In the USA, pharmaceutical and medical device companies are required by law to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories.
Despite being a key recommendation of the Cumberlege Review: First Do No harm, the UK has not introduced equivalent legislation [sometimes known as ‘Sunshine legislation].
The Cumberlege Review was published 4 years ago yet The Royal College of Psychiatrists has made no official response to it. This is surprising given that in the most recent Impact Report the College makes clear:
The Royal College of Psychiatrists has described British psychiatry’s relationship with the pharmaceutical industry as “puritanical” and a recent President of the Royal College of Psychiatrists offered this reassurance “Despite what some people think, most clinicians in the UK are not influenced by the pharmaceutical industry”.
On social media, some members of the Royal College of Psychiatrists, sometimes the most influential ones, repeatedly make light of this issue with statements such as “Classic pharma shill stuff”, or use sarcasm such as “I was paid to say that“. Not infrequently these social media threads cite the conclusion of an American psychiatrist that “psychiatry is among least influenced by industry of medical specialties”. The same source has also stated “The myth of a key opinion leader [KOL] as pied piper encouraging mass prescriptions always struck me as absurd”. However, data covering the decade following the introduction of the US Physicians Payments Sunshine Act would indicate that it is these assertions that are “absurd” and “mythical”.
In psychiatry, one area of prescribing that has drawn much attention is that of antidepressants. Because the UK has no Sunshine legislation, this post has had to focus on an example of a prominent and influential key opinion leader involved in antidepressant prescribing from the USA. There are many other US examples.
Dr Anita H. Clayton is a Psychiatry physican based in Charlottesville, Virginia. According to wikipedia she is the Chair of Psychiatry and Neurobehavioural Sciences and the David C. Wilson Professor of Psychiatry and Neurobehavioral Sciences in the Department of Psychiatry and Neurobehavioural Sciences at the University of Virginia School of Medicine. From 2005 to 2007, she was the President of the International Society for the Study of Women’s Sexual Health (ISSWSH). Dr Clayton’s research interests are in psychopharmacology, sexual dysfunction with psychiatric illness and treatment; sexual disorders; and depressive disorders associated with the female reproductive cycle.
Open Payments provides the following information. Over seven years, from 2016-2022, Dr Clayton was paid more than $231K by the pharmaceutical and other industries for consultancy and educational work. Much of this related to antidepressants including promotional work.
Open Payments provide this chart of payments to Dr Clayton [blue line]:
Open Payments has yet to cover the period after 2022. However, this declaration of competing interests, made towards the end of 2022, would indicate that Dr Clayton has a number of competing financial interests which do not yet appear on Open Payments:
Dr Clayton is a Member of the COI committee for the International Society for Sexual Medicine [ISSM] and the ISSM policy for Managing Conflicts of Interests can be read here:
There is longstanding evidence that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients. However, the Royal College of Psychiatrists has, over many years, stated that any bias introduced by industry is a problem of “yesteryear“. But without data how can we be confident this reassurance is accurate rather than just casual? Without Sunshine legislation the UK public is expected to take in good faith the repeated assertions of doctors and academics that industry does not influence science and prescribing. This matters because science, by definition, should start from a position of neutrality. It also matters in relation to patient safety as the Cumberlege Review most clearly established.