Psychiatrists & Pharmaceutical Companies
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Q:  Psychiatrists & Pharmaceutical Companies

Hi Dr. Phelps,
I don't know who else to ask about this, and you've been very upfront and honest in your site and replies, so I'm hoping you can help me.

I have bipolar 1 disorder.  I've been quite pleased with my pdoc.  He has me on 600mg seroquel and 125mg imipramine, which has me pretty stable.  I also have ativan prn, and am on fish oil (5 grams omega 3 fatty acids) and vitamin E to counteract the oxidants in the fish oil.

I'm part of a support group online, and various people in there have said that pdocs get kickbacks from pharmaceutical companies.  You had mentioned that they pay for pdocs to give speeches. That makes sense.  

But do they get paid for PRESCRIBING certain drugs?  That's what I've been told, and it's disturbing.

And if they do, I'd like to know if my pdoc is participating in this, but I have no idea how to breach the subject without sounding offensive.

Please help,
Thanks so much,

Dear Shannon -- 
Fair question, nowadays. Of course I can't tell you for certain what's going on out there, but I can tell you this much: I've never seen evidence that any doctor anywhere was getting paid directly by a pharmaceutical company to write prescriptions for their drugs. Not one. That would be highly illegal, the FDA would nail that company (or maybe at least Elliott Spitzer, the New York state Attorney General who's already sued some drug companies for violations far less obvious), with some glee I think, as they are already levying fines against several companies for marketing their drugs a bit too far outside the official limits, which come from the FDA, of what they're supposed to be allowed to market toward. 

That doesn't mean this isn't happening somewhere, through some unscrupulous pharmaceutical company representative. The rep's are paid in very direct relationship to how many prescriptions are being written for their drug, competing not only against other drugs but against other representatives for the same company, in other regions of the country. It's a very competitive industry. This kind of environment can foster stretching the rules to their very limit -- and sometimes beyond. 

All that said, we now have to consider the other forms of influence the pharmaceutical companies are indeed using. They don't pay plain money, as above, to my knowledge. But they hand out a lot of other goodies that start to get somewhat close: certificates for "medically useful" books and stuff, for example. They used to give out golf trips and deep-sea fishing trips and that kind of thing but they self-policed against those practices, starting a few years ago. Yet again, because of the pressures the representatives face, I've seen some stretching of even their own self-policed rules.  

Most of the really obvious influence I've seen is coming down through their speakers' programs, such as those in which I've participated. Thank you for reading my justification for using their money.  I just updated that justification page with this news: one company is now requiring that I use their slide set only; I can't use mine, nor refer to my website. I told them I don't work that way and they, with my firm assent, cancelled the programs we had scheduled.  I hope more and more doctors will refuse to participate in this company-driven process, and that we'll evolve a new arrangement for their involvement in physician education. But that will still likely involve as much influence as they can manage under whatever new process rules emerge.  

I think that was a very long way of saying "no".  You could ask your doc' if he is doing any speaking for any company. That shouldn't be too offensive and would give you an idea of which products, if any, you'd have to watch for him perhaps having been influenced about. I mention to may patients, in some cases, when we're looking at lamotrigine, that I really liked the drug even before I called up their representative to pitch the idea of their supporting my talks, but that they have given me a very substantial amount of money and that this could conceivably influence my judgment when we're choosing medications. 

You have a legitimate concern, even though I don't think the issue goes as far as you've heard. I hope I'm not just being naive. I don't think so.  Thanks for asking. 

Dr. Phelps

Published January, 2006


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