Psychiatry and psychoanalysis were supposed to transform humanity for the better by allow us to understand what makes us happy, sad and crazy and to control it, rather than to let it control us. But after a century that witnessed  Woody Allen undergoing intense treatment for decades that resulted in his marrying his step-daughter (and feeling darn good about it!), the profession is increasingly resorts to a shrug and a prescription. The good news is that many of the new drugs seem to do the job a lot better than Dr. Freud’s couch; the bad is that psychiatrists are often conflicted by their financial ties to drug companies.

Writing in the current issue of the Journal of the American Medical Association, Dr. Thomas Insel, Director of the National Institutes of Health, states that American psychiatrists need to reform a “culture of influence” that has been nurtured by too many goodies offered to doctors by pharmaceutical companies and happily accepted, including big ticket items like research grants, trips, fees for writing friendly journal articles and entertainment, and smaller trinkets like coffee mugs. When it comes to telling a patient which company’s drugs to buy, a psychiatrist just might lean a little bit towards the ones that send him checks—or a lot. The bias might even tip the scales as the doctor decides whether to recommend non-drug therapy or just to tell a patient to take a pill. What must occur, Insel says, is increased transparency and attention to ethical standards.

There had to be some good stuff buried in that 3000 page health care bill, and there is. One provision requires drug companies to report the payments and gifts they make to individual doctors, so patients can check to see what companies their doctors are beholden to.

The current National Institutes of Health rules on financial disclosure are far too lax, allowing researchers to make their own judgments about what constitutes a “significant financial interest,” (this is the kind of vagueness that often comes from self-regulation) which they must report to their academic or research institutions. The rules have ridiculously high thresholds of tolerance for potential bribes, kick-backs and “persuasion,” exempting disclosures of anything below $10,000 annually or 5 percent equity interest in a company.

The new reporting requirements were spurred by the 2008  investigation by GOP Sen. Chuck Grassley of Iowa, whose hearings uncovered millions of dollars in unreported fees paid by drug industry to  researchers. Dr. Insel now believes that psychiatry may have more drug ties than other medical specialties. Psychiatric journals have higher rates of industry funding for published studies than other medical journals, and research indicates that as much as 90 percent of the advisers who help write American Psychiatric Association guidelines have undisclosed financial ties to the pharmaceutical industry.

Might all this money lead a researcher to sing the praises of one drug over another? Might that free trip to speak at a company retreat cause a psychiatrist to insist on that company’s brand rather than the cheaper generic version? Might the pay-offs lead to doctors’ preference for drugs over therapy? Congress thinks so, and so does Dr. Issel. As with all conflicts of interest, the issue is trust. A patient has reason not to trust that a psychiatrist is doing what the patient needs, based only on the patient’s needs, if drug company money might be influencing the doctor’s judgment.

Members of Congress understand how that works (cough, cough).

It would have been more fair, honest and transparent if the public could have known what was in the health reform package before it was passed, but requiring open reporting on ties between doctors and pharmaceuticals is certainly one of the provisions that deserves applause. It will help cut prescription expenditures, improve treatment, and bolster trust. Best of all, those of us who have been driven crazy by the twists and turns of the health reform battle will be a bit more secure that our shrinks’ diagnosis  will be dictated by our symptoms, and not by the logos on their coffee mugs.