharmaceutical
industry," the press officer said.
But in June, one month before Grassley's letter, the New York
Times featured an article alleging that psychiatric researchers at
Harvard Medical School may have failed to properly report drug-industry
funding they received.
Also, an analysis by the state's attorney general of pharmaceutical monies
given to doctors in Vermont found that among the 100 Vermont physicians
receiving the largest amount of money from drug manufacturers, 11 were
psychiatrists, and they had received a total of $626,379. That total was
greater than the totals for any other group of specialists on the list,
according to the attorney general's report. (In 2002, Vermont became the first
state in the nation to require pharmaceutical companies to disclose their
gifts and cash payments to doctors, hospitals, and other health care
But Stotland and other APA leaders who spoke with Psychiatric News
pointed out that though the 11 psychiatrists who were among the top 100
recipients of pharmaceutical funds received the largest total amount of money,
it should not be inferred that psychiatrists generally in Vermont or elsewhere
were receiving more money than other physicians—as the New York
Times seemed to report on June 27.
The paper ran a correction on July 3 in which it stated that the average
dollar figure the newspaper had reported for psychiatrists receiving
pharmaceutical money applied only to the 11 psychiatrists in the top 100, not
to all psychiatrists in the state.
"The issues of conflict of interest and relationships with industry
transcend all the specialties and are by no means limited to
psychiatry," said Paul Appelbaum, M.D., past chair of APA's Council on
Psychiatry and Law and a past president of APA.
He added that for some specialties, such as cardiology and orthopedics, the
issue of industry collaboration extends beyond pharmaceuticals to devices and
technology. "I find it hard to believe that psychiatrists are any more
prone to this kind of involvement than other specialties," Appelbaum
APA leaders who spoke with Psychiatric News generally agreed with
Stotland that the Association has been diligent about monitoring conflict of
interest at the organizational level well in advance of the current intense
public scrutiny and that individual problems around conflict of interest are
pervasive throughout medicine. (For more information about APA's relationship
with the pharmaceutical industry, see "From the President" in the
July 18 issue and "APA Enforces Strict Rules to Keep Bias out of
CME" in the April 4 issue.)
Michael Jibson, M.D., chair of APA's Committee on Industry Relations, which
is responsible for monitoring the content of industry-supported symposia at
APA meetings, said APA's efforts in this area are "pretty
In keeping with requirements by the Accreditation Council on Continuing
Medical Education, pharmaceutical companies are not allowed to determine the
subjects for symposia—those are decided by the Scientific Program
Committee—but can choose only from a menu of subjects if they want to
sponsor a session.
Additionally, since 1998 APA has monitored the content of
industry-supported symposia at the annual meeting and the Institute on
Psychiatric Services through its Resident Monitoring Program. Psychiatry
residents attend the symposia and, using guidelines developed by APA's
Department of CME and Committee on Commercial Support, monitor the balance in
each presentation, disclosure of conflicts of interest by faculty, use of
generic vs. brand names, discussion of unapproved or investigational uses, and
bias toward the supporting-company's products.
"[The process] is rigorous, and it's unusual to find anything that is
objectionable," Jibson told Psychiatric News. "We have
everything audiotaped so that if a question is raised about someone saying
something that was not supported by the general literature, we can go back and
But while APA's policies for monitoring conflict of interest at the
organizational level may be advanced, Stotland and others agreed that
standards and expectations around conflicts of interest in medicine are
evolving as public scrutiny mounts and that further refinements of policy may
Appelbaum said that some organizations, such as the American Academy of
Child and Adolescent Psychiatry, are moving toward developing
conflict-of-interest guidelines for individual clinicians.
"There are two separate loci for monitoring clinicians in this
area," he said. "One is at the medical school and hospital, where
there is the greatest potential for overseeing relationships. The other is at
the level of professional organizations like APA, which obviously have less
leverage in terms of regulation but can certainly develop guidelines for their
members. It may be appropriate for APA to do that as well," he said.
The report on Vermont physicians is posted at<www.atg.state.vt.us>.▪