NY Times: Docs Rake in Money, Prescribe More drugs

The article that appeared May 10 in the New York Times is very important because it addresses an issue on which current data is rather lacking--the "proof" that physicians are influenced by benefits received from industry. The hypohesis that physicians will alter prescribing behavior based on goodies, obviously, cannot be studied in a randomized, controlled trial. There is always the possibility of contamination. The available data strongly suggest that the hypothesis is true, and no good evidence tends to disprove the hypothesis. But any further data, even if of questionable quality, helps to make the case.

That is what the Times reporters seem to have done. They took advantage of the legal mandatory reporting system in Minnesota, requiring companies to report payments to doctors. They chose a small slice of medical practice--child psychiatry. They picked one variable that they could find in public data--prescriptions for atypical antipsychotics to children under the state's Medicaid program.

These prescriptions are especially important for a couple of reasons. First, most of these drugs are poorly studied in kids and some experts belive that they are now being greatly overused. (In defense of the docs, we should add that the average Medicaid patient will get a private audience with the Queen of England about as soon as he will get long term, competent psychotherapy; so the docs might reasonably feel that their only choices are to prescribe possibly dangerous drugs off-label, or do nothing at all.) Second, if these drugs are actually effective for anything, it is very likely that cheaper, older antipsychotics are actually just as good as well as being a lot cheaper--tho again, we are not sure when it comes to kids.

So what did the Times reporters find? Between 2000 and 2006, payments to MN psychiatrists from the manufacturers of these drugs rose more than 6 times; and the number of scripts written for these drugs rose more than 9 times. The docs who received at least $5000 from the drug makers appear to have written 3 times as many of those scripts as psychiatrists who received less or no money.

The article went on to describe at length the payment arrangements for these MN psychiatrists. Most of them are paid as members of company speakers' bureaus. From this article, it appears that virtually every child psychiatrist in MN is a member of one of these speakers' bureaus, leaving one to wonder who the audience is--maybe they sit in a big circle and pass the microphone around the table. Actually, it's not quite that bad; the article stated that "more than a third" of MN's licensed psychiatrists took money, so maybe more than half did not.

My personal sleaze award goes to Dr. Suzanne A. Albrecht, from Edina, MN, who earned more than $188,000 over a 3 year period for giving these talks. (She's nothing compared to Dr. Annette M. Smick, near Rochester, who topped the list by earning $689,000 over a 6 year period.) Dr. Albrecht defended herself to the Times by saying, "If someone takes the point of view that your doctor can be bought, why would you go to an E.R. with your injured child and say, 'Can you help me?'"

It's worth taking that comment apart word by word. What is Dr. Albrecht saying? That because all docs are like her, you should not take your injured child to an ER? (Like you have a choice?)Or that because you would take your injured child to an ER, that somehow proves that what she is doing is OK? Dr. A. seems oblivious to the logical conclusion, that if someday, people actually did so lose trust in physicians that they hesitated to take their injured kids to the ER, people like her could look themselves in the mirror and say that they were the reason for this distrust.

Another great quote in the article comes from Dr. Melissa DelBello, a strong advocate of the use of atypical antipsychotics for kids diagnosed with bipolar disorder. Dr. DelBello teaches at the University of Cincinnati, and since she is not from MN, the Times could not find figures on what she was paid as a speaker. "Trust me," she told the reporters, "I don't make much." In Hooked, I used a classic quote from P.G. Wodehouse, "When an Englishman says 'trust me,' it's time to start counting the spoons."

Gardiner Harris, Benedict Carey, and Janet Roberts. "Psychiatrists, Children and Drug Industry's Role." New York Times, May 10, 2007.