Psychiatry is nothing more than a well-funded front for big pharma, according to lawmakers investigating the field’s premier organization, the American Psychiatric Association. Unlike psychologists, psychiatrists can write prescriptions, giving pharmaceutical companies a powerful incentive to lavishly subsidize both their lifestyle and profession.
Nearly a third of the Association’s $62 million budget comes from big pharma, which also showers individual practitioners with lucrative ‘consultation fees’. The problem isn’t that the profession lacks adequate ethics guidelines or regulations, but that some psychiatrists simply ignore the rules.
As a group, psychiatrists earn less in base salary than any other specialists, according to a nationwide survey by the Medical Group Management Association. In 2007, median compensation for psychiatrists was $198,653, less than half of the $464,420 earned by diagnostic radiologists and barely more than the $190,547 earned by doctors practicing internal medicine.
But many psychiatrists supplement this income with consulting arrangements with drug makers, traveling the country to give dinner talks about drugs to other doctors for fees generally ranging from $750 to $3,500 per event, for instance.
While data on industry consulting arrangements are sparse, state officials in Vermont reported that in the 2007 fiscal year, drug makers gave more money to psychiatrists than to doctors in any other specialty. Eleven psychiatrists in the state received an average of $56,944 each. Data from Minnesota, among the few other states to collect such information, show a similar trend.
In both states, individual psychiatrists are not top earners, but consulting arrangements are so common that their total tops all others. The worry is that this money may subtly alter psychiatrists’ choices of which drugs to prescribe.
An analysis of Minnesota data by The New York Times last year found that on average, psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs appear to have written three times as many prescriptions to children for the drugs as psychiatrists who received less money or none. The drugs are not approved for most uses in children, who appear to be especially susceptible to the side effects, including rapid weight gain.
A psychiatrist’s office is a “safe space,” where it’s ok to ask any question, including: “have you received any compensation from any drug company?”
Psychiatric Group Faces Scrutiny Over Drug Industry Ties [NYT]
(Photo: Getty)
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@rocket72: Well said.
Btw, radiologists are very vulnerable to malpractice suits–sometimes there’s an issue of genuine incompetence, sure, but more often it’s because Mom dies of cancer, and the kids decide it must be because of a radiologist who “should” have been able to prevent it. Because doctors are supposed to be magic, right?
Fear of lawsuits means fewer radiologists read mammograms.
Missed breast cancer is the most common basis for medical malpractice lawsuits in the United States, according to the Physician Insurers Association of America, a trade group of medical malpractice insurance carriers.
But, experts say, the problem is not inept radiologists, although there are certainly some of those. Instead, the problem is a misconception about the effectiveness of mammography…
@katylostherart: The reason most Doctors make that much money, is because there is a high demand/low supply of medical professionals. So if the Government caps doctors income they better start forcing people to become doctors, because it is one of the most stressful fields you can work in.
So if you want doctors to make less money then encourage more people to become doctors.
Also in the interim enjoy the results of a Lawsuit happy society, fewer and fewer people want to become doctors because of the stress and such so its going to get more expensive before it gets less.
@xanax25mg: Thank you for this post. As a soon-to-be psychologist (on internship currently), I took offense at the poster negating my education by saying I will “at best” have a Ph.D. (and, frankly, I’m a long-time lurker posting for the first time because of this comment). Who is best equipped to provide the most efficacious treatments for psychological disorders: a Ph.D. with years of supervised training in CBT (and the like), or an M.D. with at most “1 class in cognitive behavioral therapy?” At least we know when combined treatments are appropriate.
I’m in medical school and I don’t understand why medicine should be as stressful as it is. Increase seats at medical schools (esp state schools), subsidize tuition for all state schools (private schools be damned), decrease hours for both nurses and doctors and subsidize malpractice insurance (yes, you heard me). It’s very simple, yet there is way too much bureaucracy in the medical field for any of this to pass.
@thelushie: My mother is the same way. If it weren’t for her medication she would not be alive today, no exaggeration.
HOWEVER. This does not make it right for big Pharma to jack up prices on medicine, bribe psychiatrists, and, y’know…do any of that sketchy stuff they tend to do. Your argument makes no sense. So because you need meds to function it’s okay to let them do whatever they like, forget ethics?
