S-29-01
Conflicts of interest in the conduct of medication trials
M. Maj. University Of Naples Of Sun Dept. Of Psychiatry, Naples, Italy
A conflict of interests occurs when a professional (e.g., a physician) is unduly influenced by a secondary interest (e.g., financial gain, political commitment, or the desire to favour a relative or friend) in his decisions concerning the primary interest to which he is committed (e.g., the health of the patients, the progress of science or the education of students). Since the early 1980s, one specific type of conflicts of interests has been extensively covered in the medical literature, i.e., the financial conflict of interests (conflict between the primary interest represented by the health of the patients or the progress of science and the secondary interest represented by financial gain). This type of conflict of interests has been largely discussed and documented also in the field of psychiatry. The many, sometimes subtle ways by which a psychiatrist can be influenced in his prescribing habits by his relationships with drug companies, or a researcher can be influenced by these relationships in his scientific activity, have been described, with the support of some empirical evidence. Several possible remedies to this problem have been proposed, including disclosure of potential conflicts and the adoption of a code of conduct by both physicians and drug companies. On the other hand, it has been pointed out that the current discussion on this issue is "affectively charged", that the pharmaceutical industry is virtually the only source of development of new therapeutic agents, and that as far as these agents are effective there is an obvious convergence of interests between psychiatrists, companies, patients and patients' families. Other types of conflicts of interests are beginning now to be discussed. There is an emerging evidence concerning how the allegiance to a treatment modality (in particular, a psychotherapy or a psychosocial intervention) may influence the results of empirical studies concerning that treatment, thus colliding with the primary interest of validity of research. There is also a small body of literature concerning political commitment as a source of conflict of interests. The issue of conflicts of interests in psychiatry is probably more complex and multifaceted than commonly believed.
S-29-02
The psychiatric profession and its human rights aspects: Should they vary from culture to culture?
M. Kastmp. Rigshospitalet Psychiatry Clinic, Copenhagen, Denmark
In recent years, we have in the Western countries witnessed an upsurge in the attention paid to the ethical and human rights aspects of the psychiatric profession. Several reasons may be given hereto, including the pluralism seen in modem Western societies, and the increasing respect for the autonomy of the patient. Alongside, the rules and declarations guiding the psychiatric profession are in focus. Some are common to all medical professionals, others reflect the specific role of the psychiatric profession, but all claim their universality independent of the cultural context. The existence of ethical guidelines, etc. is however not sufficient. We are living in a world of rapid change, thrilled in what may be the most rapid global transformation anyone has ever seen. Value systems change and ultimately the individual psychiatrist has to decide whether or not to adhere to ethical guidelines and may look for an answer to: Do they give meaning in the given cultural setting? Are they compatible with the cultural value of the doctor and that of the patient and his immediate families? The paper will comprise an overview of the human rights issues pertinent to the profession and their implementation in different cultural settings.
S-29-03
Ethical implications of sponsoring
H. Helmchen. Free University Berlin Psychiatric Clinic, Berlin, Germany
In research and medical education as well an upward tendency of sponsoring can be observed. Such co-operation between industry (or even governments) and psychiatrists is needed be-cause psychiatrists have access to and experience with patients and the industry has the finan-cial means for research which are needed both to its enormous costs and the cutting of public financing. However, this increasing interweaving between industry and psychiatrists on the individual and particularly the institutional level may impair the independence of psychia-trists' decisions towards the individual patient as well as that of his judgement both in clinical practice and in research. Ethical implications from this threat will be exemplified by i) educa-tional grants, ii) research in developing countries, iii) publication bias, iv) costeffectiveness analyses, v) placebo-control. Finally it will be recommended: you may dance with the porcu-pine, but you should read all contracts in advance and reflect their ethical implications with regard to published ethical guidelines.
S-29-04
Forensic psychiatry: Two masters, one ethics
J. Arboleda-Florez. Queen's University Dept. of Psychiatry, Kingston, Ontario, Canada
The growth and impact of Forensic Psychiatry as an alternative to the general mental health system over the last fifty years has been quite well documented. Such growth even theatens funding for the general mental health system as more and more budgetary allocations have to be made to cover the large number of mental patients being processed by the courts or ending up in the correctional system. Mental Health Courts and a number of management initiatives have developed while larger number of forensic psychiatrists are required. Little has been written, however, about the ethical demands and moral exprapolations that forensic clinicians have to address in their day to day activities as they crisscross systems with antithetical demands and contrary aims and objectives. Serving two masters creates conflicts of double agency for the psychiatrist and cognitive confusion among patients. This presentation will review these ethical problems and will present guidelines for reconciliation.
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