Comments on “Presidential Address: Advocacy as Leadership”

To the Editor: As psychiatrists and APA members, who also work in the pharmaceutical industry, we are writing to address what we feel are incorrect statements made by Steven S. Sharfstein, M.D. in his presidential address recently published in the Journal(1) . Dr. Sharfstein devotes a significant portion of the address to a critique of the pharmaceutical industry, including the statement that “psychiatry and the pharmaceutical industry abide by different ethics and values” ( 1 , p. 1713). This attack puzzles those of us within the industry who have dedicated our careers to developing and studying therapies that produce the improvements in care Dr. Sharfstein seeks. However, despite key therapeutic advances, there are still substantial unmet needs with countless people still requiring help. It is only through collaboration with our peers in academia and clinical practice that new medications can be evaluated, understood, and find their place in the treatment armamentarium.

Dr. Sharfstein sees in the pharmaceutical industry a profit motive at odds with the psychiatrist’s aim to provide the highest quality of psychiatric care to patients. For those committed to expanding the range of treatment options available to patients with serious mental illness, the path forward requires a more critical evaluation of the current state of psychiatry than simply advancing the notion that “big pharma” is responsible for avariciously pushing the field toward an increasingly biological model. That sweeping condemnation detracts from both the true complexity of the underlying factors contributing to this trend and the contributions pharmaceutical research has made to patient care. Certainly, the primary role for the pharmaceutical industry is to help serve the collective desire for innovation that offers tomorrow’s cures. For this reason, we respectfully disagree with Dr. Sharfstein’s suggestion that the interests of patients and the field are best served by adding distance to the very partnerships that have enhanced the quality and quantity of life for so many.

Unless another model is proposed and shown to be effective, we believe that the strong partnerships and collective contributions of academic, clinical, and industry-employed psychiatrists and neuroscience researchers can best maximize our potential to deliver the highest quality of psychiatric care to all who suffer from mental illness.