When I was a teen I went to the same psychiatrist that saved my mother’s life. He would shove a new prescription at me almost every single session. “Insomnia troubles? Here’s some Valium!” “Feeling sleepy all the time? Have some Wellbutrin!” I’ve been on tons of different meds (including lithium, which is pretty serious stuff), and guess what? None of them worked for me. Later I graduated from high school and started feeling much better…turned out the major cause of my depression was my shitty high school!
And now that I think about it, I do remember a point where he said he was not accepting anything from drug companies anymore. I was like “You mean like, pens and notepads and stuff?” “No, it was more than that. Like free vacations and electronics and things…”
whoa whoa whoa.
Psychiatry isn’t specific enough for what you are complaining about. Psychiatry can refer to any kind of mental health assistance, science, therapy, and pharmacy.
While I too think that some psychopharmacy is unnecessary, in the effect that many drugs are over-prescribed, that isn’t a valid conclusion to debunk what psychiatry is, which is defined generally as the diagnosis and treatment of mental illness.
Yes, the difference between a psychiatrist and a psychologist is the MD that the psychiatrist has, which enables the psychiatrist to prescribe medication, but that doesn’t necessitate that all psychiatrists do that, or at all psychiatry is a front.
I hope other people who stumbled upon this commentary and the linked article realize that mental health is often overlooked, and it comes with an unfortunate stigma at times when people seek help.
There is a major problem with the way pharmaceutical companies are permitted to market toward medical professionals in general, i.e. any kind of doctor that prescribes medication.
We need to take a step back and examine the root of the overall problem, and not focus energy in such a way that could hurt people.
Gee, that’s funny. I’ve been a Doc for 23 years and nobody has given me a laptop or flown me off to “exotic” locations. All these stories!. Greed, opulence, decadence! Abuses exist, Gardisil/Chantix/the Statin Push/Ambien/Lunesta/Rozerem/etc WAY overpushed. But I guess I am just a well educated ethical guy who tries to do right by my patients, prescribing (if a prescription is necessary), what’s reasonable & cost-efficient, while getting stiffed & sued by patients, having to spend hours with managed care companies trying to get paid or explaining to the patient that it’s not reasonable for me to stop what I’m doing right now (caring for a patient) and call their insurance company because they insist I get an override NOW because they insist on Cialis.
Keep in mind, sometimes your Doc is just a good guy trying to take care of you, do right & feed his kids too.
I notice nobody mentions the new regs where a rep can’t give you a pen?
And yes, drug prices ARE ridiculous.
To those who cite laptops & exotic locations, I call shenanigans. Hasn’t happened in years, & if you believe it’s true, feel free to post the Doc, the Company & the details. I’ll follow up
Psychiatry is not a fucking make-believe bullshit magic science whatever. I hate the way dumbass blogs phrase shit like that.
But anyways: yes, drug companies bribe/push drugs on everyone and everything. It’s not good, but the BIGGER ISSUE is that psychiatric research goes largely unfounded and many, many, many people are not getting the help they need. If a doctor is offended because he got a muffin, he can eat shit (obviously it’s more complicated than that… but I’m grumpy).
Oh, and the approved for use in children bit? Hardly any bipolar meds are approved for children, and I needed them, so… the choice is I kill myself on no medication, or be alive and have side effects on medication that’s kind of risky. I picked.
@csmcdonald:
Thank you.
If you need help, talk to a friend, a school counselor, a therapist, a psychiatrist, or just someone you can trust. Don’t wait. Your life is too important.
As a college student I’ve seen drug companies at career fairs. Judging by the drug reps and a few things I overheard, pre-requisites for the job apparently include being a gorgeous leggy sorority girl, the ability to never take no for an answer, and the willingness to essentially live and work out of your car. Intelligence and a related major are not required.
I just wish the drug companies would bring all the good schwag they give the doctors to the career fairs. I’ll take a cereal bar from Aldi’s over a GSK pen anyday!
@Leiterfluid:
Mmmm, not necessarily. Look into the steps it takes to earn a PhD. and become a licensed psychologist. Especially CA or NY.
