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Hadi Farahani

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Drugs (Pharmaceuticals)

Psychiatry and Psychiatrists


Medicine and Health

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Drug Companies Get Too Close for Med School's Comfort


Published: January 20, 2004

One of our psychiatry residents smiles and leans against the wall. A woman, a few years younger, stops filling the mailboxes with pens and sheets of paper advertising a new antidepressant and faces him squarely. Her voice is melodic and bouncing. Her eyes open wide and she laughs at something. He smiles. He moves to scratch his cheek and she makes the same movement, they are scratching in unison now. They remind me of a flirting couple on a first date.


He has completed medical school and is in the second of four years of psychiatric training. Assuming all goes as planned, in a few years he will be licensed as a psychiatrist.

When he starts practicing independently he will write thousands of prescriptions every year; he already writes hundreds. She is "detailing him," teaching him new uses for her company's antidepressant.

My office sits just outside the mailboxes and I've been watching her. She's been lurking, slowly filling the mailboxes. He is the third resident she has "detailed" in an hour.

Our psychiatry department at the University of Arizona is divided over these interactions. On one hand, a number of professors and a few residents have grown concerned that the department is allowing the pharmaceutical industry to teach our residents to embrace newer, more expensive drugs. On the other, many residents have argued against restrictions, suggesting that they should learn to respond to the marketing now and that prohibiting contact would leave them unprepared for the future. A minority have argued that academic freedom gives the faculty and residents the right to speak with whomever they choose.

There have been debates in a grand rounds forum, in faculty meetings, and in the weekly resident lunch. In response, our department head recently formed a committee to draft a new policy governing relationships with the pharmaceutical industry.

Drug company representatives are a major presence. They sponsor Journal Club (where trainees learn to review new data and research), they pay for many of our weekly speakers and regularly offer free dinners for the residents and faculty. They enjoy free access to our mailboxes and regularly detail our trainees in their offices, hallways and in our little kitchen.

This is not uncommon. Meredith Rosenthal at the Harvard School of Public Health reported in The New England Journal of Medicine that the industry spends roughly $15.7 billion annually marketing medications, with $4.8 billion dedicated to detailing individual physicians, or roughly $6,000 to $11,000 a doctor a year.

Studies indicate that most physicians meet with pharmaceutical representatives four times a month.

Studies also reveal that most physicians erroneously believe the representatives do not influence prescribing habits.

When doctors and trainees meet with reps, they change their prescribing habits and are far more likely to prescribe the drugs described, even when they are more expensive or have no benefit over alternatives. They are also more willing to request illogical changes to hospital guidelines that govern which drugs can be prescribed.

Estimates suggest that roughly $1 billion was spent advertising antidepressants to health professionals in 2000.

More than 400 psychiatrists were asked by Dr. Timothy Peterson and his colleagues at Harvard to describe their beliefs about antidepressants. More than half said they believed that newer agents were more effective than older antidepressants known as tricyclic antidepressants and that newer antidepressants, called selective serotonin reuptake inhibitors, or S.S.R.I.'s, had fewer side effects than generic S.S.R.I.'s.

But studies conducted at Oxford, Duke, the University of Manchester and the Canadian Coordinating Office for Health Technology that used a statistical strategy called meta-analysis to combine the results of hundreds of independent studies found that S.S.R.I.'s were as effective as tricyclic antidepressants or slightly less effective. They also revealed that S.S.R.I.'s were tolerated by slightly more patients but had as many side effects.

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