Wednesday, December 12, 2007

American Psychological Association Awakens From Slumber, But For How Long?

As reported on a pair of my favorite blogs (Pharmalot and the Pharma Marketing Blog ), the American Psychological Association Task Force on External Funding has issued a wake-up call to psychologists. To briefly summarize, when legendary psychologist Philip Zimbardo was APA president in 2002, he was taken aback by the corporate-sponsored largesse at the American Psychiatric Association convention. Being a forward-looking fellow, Zimbardo saw the writing on the wall: As psychologists move toward attaining prescription privileges, drug companies would descend on the profession like vultures.

Read the article based on the committee's findings here. It's very good reading. They make a long list of recommendations, 24 to be exact, including highlights such as...
  • External funds (i.e., drug money) should not be a part of APA's core budget
  • Exhibitors at APA conventions should not pimp their wares in bizarre manners (see the American Psychiatric Association convention for examples of marketing gone awry)
  • APA should consider not allowing continuing education credits for industry-sponsored courses
  • No drug pens or other branded material on display where psychologists work
  • Psychologists should not accept gifts from corporations (including meals)
Here's the deal. APA has been pushing hard for psychologists to obtain prescription privileges for several years. At this point, they can point to modest success at best, as psychologists in New Mexico and Louisiana can prescribe psychiatric meds after some additional training and experiences. There has been a lot of debate about whether psychologists should be allowed to prescribe or not, but that is not the point of this post. The point is to make predictions. Here comes the future.

APA will not heed the recommendations of their task force, at least not many of the important ones. Should psychologists attain prescription privileges in more states over the next 10 or 2o years, drug companies will throw their money at psychologists in the following ways (and then some)...
  • Gifts, small and large
  • Sponsoring continuing marketing, er, education
  • Funding APA directly
  • "Unrestricted" research grants
  • Psychologist-to-psychologist marketing. Paying psychologists to "educate" other psychologists about medication.
  • Having psychologists rubber stamp their name on ghostwritten, pro-industry "research" pieces
Prediction 1. APA won't turn down money from drug companies. They may try to do so for a few years, but eventually they will not be able to resist the lure of cash. Of course, they will insist, as does the American Psychiatric Association, that accepting money from corporate sponsors will not impact the mission of the organization.

Prediction 2. APA and the various state psychological associations will not restrict CE credits based on who funds them. There is already grumbling about a lot of what passes for continuing education of psychologists being nothing more than fluff, puffery, or a feel-good session. That being the case, there will be many who will be drawn to the allure (however fake it may be) of science surrounding drug company-sponsored continuing education. Of course, some psychologists already receive pharma-funded continuing ed, but there is much room for drug companies to move into "educating" psychologists about their products.

Prediction 3. Psychologists will become more involved in drug research. Some people have stated, I believe quite naively, that if psychologists become more involved in drug research, they will clean it up. Um, what makes psychologists more capable of cleaning up the dirty research system (1, 2) than the current body of medical researchers. Seems like a rather arrogant belief to think that psychologists will clean up a system of biased clinical research just because they are psychologists. Psychologists will also be involved in signing their names onto puff pro-drug pieces.

I could be wrong. APA could take a stand. But APA has dedicated many resources to getting psychologists on-board as prescribers. Just read through APA press releases and see their enthusiasm (1, 2). So don't make a bet on it. For psychology to make the moves suggested by the Task Force, there will have to be a very vocal group of psychologists who constantly harrangue the leadership of APA into taking a firm stand. I'd suggest they start up a blog, get in the ears of reporters, and do anything they can to draw attention to their very legitimate concerns. I realize that prescription privileges for psychologists and being corrupted by pharmaceutical marketing are not necessarily one and the same. Only time will tell if psychology will be more strongly influenced by science or by marketing.


freelance radical said...

.....on the plus side: psychologists would (if they got the right) be subjected to very expensive lawsuits for having caused suicides,
murders, and a long list of other explosions of madness, with their delicious meds....

Anonymous said...

That there may be liability issues is the reason to not offer this treatment option to our patients/clients even though is sufficient evidence of effectiveness. Perhaps we should not drive as we may kill people. FYI, optometrists liability insurance rates when down after the got prescriptive authority. All the claims of blinding and killing their patients didn't happen. Prescriptive authority is an option for psychologists, not a mandate.

Anonymous said...

I at least commend the APA for approaching the subject. In nursing, we are also tied to the hip of big corporate funding. What a nurse uses in our practice of nursing is influenced by the Big Corps as much as Big Pharma. Nurse Practitioners continue to push for their independence to write scripts and gain autonomy from MDs and therefore open the door to more liability. Unfortunately, the lack of critical thinkers in nursing, as may be true in psychology or psychiatry, will keep the "status quo" going for some time now. Change is slow in the medical world even though it's the obvious thing to do.