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Friday, 28.04.2017

Carlos R. Hojaij: Ethics for psychiatrists

Samuel Gershon’s comment


            Carlos has written a considered and thoughtful analysis of the situation related to two anti-inflammatory compounds marketed worldwide with major and dramatic claims for their efficacy and minimal side effects. Then followed a number of epidemiological studies and numerous case reports seriously questioning their safety. This raised the huge economic issue of the necessity of their withdrawal from the market.  Here we now have not only the intrusion, in large letters, of huge financial interests, we have  also reached the stage of mounting a conflict for or against withdrawal or other restraints. The two sides have assembled and deployed two armies, one army for each side of the argument. The soldiers recruited in this case are usually physicians. Clearly, they are recruited to support one position against the other. Thus, this is a classic example of physicians being mobilized for a conflict and having to declare, when hired, they will take one position if used by one side and the opposite position for the other side.
            This case is just a gross example of these combatants, essentially mercenaries, being asked to go to battle for two opposing financial interests. Here is a great play being acted out on the world stage: A classic portrayal of the interaction of Ethics, Morality, Professional Principles and Good Practice being thrown into the battle. Looking at each individual player in this exchange presents for us the Ethical issues with which each one must grapple.
            This ethical conflict on many universal questions has been on going. How do we develop ethical standards for almost any aspect of human behavior? With great difficulty, if at all.

             Many learned societies introduce a variety of ethical rules into their constitutions. One such rule that has become popular and widespread is a declaration of conflict of interest (COI) by the authors of articles. As an editor of a scientific journal, I have seen these declarations being extensively presented for publication with the associated article. Some of these declarations cover dozens of possible relationships with a variety of companies. Thus, we say the authors have fully complied. These lists of COI are essentially worthless in determining any actual conflicts at all.

            Several years ago, there was indeed an epidemic of claims of unethical behaviour by senior members of the psychiatric profession. The range was wide and included authors putting their names on articles or books which were essentially ghost written, along with many other dodges to benefit from funding by Big Pharma. These particular episodes reached such a level of Congressional concern that Senator Grassley held hearings on these matters. Well, several individuals had to resign their positions, etc., but really, nothing changed.        
            I believe that society has changed over the last 100 years and that these epidemics
will not go away; they will reappear frequently and we will be surprised all over again.


Samuel Gershon

April 13, 2017