Richard Ratner, M.D.
So the APA Assembly met again in November at the JW Marriott in Washington, DC. It’s unclear whether it will ever meet again in its current form because of APA’s seriously declining revenues from the loss of big Pharma advertising and participation at annual meetings. During the past year, the Board of Trustees laid off at least 12 people, cut 20 positions, combined or disbanded some committees, and has left others to die on the side of the road. One of these was the Committee on Psychiatric Dimensions of Disasters (CPDD), whose members have been passionately trying to reconstitute, possibly as an Assembly committee. The trustees mandated a $200K reduction in the Assembly budget, and then as the meeting began, directed that an additional $200K be cut.
The Assembly went about cutting expenses via a variety of proposals, which included changing to one meeting per year, cutting out the deputy representatives from the Assembly, or keeping everyone on board but requiring that all the delegates pay some or part of their own travel expenses to Washington each November (Nobody is paid to attend the other Assembly meeting that takes place just before the annual scientific meeting in May).
Ultimately, the Assembly voted to de-fund most of the dep-reps, reduce representation from certain parts of the country, eliminate certain meetings and travel budgets, but continue to meet twice yearly. Further cuts are entirely possible. One bright light at the end of the financial tunnel is DSM-V. When it comes out it will doubtless prove another windfall for APA (DSM IV was a gift that even now keeps on giving).
With all the attention on state of finances, there was less time and energy left for other initiatives. One, the approval or rejection of the Draft Report on Relationships between Psychiatrists and the Pharmaceutical/Medical Device Industries, was put off for reconsideration until the spring. This document, dubbed the “Appelbaum report”, if passed will have the status only of “recommendations” rather than ethical precepts. In other words, members would have the option to ignore them if they so choose.
There has been a lot of controversy over this document. It basically frowns on nearly any “perk” traditionally extended from industry reps to psychiatrists, including “gifts”, even of “token value”, food of any sort paid for by drug companies, and involvement in many consulting arrangements. The real objects of the guidelines are colleagues who have gotten too dependent upon drug company money and who are likely to shade their research or clinical presentations, not to mention involvement in other forms of potential conflict of interest
Many of the rank and file among us are upset by the guidelines, which not only imply but virtually state that the presence of pens and pads in our offices and luncheon sandwiches over which reps make their pitches adversely influences our behavior to our patients. My view is that the colleagues who have made such Draconian recommendations necessary are the relatively few who have allegedly sold out in big ways and have reaped rewards of a different order of magnitude than pens and pads.
Nonetheless, the temper of the times, coupled with the misbehavior or a few, have brought these recommendations about. The AMA and other groups have already enunciated similar guidelines, and for its part, Pharma seems to have cut far back on its own. If APA were to reject them, we would likely be singled out for abuse by all the usual critics of organized psychiatry. They are in any case, recommendations only, and after an opportunity to vent their frustrations, I expect the Assembly to approve them.
Among motions that were passed was one calling on the APA to “endorse and promote “patient” as the official and appropriate term for psychiatrists to use in referring to those persons they diagnose and treat. It should be clear to all readers where that resolution came from. A position statement was also passed cautioning against the abuses implicit in what was called “high volume” psychiatric practices, where individuals are simply not given enough time for any meaningful treatment. Another motion that passed calls on the government to do away with the “don’t ask, don’t tell” provision for dealing with homosexuality in the ranks of the military.
One other measure passed requested that APA look at the issue of so called “me-too” medications. Many organizations would like to limit their formularies to only a couple of antidepressants or antipsychotics, complaining that the numerous other medications in those classes are simply “me-too” and as such are not needed. All of us with actual experience have found that, whatever the reason, some of these meds will work when others, closely related, will not. To either not keep them available or to discourage research and development is a negative outcome that this action paper hopes to prevent.
The Assembly will meet again in May 2010 in New Orleans, site of the next annual scientific meeting. Before then, elections will be held, with Donna Norris and John Oldham running for President-elect, and David Fassler and Paul Summergrad running for Treasurer. As usual, this issue of the ASAP newsletter contains the president-elect statements for us to read before voting.
Until then your trusty APA rep/liaison is signing off. Hope to see you all in March in LA and in May in New Orleans.