As I mentioned in my last post, I am currently enjoying the bliss and happiness of wedded life. And to answer one obvious question, no, my wife and I are not on a honeymoon. We’re putting that off until later. (Otherwise, I’d have a lot of explaining to do right now!!) However, amidst the joy and pleasure of the last few days, I’ve received a few inquiries from my regular readers and Twitter followers, particularly those who know me well. Specifically, they want me to explain who the “lucky woman” is.
In other words, they’re asking me—as they would any professional writing about his or her field of expertise—to disclose any potential conflicts of interest. I figured it’s best to put it out in the open, once and for all: I’m married to a pharmaceutical sales rep.
At first, I wondered whether such a disclosure was necessary. This blog is not a commercial enterprise (i.e., I make no money from it), my posts aren’t intended to guide practice, and my writing—like that of almost anyone in the blogosphere—represents my own personal opinion. Besides, I’ve been up front with my employers, and colleagues, and peers about my relationship, and it has never presented a problem. Nevertheless, I know that this blog has attracted attention from other mental health professionals and from some patients and certain websites that advocate on behalf of patients, so I believe it’s only right to disclose this fact.
For readers who only know me from my blog posts, this disclosure may come as a surprise. And more specifically for those who understand modern psychiatry or pharma sales (or both), it might very well be a reason to question what I write on this blog.
How so? Well, I could, for instance, advocate in favor of my wife’s drug but for none of her competitors’. I could write negative stories about other medications but nothing critical about hers. Or, unbeknownst to readers, my wife and I could share detailed information about patients—or about the inner workings of the pharmaceutical industry—so that I can write posts that disparage her competitors and/or strengthen her sales pitch for her drug.
I can state emphatically and unequivocally that none of the above has come to pass.
What attracted me to my wife were her wit and charm, her character, her world view (the world beyond psychiatry, that is), and her own personal background—some of which is strikingly similar to my own. Not her smooth-talking sales pitch or the fact that I might get some perks or kickbacks from the company that provides her paycheck. (For the record, I have received no “perks” or “kickbacks” from her employer, nor has anything of the sort been offered or implied. Moreover, I am not in her “territory,” so my prescribing patterns have no bearing on her success, or vice versa.)
As it turns out, we share even more than I had anticipated. She is thoughtful and insightful, yet justly skeptical and always curious for evidence to support what she says or what I prescribe. She can engage in intelligent conversation about the future of psychiatry, but she also doubts the universal efficacy of psychopharmacological intervention. Furthermore, just as I find myself routinely questioning conventional psychiatric practice, she is also a keen observer of her own industry. She has been quick (and correct) to denounce the unethical behaviors of some of her competitors, many of which have come to light in the last few years (thanks, in part, to my fellow bloggers). She also recognizes the deficiencies of the medical model of psychiatric illness—and, frankly, the limitations of her own drug—and implores her customers (i.e., doctors like me) to see their patients as whole, living beings, rather than simply as consumers of her product.
I’ll admit that some predictable difficulties have emerged in our unlikely partnership. For instance, I have a scientific background, many years of medical training, and vast exposure to patients with complicated life stories. She, on the other hand, is employed by a corporation, has to follow strict guidelines, and only interacts with patients (and anonymously, at that) in a doctor’s waiting room or parking lot. Each of us is astonished by the frequent discrepancy between what she is expected to discuss with doctors, and what actually happens in the psychiatrist’s office. And don’t get me started on the issue of what we each believe is a “fair” price for a new drug.
At the same time, however, we’ve learned from each other’s experiences. I don’t discuss the specifics of clinical cases with her, but she understands that there are multiple dimensions to any patient (far more than the DSM-IV or clinical trials would predict). I now know far more about how drugs are marketed to doctors, and how my colleagues use (or don’t use) such information. Whether these observations make her a better salesperson or me a better clinician, neither of us can accurately judge. Speaking for myself, however, I think they’ve made me a more informed—and more critical—prescriber.
So in sum, I don’t see my relationship as a conflict, but rather as a source of wisdom and insight. Or, at the very least, a way to keep grounded in the reality of medicine as both as a healing art and as a business.
But I must conclude with one additional point. As some of my readers know, I have had my own personal history as a psychiatric patient. I speak with some confidence when I say that I believe I’ve overcome the challenges of my past, but I also know that nothing is ever 100% certain. Nevertheless, my hope for rehabilitation, recovery, and ultimate freedom from long-term psychiatric care, is something I bring to every patient, because it’s a part of my own experience I wish to share with others.
Unfortunately, I know too that my history—in addition to my relationship status—makes me an “easy target” for those who wish to criticize the unholy alliances and conflicts of interest that seem rampant in psychiatry. I believe, however, that both aspects of my past strengthen my observations—and criticisms—of the state of this field today.
In the end, I know that I cannot please everyone. Thus, I’ll concentrate on keeping (a) myself, (b) my wife & family, and (c) my patients, happy, healthy, and empowered. I would be overjoyed if my blog continues to educate, entertain, and inspire discussion. But I would also understand any suspicions that may emerge among my readers.
I can only hope that I’m judged by the accuracy of my words, the novelty of my ideas, and the strength of my actions—not by any perceptions, accusations, or expectations of bias.
If I fail at this, I want to know. I want—and need—to set it right.