APA’s Institute on Psychiatric Services, held last month in Philadelphia on the theme "Psychodynamic Psychotherapy," had the highest preregistration ever. (The next issue of Psychiatric News will contain coverage of this meeting.) There were many positive comments about an increased focus on psychotherapy. Juxtaposed with these findings was the significant presence, if not dominance, of pharmaceutical companies at the meeting.

APA is overly dependent on pharmaceutical companies. Approximately one-third of APA’s annual income is derived from the pharmaceutical industry. This figure drops to one-fourth when income from our combined publishing activities is added to next year’s budget. We have been largely unsuccessful in obtaining other major sources of outside funding, although we do receive important research grants and minority fellowship funds from governmental agencies. Drug company support is appreciated very much, but it isn’t good business practice for any organization to rely so heavily on a single source of funds.

Revenue from pharmaceutical companies is divided roughly into three groups. Educational activities including industry-supported symposia (ISS) and exhibits at the annual meeting and Institute on Psychiatric Services account for about 45 percent. Advertising in our journals and Psychiatric News accounts for another 44 percent; the remaining 11 percent consists of grants and contracts. The grants support most of the APA fellowships, which have reached an impressive total of 125.

Print advertising dollars are linked to the number of new psychotropic medications on the scene. Our advertising income rises when there are a number of new products, but can fall precipitously as medications become well established, and fewer new ones arrive to take their place. This increases the difficulty in planning APA budgets, especially long-range fiscal planning.

ISS are always very well done, well advertised, highly rated by attendees, and only occasionally criticized for bias. They are also regularly preceded by a complimentary meal. The Institute on Psychiatric Services had 12 ISS and 20 pharmaceutical exhibitors. The annual meeting usually has 40 to 45 ISS and a larger number of exhibits.

I have talked to pharmaceutical industry representatives in multiple settings about their wonderful, effective medications and about the image problem they have with our members. I have also encouraged them to eliminate those activities that damage their image and to enhance the noteworthy things they do for our organization. Providing free, lavish outside social and recreational events doesn’t help. Fewer ISS with less food in exchange for increases in unrestricted educational grants and funding of award lectures would be most welcome. Extravagant outings must be eliminated.

APA committees screen ISS and approve those that meet our educational standards. However, the same speakers often propose and appear in lectures for the same companies, and there is a chronic lack of minority and women presenters. It appears that minorities and women are somewhat scarce in the regular programs as well. I have appointed a task force to evaluate the apparent underrepresentation and to make recommendations that would apply to all lectures.

In September the American Psychiatric Foundation’s leadership and APA representatives met with the foundation’s Corporate Advisory Council, including representatives from nine pharmaceutical companies. This was an effort to educate the attendees about APA’s enterprises and structure and to share ideas. The companies expressed interest in supporting additional important APA activities including pilot programs for our Business Relations Initiative to improve employees’ access to high-quality psychiatric evaluation and treatment.

We need the pharmaceutical companies, and they need us. Working together on new ventures will demonstrate that the companies are clearly interested in more than marketing their products. The larger firms are among the most successful businesses in the world, with profits in the range of 35 percent a year. When one blockbuster medication can mean billions of dollars, it is not surprising that companies market their products aggressively. Our job is to help them maintain a balance in their interactions with our members and to remember there is more to psychiatric treatment than psychopharmacology. Early in 2001 the medical director and I plan to meet with the companies for a mutually beneficial, constructive dialogue.