Today’s Must Read

June 9, 2008 10:09 a.m.

The system designed to keep corporate cash from secretly slipping into the hands of doctors who do highly influential medical research isn’t working very well.

Even at the nation’s top institutions – such as Harvard – and affecting the most vulnerable populations – children with psychiatric problems.

A front-page story in Sunday’s New York Times reports that a Congressional probe found some top child psychiatrists earning more than $1 million in often undisclosed consulting fees from drug firms.

What’s most troubling about the investigation is that the these individual doctors and their public advocacy for certain drugs for mentally ill children “has helped fuel an explosion in the use of powerful antipsychotic medicines in children.”

Dr. [Joseph] Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

Biederman, who works at Harvard Medical School’s department of psychiatry, received $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given congressional investigators.

While there are rules for disclosing such payments, there’s virtually no enforcement of those guidelines.

“It’s really been an honor system thing,” said Dr. Robert Alpern, dean of Yale School of Medicine. “If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don’t even know how to check on that.”

While the probe, led by Sen. Charles Grassley, (R-IA) is scrutinizing the system for disclosing such payments, there is no effort to examine whether these payments may have influenced the doctors’ research.

As the Times notes: “The Grassley investigation did not address research quality.”

Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.

More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.

“The price we pay for these kinds of revelations is credibility, and we just can’t afford to lose any more of that in this field,” said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute, which finances psychiatric studies. “In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.

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