Editorial Takes On Conflicts of Interest and Propaganda in Psychiatry

Justin Karter
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In a scathing editorial in this month’s Psychotherapy and Psychosomatics, Dr. Giovanni Fava takes aim at prominent medical experts who have downplayed the role of financial conflicts of interest (FCOI) in medical research and practice. Fava retraces the development of the problem, the mechanisms of “propaganda” that allow conflicts to flourish, and offers suggestions for reform, including a call to boycott commercialized medical education programs and professional societies.

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The author credits Cosgrove and Whitaker’s recent book for detailing the effects of financial conflicts of interest in psychiatric research and practice

“The hidden costs to the society of financial conflicts of interest in medicine need to be addressed at various levels,” writes Fava, a Professor of Psychiatry at the State University at Buffalo.

He cites Robert Whitaker and Lisa Cosgrove’s Psychiatry Under the Influence as an example of a work that has systematically documented how corporate interests have manipulated research to the detriment of clinical practice and the health of our communities.

Fava positions his editorial as a direct response to recent articles published in the New England Journal of Medicine (NEJM) and JAMA, which he understood as declaring that “time seems ripe for getting rid of these worries” about FCOIs and “to return to business as usual.” Three articles in NEJM by Lisa Rosenbaum are singled out as particularly troublesome. He summarizes her conclusions as follows:

“‘The bad behavior of the few has facilitated impugning of the many.’ The effects of this behavior were amplified by journalists who fed a vicious cycle in which each story generates more distrust in the public. Dr. Rosenbaum suggested that current restrictive rules may ‘undermine potentially productive research collaborations, dissemination of expertise, and public trust.’ She acknowledged that studies by pharmaceutical companies are more likely to have outcomes favorable to the sponsor and that physicians who attend events funded by pharmaceutical companies tend to prescribe the featured drugs. However, she claimed that these interactions might actually be beneficial to the patient and that much of the harm was ‘invented.’”

Equally troubling for Fava was a viewpoint published in JAMA suggesting “substituting the pejorative term ‘conflict of interest’ with ‘confluence of interest.’” (MIA’s coverage of this article here) Likening this name change to the description of SSRI withdrawal symptoms as “discontinuation syndromes,” which eased the shift from benzodiazepines to antidepressants for panic symptoms, Fava points out that “a name change can be important.”

“The shift from benzodiazepines to SSRI has probably been the most successful achievement of pharmaceutical propaganda in psychiatry, with full endorsement of guidelines and professional societies. Will the term ‘confluence of interest’ achieve the same success?”

Fava compares Noam Chomsky's propaganda model to the influence of financial conflicts of interest on research.
Fava compares Noam Chomsky’s propaganda model to the influence of financial conflicts of interest on research.

Fava invokes the mechanisms of propaganda put forward in Noam Chomsky’s seminal work on the topic, Manufacturing Consent, to describe the systems through which corporate interests and “academic oligarchies” influence clinical practice and scientific studies.

“Corporate interests have fused with academic medicine to create an unhealthy alliance that works against the objective reporting of clinical research (censorship), sets up meetings and symposia with the specific purpose of selling the participants to the sponsors (engineering opinions), gets its prodigal experts into leading roles in journals, medical associations and nonprofit research organizations (using the public relations industry) and provides the appropriate degree of retaliation to outliers (marginalizing dissident cultures).”

Fava’s powerful editorial has been published Open Access, and can be read in full here

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Fava, G. A. (2016). The Hidden Costs of Financial Conflicts of Interest in Medicine. Psychotherapy and Psychosomatics85(2), 65-70. (Full Text)

14 COMMENTS

  1. At this point it is hard to know what if anything in psychiatry as a profession is not infected by conflicts of interest. Almost everything coming out of mainstream psychiatry, to this reader, is propaganda – it starts with using the scientifically unproven term mental illness for problems of behavior and thinking, and with using invalid diagnoses as if they held real weight.

    The attempt by psychiatrists to say that conflict of interest is a pejorative term that is hurting psychiatrists is ridiculous and pathetic.

    I agree with the cat that freedom of information on the internet is a weapon that should be used to undermine and take aim at establishment psychiatry to the maximum degree possible. The internet provides some leveling of the playing field between small, less financially powerful actors and big corporations and government. That is why figures like Edward Snowden and Julian Assange were able to use it to such powerful effect in a way that was so upsetting to government and corporations.

  2. Psychiatry is an organized crime. Their propaganda is everywhere, misleading everyone through many ways, including invisible ones. If you will say something against psychiatrists and their drugs, you will be heavily attacked by the public because a big part of this ‘public’ is paid to have this reaction and defend these drugs.

  3. Putting people in jail before they commit a crime is insane.
    Drugging people for life so they can not commit a crime is insane.

    Psychiatry gets paid for both and will continue to be paid.

    “They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.”
    ― Benjamin Franklin

    “Those who deny freedom to others, deserve it not for themselves”
    ― Abraham Lincoln

    Like preachers quote from bible references
    John 8:32 “And you will know the truth, and the truth will set you free.”

    Doctors/Psychiatrists use references to previously published material as if it was fact.

  4. Conflicts of Interest in Psychiatry.

    The same people deciding who is sick and who is well are the people charging like $1000 a day.

    Universal Health Services profits jump to $182 million in second quarter
    Second-quarter revenue for UHS jumped 11 percent to $2.28 billion, compared to $2.05 billion in the year-ago quarter.

    And inpatients locked in UHS hellholes are not able to make “long distance” phone calls outside the hospitals area code to call family and friends from the jail like phones on the wall.

    “Long distance phone call” I can’t even remember the last time I heard someone say that antiquated phrase cause its 2016 .

    Thats nothing check out https://watchinguhs.wordpress.com/

  5. Just when I actually believed someone was listening to what’s really happening between Big Pharma, and the millions of doctors they pay to push their drugs, I am gravely disappointed. I:

    Energy & Commerce Committee – United States House of Representatives Chairman Fred Upton
    2015 Text of H.R. 6, 21st Century Cures Act

    http://docs.house.gov/billsthisweek/20150706/CPRT-114-HPRT-RU00-HR6.pdf

    p. 292 Subtitle C – Encouraging Continuing Medical Education for Physicians (In large, BOLD font)

    (xiii) In the case of covered recipient who is a physician, an indirect payment or transfer of value to the covered recipient —

    “(I) for speaking at, or preparing educational materials for, an education event for physicians or other healthcare professionals that does not commercially promote a covered drug.”

    “(II) that serves the sole purpose of providing the covered recipient with medical education, such as by providing the covered recipient with the tuition required to attend an educational event or with materials provided to physicians at an educational event.”

    Are they kidding me? We all know that 90% of CME are sponsored by drug companies who pay handsomely to attract new doctor drug pushers. I see them everyday on psychiatric websites heavily sponsored by pharmaceutical companies that have so many pop-up drug ads that it’s difficult to even read one of their propagandized articles. I’m more than mad in america. I’m thoroughly disgusted.

  6. Fava invokes the mechanisms of propaganda put forward in Noam Chomsky’s seminal work on the topic, Manufacturing Consent, to describe the systems through which corporate interests and “academic oligarchies” influence clinical practice and scientific studies.

    Off the point but every time I read about Chomsky I start wishing that he would apply his prodigious intellect and linguistic understanding to deconstruct the entire “mental illness” concept — a connection he apparently has yet to make.