Psychiatrists top list of drug maker gift recipients

The New York Times continues its theme of investigating psychiatry and mental health with an article noting that US psychiatrists receive drug company ‘gifts’ worth the largest amount among all the medical specialities.

The data is only from two states, because they are the only ones which have gone public with their records of payments to doctors.

The practice is widespread and usually doesn’t take the form of direct cash payments, but instead funds everything from trips to conferences (which are often little more than marketing presentations in luxurious holiday destinations), to expensive meals and outings, to footing the bill for medical school events and symposiums.

The extent of the funding is quite eye-opening: the article reports that the average payment to each psychiatrist in Vermont last year was over $45,000 dollars.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

The state of psychiatric drug marketing is shocking. It’s gone beyond the point of promotion to what seems to be little more than outright bribery.

As you might expect, this practice has a strong and significant effect of the prescribing behaviour and attitudes of doctors when medical decisions should be taken on the best empirical evidence rather than on marketing information provided by commercial vendors.

UPDATE: An important clarification from Doctor X, taken from the comments:

While I am concerned about the influence of big pharma on psychiatry, I was taken aback by the figures presented in the Times story. I did a little checking and found that the Times article grossly misrepresented the facts as presented in the original Vermont report. The $45,000 per year figure is for the top 11 psychiatrists who are recipients of pharma money. The report does not indicate the average or median for psychiatrists across the state, but extrapolating from the report figures it looks like $1000.00 per year is probably more typical and closer to the median figure for all psychiatrists. The mean is probably in the neighborhood of $4,000 per psychiatrist, a figure that is probably skewed upward by a heavily lopsided distribution of money and fees paid to top recipients.

Further explanation here.

Link to NYT article ‘Psychiatrists Top List in Drug Maker Gifts’.