"I set out to try to understand whether the problems of industry influence were worse in psychiatry than in other specialties, and I came to the conclusion that we just can't determine that," Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), told Psychiatric News.
"But that's not the key question. Whether the problem is better or worse in psychiatry, there is a still a problem. And I think that [the public perception regarding the problem of industry influence] is more hurtful for psychiatry than it is for other specialties. While this problem may be endemic, my sense is that it probably will do more damage to psychiatry than in other areas of medicine. We have less public trust to waste."
Insel spoke with Psychiatric News following the publication of a commentary in the Journal of the American Medical Association titled "Psychiatrists' Relationships With Pharmaceutical Companies: Part of the Problem or Part of the Solution?"
In that article, Insel cited a "culture of influence" among academic researchers, practitioners, and pharmaceutical companies and warned against "a defiant embrace of the status quo, in which psychiatrists are seen as a leading source of the problem rather than as leaders in finding the solution for financial conflicts of interest."
Speaking with Psychiatric News, Insel expanded on those views and reiterated his belief that psychiatry as a profession needs to be "out in front" of the issue of conflict of interest. He acknowledged that he was unfamiliar with some actions APA has taken (Insel is not an APA member), including requiring speakers at APA meetings to disclose conflicts and monitoring speakers at industry-supported symposia for possible bias (see Psychiatric Leaders Agree Changes Due in Psychiatry-Industry Relationship).
Insel said, however, that he believes that disclosure of conflicts of interest alone is not enough and cited findings from cognitive science showing that disclosure may actually increase bias rather than work to decrease it. "There has been a presumption in the academic community and among practitioners that somehow disclosure is the way to mitigate conflict of interest," Insel said. "I think disclosure of conflicts is necessary but not sufficient."
In the JAMA article, Insel suggested that what is needed are clear lines of demarcation between science and marketing. "The focus on financial conflicts of interest in psychiatry is an opportunity to take the lead in setting new standards for interactions between all medical disciplines and industry," Insel wrote. "Academic leaders, professional societies, and patient-advocacy groups could turn the tables of public trust by developing a culture of transparency for psychiatry's collaborations with industry, including the clear separation of academic-clinical missions from industry marketing."
So what is the future of drug development and discovery, how should psychiatrists and industry collaborate going forward, and what is the role of NIMH?
Those questions are at the heart of a Weblog posting Insel wrote in March on the NIMH Web site titled "Who Will Develop the Next Generation of Medications for Mental Illness?" In that posting, he cited evidence that pharmaceutical companies were pulling back from research on central nervous system targets because of the costs and difficulty associated with developing new drugs in this area.
As a response, he cited some federal government initiatives, such as the Molecular Libraries Program, an effort throughout the National Institutes of Health to enable academic researchers to screen for molecules that could become lead compounds for drug development.
"For the last five or six years, we have been working on empowering academic investigators to become more involved in drug development through specific programs at NIMH," Insel told Psychiatric News. "This is really the key question—how is drug development going to happen in the future?
"There are three answers—the first is that NIMH can continue to do more in drug discovery and development," he said. "We have experience doing research on neglected targets—such as autism—in which pharma may have had less interest. Second, we can catalyze what happens in the pharmaceutical industry by making the kinds of discoveries that encourage pharma to stay in the game. And we can create opportunities for partnerships between academic researchers and industry. It is a gross misreading of NIMH's position to say that we are antagonistic to pharma or that we don't want academic investigators to work with industry. It's not true.
"But there is a difference between having academic and industry investigators collaborating on science and having them collaborate on marketing," Insel continued. "Pharma is a complex industry, and to the extent that we are talking about drug development, there is a lot of interest in working together. To the extent that we are talking about marketing of patented compounds, that is the job of people who work for pharma. I don't think government or academic researchers will gain a lot of trust by participating in that."
"Psychiatrists' Relationships With Pharmaceutical Companies: Part of the Problem or Part of the Solution?" is posted at <http://jama.ama-assn.org/cgi/content/full/303/12/1192?home>. "Who Will Develop the Next Generation of Medications for Mental Illness?" is posted at <www.nimh.nih.gov/about/director/index.shtml>.