Thomas Insel, director of the National Institute of Mental Health, weighs in this week on financial conflicts in psychiatry, decrying a "culture of influence" from drug companies. In a commentary in the Journal of the American Medical Association, Insel points to allegations since 2007 by Senator Charles Grassley (R-IA) that seven academic psychiatrists--some with NIMH research funding—failed to disclose income from industry.
Insel first wonders if Grassley is unfairly picking on psychiatrists. Is the conflicts problem "worse for psychiatrists or are psychiatrists just an easy target?" he asks. Reviewing disclosures data and surveys, he finds that it's not clear whether "academicpsychiatrists receive more or disclose less" than other medical colleagues.
But it is clear that ties to companies are "prevalent," he finds. For example, 90% of psychiatrists writing treatment guidelines had undisclosed industry ties. Moreover, psychiatrists tend to favor brand-name drugs over cheaper generics and shun non-drug treatments like cognitive behavioral therapy, Insel says. That, too, is "not unique to psychiatry" but "in no way diminishes the severity of the problem."
What should be done? NIH is tightening its financial disclosure rules, Insel notes. But he also calls for the field to "take the lead" and "turn the tables of public trust by developinga culture of transparency for psychiatry's collaborations withindustry." The health bill signed into law this week will aid Insel's cause by requiring drug companies to report their payments to physicians for posting in a public database.