Thomas A. Ban’s reply to Jose de Leon’s comment on his essay on Conflict of Interest in Neuropsychopharmacology - Marketing vs. Education

Thank you very much for your comments. If conflict of interest issues could be restricted to financially motivated actions contrary to fiduciary interest, i.e., to the legal-ethical definition of the concept I would agree with you to leave it to those currently involved with them. But this is not the case and my essay addresses a “conflict of interest” issue that has not been addressed to date in so far as I know. It is the “conflict of interest” that arises from the ”conflict”  between “marketing” with the objective to get a particular psychotropic product prescribed for the widest possible population and “education” with the objective to provide a guide for the judicious and discriminate use of psychotropic drugs.  Introduction of psychotropic drugs during the 1950s, focused attention on the pharmacological heterogeneity within psychiatric diagnoses. To meet educational and also research objectives in neuropsychopharmacology, there was a need to resolve this heterogeneity. Yet, in keeping with marketing interests, the randomized clinical trial was adopted for the demonstration of therapeutic efficacy in pharmacologically heterogeneous diagnostic populations. There has been virtually no effort for well over half a century to develop a clinical methodology for identifying the treatment responsive subpopulations. Compromising the objective of education for marketing interests interfered with the development of neuropsychopharmacology. It also encouraged the indiscriminate use of psychotropic drugs. Addressing ”conflict of interest” issues which qualify for the legal-ethical definition of the concept  may assist in capturing crooks, whereas addressing conflict of interest issues which arise from the conflict between marketing and education by adopting or developing a methodology that would provide pharmacologically more homogeneous diagnostic populations than current consensus-based classifications  may open the path for the development of more selective and thereby more effective psychotropic drugs.

Thomas A. Ban

December 11, 2014