Wednesday, March 24, 2010
Dr. Tom Insel, NIMH Chief, Scolds Psychiatry
In the latest issue of JAMA (the Journal of the American Medical Association), Dr. Thomas Insel, the chief of NIMH (National Institute of Mental Health) accuses academic medicine of having become a "culture of influence," in which drug industry marketing goals have pervaded the practice of psychiatry.
Insel's commentary is entitled "Psychiatrists' Relationships with Pharmaceutical Companies: Part of the Problem or Part of the Solution?" While acknowledging (as we all should) that some collaboration between physicians and pharma is a good thing, he concludes that industry influence has radically skewed psychiatric practice in favor of the most expensive drugs, even when evidence shows that cheaper generics work as effectively. He also bemoans the fact that effective psychotherapeutic techniques are "woefully underused and frequently not reimbursed."
In what I believe is an oblique endorsement of an APA Work Group's report on the relationships between psychiatrists and industry, Insel calls on organized psychiatry to lead the way to reform:
"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. 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."
Not all wags see Insel's commentary as optimistically as I do, of course. Bernard Carroll, over at Health Care Renewal, believes that Insel went soft on some of the poster boys of corruption, such as Charles Nemeroff, who resigned his chairmanship of Emory after it became clear he deceived the university regarding his promotional work with industry. Carroll points out that Insel might have considered disclosing his history of close ties with Nemeroff:
"Though Dr. Insel spoke in platitudes about the need for transparency as a solution, the spirit of transparency did not move him to disclose that Nemeroff is his former boss at Emory; that Nemeroff found a position for him when Insel was departing the intramural research program at NIMH; that Nemeroff lobbied for Insel’s appointment as NIMH Director; and that Insel appointed Nemeroff as an advisor soon after he moved to NIMH. These are pertinent conflicts of interest that readers of JAMA deserve to know about."
If this is true, this is interesting information that is new to me. Nonetheless, in my opinion it does little to detract from the power (and courage) of the country's chief psychiatrist calling his own profession out on the carpet for bad behavior. Bravo to Dr. Insel!