@xanax25mg:
Here here, sir/madam. I’m a licensed marriage and family therapist (only a Masters so I must REALLY be unqualified) who has worked in non-profit agencies before going into private practice. I loathed seeing that a lunch was scheduled for us to listen to a smarmy sales person who has no training or genuine understanding of other resources that are out there for people. I do believe that psychotropics can be beneficial in some cases. I’d take an empathic, knowledgeable therapist/counselor who I can trust and connect with to help me learn how to approach a situation differently than someone who (yes, has spent many years in med school) gives me 15 minutes of his/her time and is convinced that a pill will be the answer. That being said, psychiatry isn’t the issue and there are good psychiatrists out there. The issue is unethical ones who find greater value in our crappy dollar and swag than connecting with and helping someone in need.
@Canino:
Yes, there was. I was in a clinical trial for a treatment for ADHD 32 years ago. You don’t know what you’re talking about, but most mental health “experts” share your lack.
As for being a cash cow, the two most popular treatments for ADD/ADHD are Ritalin and Adderall, both of which have had generics available for years. At least 15 that I’m aware of for methylphenidate, dating squarely back to the days when ADD was the “it” diagnosis. The first medication I was ever prescribed was dexedrine, also available as a generic during that time.
If you’re going to say that selling a lot of something is a plot by Big Pharma to make big bucks, then how come nobody ever points to something like Tylenol or Aleve? They sell a metric buttload of that stuff every year, but nobody ever says we overdiagnose headache or sore knees. Everybody’s an expert when it comes to mental health, though.
@dabofug:
I’ve been lucky to have more doctors like you than not. Sometimes I think the medical establishment has been a little too good in imbuing doctors with omnipotence, so patients forget their doctors are human, too. Thanks, doc.
Bummer about the pens, though. Drug reps always have the best pens.
@bria: Hey, Tom Cruise wouldn’t jump up and down like a crazy person on a couch for nothing. If we can’t trust our celebrities, who can we trust?
Here goes the “Doctors make too much money it’s not fair” crap. First off, where the heck do they get the 400k figure for radiologists? All my sources point to 200k being the average, post training salary which goes up to around 300k on average after 3 years of post residency work. Second, screw you assholes. Medicine is hard work that very few people are able to handle. Do you have any idea what kind of stress is involved in becoming a doctor? How much money and lost income due to YEARS AND YEARS OF TRAINING? Average debt following medical school is around 300k. Physicians are some of the best trained people in the world and it takes a lot more work to become a licensed, board certified physician than pretty much anyother job out there. In burns me up to hear people bitching about physician salaries when I’ve sacrificed so much to get here and work so hard. You get what you pay for. You want to cut physician reimbursements rates as is happening with medicare/medicaid, expect to find yourself without a competent doctor who is willing to accept you.
Have a Scientologeriffic day.
There’s also the issue of patients going to their doctors and expecting to be issued with a prescription – mild situational depression does not require medication – but some patients will not feel validated unless they are given drugs (I’ve heard this from an exhausted general practitioner), also patients insisting on antibiotics for viral illnesses where they have no provable benefit.
It would seem that some patients measure how good a doctor is by the number of items on their RX – and big Pharma’s advertising probably has a lot to do with that concept. All these heavily-hyped illnesses that never existed until the marketing department dreamed them up…which lots of patients suddenly decide they have because they saw it on Oprah.
Typing as someone who needs big Pharma products to function (I’m bipolar) I’m grateful that they do spend money on research as I’m now far less likely to get tardive dyskinesia from my meds, and have fewer other side effects to boot, but I do think that a drug that works should sell itself…or is that rather naive of me?
I don’t care how much money my doctors make as long as they are genuinely working to improve my health. What these junkets/gifts etc do is muddy the waters of perception on the patients’ side. Am I being prescribed this because the doc gets a bonus for each filled Rx or because it’s the best drug for me?
Simple rule of thumb is to find a doc that doesn’t over-prescribe and hang in there with them. Any doc that prescribes anti-biotics/steroids for flu (unless you’re elderly or infirm) is in big Pharma’s pocket and should be avoided (assuming, of course, you have a choice in your health-care provider).
