FIG1Sometimes a perfect storm,
or a confluence of influence, can be a good thing. Last March, the APA Board
of Trustees began a process of self-examination about the relationships
between APA and the pharmaceutical industry, a topic about which many of our
members have been concerned. Jeffrey Geller, M.D., chairs a work group that
has prepared a report for the Board offering options for the reduction of
pharmaceutical funding over the next five years. The work group began with a
breakdown of the kinds of relationships we have and of the activities on which
we spend that money—and your dues. The APA staff were extremely helpful
in putting this information together.
Several months after our work group began its task, the media erupted with
stories alleging that prominent physicians, most of them psychiatrists, had
received, and not reported to their institutions, large sums of money. Many of
us get questions about these media reports from relatives, friends, and
patients. Most of these allegations remain unresolved.
As you know, members' feelings about funding by pharmaceutical companies
vary a great deal depending on what the money is meant for. Most members have
no objection to pharmaceutical advertising in our journals and Psychiatric
News. The exhibit halls at our meetings are another means of advertising.
They are set off from the scientific sessions, but some members find them
inappropriate. Industry-supported symposia arouse the most controversy. Among
the members I've heard from, most have negative feelings about them, but
others consider them the high point of the meetings.
While we were analyzing our relationships with industry, organizations
including the Association of American Medical Colleges and the AMA were
addressing the issue of pharmaceutical funding of undergraduate, graduate, and
continuing medical education. Each recommended a significant diminution or
cessation of that funding. These decisions do not come without resistance; the
AMA House of Delegates sent back its council report for further
Our sister specialty organizations are weighing the merits of the
relationships between their associations, their individual members, and
industry. The American College of Obstetricians and Gynecologists has adopted
a policy that no member of its board may receive money from pharmaceutical
companies except for the conduct of multicenter trials. The American
Association of Orthopedic Surgeons has developed a set of standards and an
online educational module to help their members talk with their patients about
any relationships they have with companies that manufacture artificial joints
and other orthopedic devices.
Overall, as the politicians say, my mail is running heavily against
pharmaceutical support, mainly of APA educational activities, but perhaps of
other activities as well. At the same time, the United States and world
economies have been in turmoil. Many members, including me, are concerned
about their practices, loans, mortgages, children's educations, and
retirements. That's the final element of the perfect storm.
So we have to prioritize. We want to minimize our use of reserves. We spend
$3.2 million of our income on governance: the Board, the Assembly, and the
components (committees, councils, and so on). The rest goes to member
services, education (professional and public), and the kind of research that
directly affects our work.
As with pharmaceutical funding, members have strong feelings about
governance. We have a lot of governance; few other specialty societies have an
Assembly, and none has as many committees as we have. Each requires staff.
Each brings members together and involves them directly in the workings of
APA. The loss or downsizing of any of them would undoubtedly upset those
dedicated members and deprive us of their contributions, but it would save a
considerable sum of money. Ronald Burd, M.D., the speaker of the Assembly, and
I have appointed a work group (these work groups are functioning by means of
electronic communication) to consider changes in our governance. You can
access the list of components in the Members Corner section of APA's Web site
I need to know what you think we should do. I may not be able to continue
to respond personally to each of your messages, but I will read them and
convey your feelings to your Assembly and your Board, which has the ultimate
responsibility to carry out your wishes. It's your APA; let's put this perfect
storm to good use. ▪