Conflicts of Interest

In the midst of our APA officers' responses to negative public relations concerning pharmaceutical company payments to psychiatrists, an important initiative is being overlooked. Rather than just reacting to the media innuendo of malfeasance, we need to articulate the best practices for psychiatrists who do professional services with American industry. Rather than assuming conflict of interest “guilt until proven innocent,” APA should lead in setting standards for integrating pharmaceutical services with the other various forms of psychiatric remuneration. Combining my experience from treating patients, doing industry clinical trials, teaching residents, conducting pharmaceutical-sponsored education programs, and writing publications, I recommend these standards for psychiatrist conduct.

A presenter of pharmaceutical-sponsored education programs should conform to FDA-regulated and CME-certified content only. Pharmaceutical companies are currently required to meet this standard, and speakers should not deviate.

Speaking/consulting fees that psychiatrists accept should be reasonable by usual medical time, effort, and expertise costs. The HHS Office of the Inspector General monitors these fees for fair market value. If a fee seems excessive in one's community, donation of a portion to charity is encouraged.

If a psychiatrist's state legislature decides such fee-for-service programs raise the cost of public-funded care such as Medicaid by encouraging use of more expensive branded medicines, a doctor can decline to speak there.

If a state legislature or other official group decides that acceptance of speaking/consulting fees also raises the public health care costs through biasing a psychiatrist's choice of treatments, the doctor can curtail treatment of public program participants or provide them free medicine, as with samples.

Commercial insurance and self-pay patients deserve disclosure of our pharmaceutical working relationships, so as to judge for themselves possible conflicts regarding their treatment.

Last, influential psychiatrists owe our communities and professional organizations truthful disclosure about all of their third-party financial interests, whether pharmaceutical, institutional, agency, managed care, forensic, school system, research, or private investment sources.