BTW Kitkatsplash – Zyprexa is a nasty nasty drug – glare at the rep for me next time he comes by? Ovarian cysts are not an acceptable side effect!
I have absolutely no problem that radiologists, anesthesiologists, doctors, and surgeons etc make as much as they do. They are some of the few professions deserving of the money they make. The mental and physical stress, the years of training, and the huge amount of money invested means they they better get some really good compensation in return. Plus, they are one of the few professions where doing good is an everyday occurrence, not just something for the holiday time. Think about that the next time complaints are raised about the “crazy” amounts of money people in the medical profession are paid.
Now… pharma… I have a little experience with pharma as I’m doing some software implementation for a very large pharma company right now. There’s an industry that needs some serious cuts. Cut out most of the management (they’re 90% useless and make way too much for their responsibilities), shift money AWAY from advertisements to R&D, and use the rest to lower the costs of some of the insanely expensive drugs out there (AIDS, cancer, etc). Drug companies run a damn good racket, its just to bad very few people get the see the true benefits.
I’m wondering where exactly in the Hippocratic Oath does it talk about making a shitload of money by showing preferential treatment to the drug peddler that buys you off with the most cash?
Medical ethics has become an oxymoron in this country.
When you consider that all the fantastic new drugs coming out every year, which require ungodly amounts of money for R&D have to be paid for somehow, it seems a lot less shady.
Are drug companies working their butts off to try to make as much money as they can in a highly competitive market? Absolutely, and they owe it to their shareholders to do so.
Are we constantly being inundated with new drugs to cure everything under the sun, even if they’re often expensive? Yes, and thank you very much money grubbing Big Pharma. You act as sleazy and greedy as you like, just keep me and my family alive and healthy longer.
The VA figured this out a long time ago. They don’t play the drug companies game. Drug reps and their goodies are banned from VA hospitals. Somehow they manage to function and doctors manage to prescribe drug therapy to patients.
There was a hospital in Duluth MN that banned all drug swag and the drug reps from the campus. This really needs to become a trend where not doing this makes a hospital or clinic look possibly unethical. I would also be all for a ban on direct to consumer prescription drug marketing. They did it for smokes and liquor.
There is a very fine line here that I think is worth mentioning:
Anti-depressants and other medication in the same category are sometimes necessary for people to regain control of their emotional health. I’m speaking from my own experience and from counseling others.
Full disclosure, I was a church counselor. Simple training, only listened and offered advice on small problems. If it was “big” like suicide, etc, I referred them to actual licensed counselors.
I do agree that anti-depresants are prescribed more than they need to be. The fact that half of all americans are on anti-depresants tell me that people just want a pill to make things go away. Very few people even think about being weened off them.
The problem is two-fold: the big-pharma pushing pills and a society with a “fix it quick” mentality.
Bart Simpson: Mom, do you want to drawer opened right or opened fast?
Marge Simpson: I want it done like every American wants it: fast!
So they’re complaining about making *only* $190,000? And to make up for the obvious lack on income, they get paid to push drugs on clients?
@Leiterfluid: who is better able to deal with such problems is a fmatter of opinion and anecdote. It requires that you accept a specific behavioral range of what should be, and that a person is not in that range, and that non-pharmaceutical therapies cannot be effective. That doesn’t mean person X is not better off on a mood-altering drug than seeing a shrink or eating better. But, it does not mean that they are, nor that a person trained more in traditional medicine than in human thought and action is better at dealing with the problem.
First, any and all mental disorders and illnesses are from chemical imbalances. Eating some legumes or berries regularly might fix somebody right up. Maybe exercise=ing more will do it. Maybe talking through some emotional distress with someone trained to help them get into and trough it. Maybe changing careers or social circles will help. Maybe regularly taking a drug can do it.
@Canino: ADD existed before. It was not and is not a discipline problem, except from certain perspectives (primarily parents that wan docile normality, and school employees that want kids to do what they are told above all else). Autism was there, too. Neither had as wide a range nor low a degree of symptoms to be diagnosed as today.
ADD is a good example, though, because what now gets you a diagnosis of ADD, and a nice Rx, once just got you labeled as odd—you’d need to be serious case to be considered for drugging.
