Friday, 4 January 2013

Psychiatry panelists with ties to drug industry urge antidepressants for grief

By The Washington Post

Published: Thursday, December 27, 2012, 7:44 p.m.Updated: Thursday, December 27, 2012

It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.
The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.
When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.
In what some prominent critics have called a bonanza for the drug companies, the American Psychiatric Association this month voted to drop the old warning against diagnosing depression in the bereaved, opening the way for more of them to be diagnosed with major depression — and thus, treated with antidepressants.
The change in the handbook, which could have significant financial implications for the $10 billion U.S. antidepressant market, was developed in large part by people affiliated with the pharmaceutical industry, an examination of financial disclosures shows.
The financial ties between the creators of the APA handbook and the industry far exceed limits recommended in 2009 by the Institute of Medicine, a branch of the National Academy of Sciences.
While no evidence has come to light showing that committee members broadened the diagnosis to aid the drug companies, the process of developing the handbook was fraught with financial links to the industry:
Eight of 11 members of the APA committee that spearheaded the change reported financial connections to pharmaceutical companies — either receiving speaking fees, consultant pay or research grants, or holding stock, according to the disclosures filed with the association. Six of the 11 panelists reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment.
A key adviser to the committee was the lead author of the 2001 study on Wellbutrin, sponsored by GlaxoWellcome, showing that its antidepressant Wellbutrin could be used to treat bereavement.
APA chief executive James Scully Jr. noted that in preparing the new handbook the organization had taken steps to reduce conflicts of interest. Two years before the Institute of Medicine published its restrictions, the APA required that panel members regularly file disclosures and placed limits on their financial connections to drug companies.
Each work group member was allowed to receive as much as $10,000 a year in income from pharmaceutical companies and hold as much as $50,000 in stock. Members could also receive unlimited amounts of money from pharmaceutical companies to conduct research.
But critics argue that such ties could put public health at risk.
“It‘s not that this is a Machiavellian plot by the pharmaceutical industry,” said Lisa Cosgrove, a research fellow at the Edmond Safra Center for Ethics at Harvard University and a psychology professor at the University of Massachusetts Boston. “But when you have so many of these industry relationships on a committee, it creates a pro-industry bias that compromises their ability to be objective.”

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