Sunday, January 6, 2008

Donna Norris for President (of the APA)

These days, when you think politics, you are probably picturing the likes of Obama, Clinton, or Huckabee, but at least for the next few weeks, think Donna Norris.

Yes, it's time for all good psychiatrists to open that official APA ballot and check off their choices for who will make crucial decisions about the American mind over the next couple of years (the actual term is one year, but there is a preparatory "president-elect" year). Rarely have the distinctions between the candidates been more stark.

In one corner, we have
Donna Norris, M.D., a child and adolescent psychiatrist who has been active in APA governance for 25 years. She is currently the secretary-treasurer of the APA, chair of the Ethics Appeals Board, and a past speaker of the APA Assembly. More to the point, she is concerned about the pharmaceutical industry's influence on our profession. She chairs a special task force in charge of screening all potential members of the DSM-5 committee for commercial conflicts of interest. On a more personal note, she receives no financial compensation from drug companies, depending on her private practice for all of her income.

By contrast,
Alan Schatzberg, M.D., has no APA governance experience, although he once served as vice president of the Northern California Psychiatric Society. Even more troubling, he was involved in what many consider an ethical breach in 2002, when he wrote an article endorsing mifepristone for psychotic depression without disclosing the full extent of his financial involvement in Corcept, the company that has tried to develop the drug for this purpose. At that time he owned 3 million shares; the current value of these shares is about $12 million. Currently, Schatzberg is the editor-in-chief of a journal entitled the "International Journal of Sleep and Wakefulness" which is funded wholly by Cephalon, a pharmaceutical company that sells Provigil. The purpose of this pseudo-journal appears to be to convince readers that sleepiness is a huge public health problem and that Provigil is the mainstay of treatment.

I sent both Dr. Schatzberg and Dr. Norris a series of questions exploring their views on conflict of interest, and Dr. Schatzberg ignored me (Dr. Norris responded promptly).


CL Psych said...

I have to keep a closer eye on such developments. I did not know Schatzberg was in the running.

I wrote a little post a few months ago regarding a gargantuan conflict of interest involving Schatzberg and Corcept Therapeutics. He would not receive my vote.

Happy New Year.

Anonymous said...

Dr. Carlat, if what you write is correct re:Dr. Schatzberg, how can he state this on his APA endorsement site:
income: * 70%—Stanford University,
* 11%—Consulting to biotech start-up companies* 5%—Speaking–CM,* 8%—Writing and editing
Is Stanford really paying him that much?

Daniel Carlat said...

He does not make millions per year, although if he were to sell his current holdings today he would make close to $9 million (the $12 million figure was based on the Corcept stock price a couple of months ago). I don't know how much Stanford pays him.

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Anonymous said...

It’s time for peer review journals to take the bull by the horns!

Who runs the APA for the next term is a very important issue -- certainly worthy of debate. I do not know Dr. Norris, but I have known Dr. Schatzberg for 15-years. He has always been generous with his time and expertise, and has never seemed concerned with any financial remuneration. As I have also stated in the past, I believe that doctors are woefully undercompensated, so if a guy with Shatzberg's experience and scholarly contribution has $9 million in his portfolio, more power to him. The troubling issue for me is his co-authorship of the article in Biological Psychiatry, which was patently influential in endorsing Corcept's agent, mifepristone. I see this as (legitimately) knocking him out of the running for APA president (a position I am a little surprised that he would welcome).

Perhaps a more important issue is the need for commentaries in peer review journals accompanying articles such as the one published in Biological Psychiatry. Judging by the "ethical Breach in 2002" link in your posting, there were plenty of authorities available to write an unbiased commentary on the mifepristone story.

Psychopharmacology Bulletin has been guilty of overlooking the same kind of industry bias. In turn, we are aggressively recruiting commentaries to accompany articles that are ... well ... sensitive.

By the way, who does the nominating for APA positions? Shouldn't they be recipients of one of your questionnaires? Thank you.

James La Rossa Jr.
MedWorks Media Global
Los Angeles

Anonymous said...

Dr Schatzburg may well be "very generous with his time and expertise" and apparentally seem "unconcerned with financial remuneration" - it is unlikely he would be in a position to run for APA president without some likeable and admirable qualities. He probably has a self-concept very in line with these qualities too.

The problem is the insidious nature of money as a corrupting influence and the ability of us all as human beings to be affected by this and to fool to our conscious selves via various ego-defence mechanisms that we are OK, that we can handle the fact we've $millions in stock options or whatever.

This is a sickness throughout the medical system. I gather it is an issue in other scientific fields too. There needs to be a total divorce between the pharmacuetical/surgical products industry and financing the careers of doctors. An independent fund that industry is taxed to pay into from which researchers can draw upon for funding grants. Such a fund can sponsor peer-reviewed journals and conferences. A similar mechanism can handle the registration of all raw data.

The tax could be paid for by the savings from drug company marketing that could be outlawed or severely restricted. In that case the billions of $$$ would be plenty to go around.

Then we will have true evidence based medicine - not the corrupt sham we now have, when doctors are increasingly sceptical of whatever they read in journals.

This may sound utopian - but it is ethical and logical and would deliver the best outcomes - thus it presumably will come to pass some time in the future. Meanwhile we struggle on with some "key opinion leaders" rolling in pig swill and the rest of us wondering what to believe.

Anonymous said...

You address bigger issues than the APA election, so I thank you for moving the debate forward.

Until we, as a nation, choose to fund clinical drug trials w/ tax dollars and forgo many of our other National "extravagances," we will be dependent on private industry to fund our medical futures. As far as creating a medical Utopia by heaping restrictions on industry and publications, one has to think about the First and Third Amendment compromises this would spark -- which is, arguendo, more important to our collective futures than is our personal health. (And who would have the moral authority to regulate this agency of medical restrictions?)

The men and women who do the talking and writing are critically important to the process. They deserve some credit, as well, since they are determined enough to expose themselves to public scrutiny for what they write and talk about, which is not for the faint of heart. "Media" is a tough business because you make your mistakes in public for everyone to see.

Lost in this debate about "the insidious nature of money as a corrupting influence," as you put it, is the fact that many patients randomized to the placebo arm of clinical trials suffer increased mortality and morbidity -- oftentimes unnecessarily. This is a particularly high price to enact from those that are ill. And as long as there is an inherent "mistrust" of industry financed medicine (which is not always fair), in tandem with a lack of resolve as a Nation to put our tax dollars where they belong -- in medicine and education -- I am loathe to blame anyone other than ourselves for this current predicament. Sitting on the sidelines is what got us here; not running for APA president. Cheers, j.