Even in the case of a psychiatrist that isn’t a huge drug pusher, you still have the issue that they are MDs, and drugs are their hammer. Your problem is a nail. Some people genuinely need the drugs; but not as many as get them; and the drug companies are happy with this.
If the people-who-would-be-patients would think a bit more about they might be getting themselves (and often their children) into, this whole thing would begin to fade, at least enough not to be a major problem. Take the time to fix it, instead of covering it up.
@katylostherart:
Um, no. Regarding your statement that pediatricians make 50K/year 1-2 years after medical school, that’s because they’re doing residency, and thus aren’t certified as licensing physicians. Even radiologists have residencies, and I can assure you that no program in the country will pay a graduated medical student with no years of experience 200k. If you know of any such programs, please let me know so I can apply to them after school in order to pay off the 300k in loans I will have.
Ein’s comment was a good one – budget for adequate health insurance instead of spending money on disposable, unnecessary goods. Also, stop smoking, exercise more, and generally don’t do stupid things (like using a chainsaw when drunk) that would result in a trip to the emergency department.
There is no, no, NO excuse for doctors to be taking money from drug manufacturers. NONE. If they are not prescribing medication based 100% on unbiased, noncommercial sources of information, then they’re shams and have no business prescribing medication at all.
Natural health practitioners are the only safe way to go when things aren’t deadly serious — they won’t pump you full of chemicals you don’t need. And if things *are* serious, I highly recommend looking for a No Free Lunch doctor. (Google it — they’re docs who refuse to take drug co. bribes.)
My mom is a nurse, and she and everyone else at the large hospital she works at calls them “drug dealers”. And based on their behavior, I’d say that’s pretty darn accurate: They don’t care who gets hurt, as long as they move product. And the doctors who listen to them are no better.
(Guess what? If you became a doctor for the money…you shouldn’t be a doctor.)
Also, less than one percent of children have genuine mental health issues, and most of the ones who do are either developmentally challenged or were badly traumatized. If that’s not your kid, and you let some rich prick pump that growing body and brain full of barely-tested psychotropic substances just because you were told to…Well, enjoy your special place in hell.
@puka_pai: Haha – you proved my point. Sure there was “such a thing” as ADHD, but it wasn’t prevalent. But they came out with some drug – you yourself were involved in clinical trials you said – and once they found one then…THEN all of a sudden everyone had ADHD.
Just like autism now. Sure I’ve known autism existed since I was a kid. But now EVERYONE HAS IT OR HAS A KID WITH IT. Why? Because some pharma company came out with some medication and started getting docs to diagnose it so they could prescribe the med!
@Mary Marsala with Fries:
Doctors run clinical trials to test the efficacy of new drugs before they come to market. Are you saying that they should do this pro bono so that they maintain their neutrality?
As for “natural health practitioners,” while I’m not disputing that some of those remedies MAY have therapeutic benefits, there are very few trials that demonstrate either the efficacy or the safety of those treatments. For the most part, you are groping in the dark with this path, and your guide may not know much about what they’re doing either.
@Canino: I’ve worked with kids with severe Autism. I’ve seen the horrible effects this illness has on the families and children involved. I’ve seen an 18 year old kid bang his head into a wall so hard that his head started bleeding and he passed out. And the terrifying thing is, every year that goes by, we see more of these kinds of kids. Many of them have little to no language skills, inflict self-harm, and have no social skills whatsoever.
And yet you seem to thing that this is part of some scam of big pharma?
Go home and do you homework before you start ranting about things you have no clue about.
This was a careing post. But why is becoming a doctor more expensive than an engineer or lawyer? Whatever. I had a student Nick, who in th 6th grade was on those mind numbing drugs but then after off he not only loss weight, he perked up or “woke”up should I say and became a regular pain in the ass 6th grader. But my god “Clonodine .20″ is the nectar of the gods.(im feeling sleepy)
@Leiterfluid, xanax25mg: I graduated with only a BA in psychology, although I intended to get my PhD before I did a career change. We were SPECIFICALLY taught that ONLY those with a PhD were allowed to call themselves psychologists. Psychiatrists are MDs, but that doesn’t make them neccisarily better. It is what your needs are.
