WPA recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry

Abstract

Psychiatrists, health care organizations working in the psychiatric field and psychiatric associations often have multiple relationships with the pharmaceutical industry in areas including patient care, research, and education. Some of these relationships arise from contact with pharmaceutical representatives who market products, while others derive from industry-sponsored educational activities or research studies. For health care organizations and psychiatric associations, relationships encompass activities conducted within the organizational framework (e.g., teaching and research) as well as those based on the financial relationships of organizational leadership or the organization itself with industry (e.g., stock ownership, licensure of patents). Many benefits can flow from such relationships, including the opportunity for psychiatrists to have input into product development and organizational access to increased resources that can be devoted to the entity's primary missions. However, there is also the possibility that financial and other benefits for psychiatrists, health care organizations working in the psychiatric field and psychiatric associations may negatively affect fidelity to patients, research subjects, and trainees. As has been widely recognized, attention must be given to protecting the role of the physician and the missions of medical organizations from being adversely impacted by these relationships. The following recommendations are offered in that spirit. In the delivery of patient care, the interests of patients should take primacy over all other considerations. Psychiatrists and health care organizations working in the psychiatric field, therefore, should attempt to prevent influences on clinical decision making arising from relationships with industry that may result in decisions (e.g., the choice of medications to be prescribed) based on other considerations. The pharmaceutical industry communicates directly with physicians and other caregivers through its marketing representatives, who routinely visit physicians' offices and other sites of care. A persuasive body of research suggests that visits from representatives are highly effective in changing physicians' prescribing practices and stimulating requests for expansion of hospital formularies. Often these changes are in the direction of newer and more expensive medications, which may not always be used for appropriate indications. Although many physicians rely on pharmaceutical representatives for information about new products, studies indicate that the information provided may be incomplete or misleading. Representatives may frequent public or patient care areas in the hopes of meeting physicians in informal settings. Psychiatrists should be aware that the primary role of pharmaceutical representatives is to market medications and other products, and that the information received from such sources may not be completely objective. Concerns about influence on their prescribing practices may lead some psychiatrists to choose not to meet with pharmaceutical representatives. Psychiatrists who continue such meetings should be aware of the data indicating the likelihood of subtle influences on their behavior, and should never rely on pharmaceutical representatives as a primary source of information about treatments. Pharmaceutical representatives should be required to make appointments to see psychiatrists and should never be involved in patient encounters. Health care organizations working in the psychiatric field should develop policies that discourage their psychiatrists from meeting with pharmaceutical representatives. Some organizations may want to prohibit such meetings, while others will give their psychiatrists discretion in that regard. In the latter case, if psychiatrists desire meetings, representatives should be limited to fixed appointments and should not be permitted in the facility at other times. Pharmaceutical representatives should never be permitted to be involved in patient encounters, or otherwise to be present in patient care areas. Pharmaceutical representatives sometimes offer meals to physicians and their staff, and to the staff of clinics and hospital wards. These meals provide opportunities for informal interaction with physicians, distribution of marketing materials, and another way of ingratiating the representative to the organization. As such, they represent a mechanism to further influence physicians' prescribing decisions. Psychiatrists should forego offers of meals from pharmaceutical companies for themselves and for their staff members. Health care organizations working in the psychiatric field should develop policies prohibiting acceptance of meals sponsored by pharmaceutical companies on the organizational premises. Pharmaceutical companies frequently distribute materials with their names and logos and those of the brands that they are promoting. Like all advertising, these items are intended as re