Reply (Thomas A. Ban)

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Thank you for your comments. If the recognition that the objectives of marketing (to get a particular product prescribed to the widest possible population) and education (to guide the judicious and discriminate use of drugs) are in conflict would imply approval of illegal marketing practices, you would be correct that I “dilute moral implications“, and provide a ”straw-man definition” of  “conflict of interest”. But this is not the case. I consider those practices you condemn, such as bribing, overstating benefits, covering up adverse effects of drugs, etc., just as distasteful, and even criminal, if they violate the law, as probably you do. True, I have not addressed in my essay these well-known concerns because they are quite apparent, already voiced, and rightfully attacked by many, including your-self. Instead, I was trying to focus attention on a less obvious and unrecognized issue. It is the excessive promotion by some educators the prescribing of psychotropic drugs to an artificially enlarged population by the replacement of prototype-based diagnoses by consensus-based diagnoses in which in some diagnoses, e.g., major depression, more patients are exposed to the risk of potential side effects than would expect to benefit from treatment. Pointing fingers on individuals or blaming industry in this situation does not help to resolve the issue. It may even distract attention from the need to develop a methodology that would allow the delineation of pharmacologically more homogeneous diagnostic populations than those currently in use and make possible a more discriminate use of psychotropic drugs 


Thomas A. Ban

February March 13, 2014