ANYONE can call themself a therapist. Therein lies the “at best.” Therapists at best have taken a intro to psych class at their local community college.
Psychologists are also trained to understand mental illness, and they aren’t considered any less than a psychiatrist.
As a person who considered studying to be a psychologist, I would like to think that psychiatrists are more ethical than this.
I’d also like to point out that many “Family Doctors” prescribe mood-altering drugs used in psychiatry. With no training at all. These are probably who are prescribing the drugs mentioned above, in the very biased report.
@Canino: AdHd has actually been proven to be a neurobiological condition.
A lot of people don’t believe in certain conditions. It’s a riot that just because you can’t pull out a damaged body part, anything physical, that people simply refuse to believe in it (although they persist in believing in god).
Most of the people who are jamming pills down childrens’ throats are most likely family doctors who don’t take the time to study the child.
I have ADD and I have noticed an actual difference of assignment completion when I take Focalin (I don’t take this daily). ADD is simply an focusing problem, an attention problem.
If you have actually experienced a child with real ADHD, you would understand that it exists. No, children should not be misdiagnosed. But just because a child is misdiagnosed does not mean the disorder is made up.
@Canino:
Sorry, no. I didn’t in any way prove your point. ADD/ADHD was diagnosed much more frequently in the 90′s, and as I said in my original post, I was in a clinical trial 32 years ago. If you did the math, you’d see that was quite a long time before the 90′s. (Hint: it was the Bicentennial year.) My trial was not only for medication either, it included behavior modification to see if that was helpful, too. Most studies have shown that medication with behavioral strategies is the best approach for dealing successfully with ADD, as well as other disorders.
Also, at that point, and in the 90′s as well, they didn’t just “find” a drug. Ritalin and Dexedrine had been around long before my trial, and Adderall had been kicking around since the 60′s, too, under the brand name Obetrol. Most of the medications used to help people with ADD are varieties of stimulants and they’ve been around in one form or another for decades. For all the people who say these aren’t well-tested drugs, there’s a huge body of research and an even bigger body of consumers who’ve taken them to show that they’re both safe and effective.
@luketheobscure:
Amen.
@Canino: Long version – I have Asperger’s Syndrome, an Autism Spectrum Disorder. I was diagnosed back in the 80s, when ASDs were pretty much nonexistant to the public. Back then, and even now, a person with a possible ASD is put through a strict series of screenings before they are diagnosed.
Are you even aware of what the symptoms of ASDs are? Do you know how many people have been misdiagnosed in the past? I bet you wern’t aware that people with ASDs have been misdiagnosed as being mentally retarted.
No one is put on medication for autism. Autism can increase the likelyhood of other disorders, disorders that can be treated with medications.
Learn a bit about what you’re against before you make claims.
Alternative shorter version – Fuck off, you ignorant prick.
In many respects it’s true. I’m a qualified mental health practitioner with a state funded program. A large part of my job is to complete assessments and give diagnoses. The way the state system is set up, I am actually not allowed to conclude that a person is mentally healthy. I’ve tried before and been told I’m not doing my job. Other interesting fact, 23% of the U.S. federal budget goes to medicaid and medicare. That’s more money than is allocated to The Department of Defense. Prescriptions for psychiatric meds can often exceed $1,500 per month for a single client. This gets billed to the taxpayer/medicaid/medicare and the money goes to the drug companies. Other fact, pharmaceutical companies post higher profits than any other companies in the United States. These comments below keep me mystified why people are so reluctant and sheepish when it comes to criticizing the field of medicine, of which I no longer consider psychiatry a part. The “medicines” in my experience usually cause more harm than good. I’ve seen plenty of normal people prescribed these psychoactive substances freak out. Most of my clients are indigent and pressured into pleading insanity to obtain the basic necessities in life. Social security pays out reasonably well if you have a psychiatrist who will say you’re crazy. I believe mental illness exists, but I don’t think the DSM can define it. And psychiatric meds certainly don’t solve it. Take it from someone who spends his days watching the effects of the meds on people from all different walks of life. If you’ve never had any experience with the mental health system or psychiatrists you really can’t talk.