Pills, Thrills and Corruption

The New York Review of Books has a good article in the last issue about the financial ties between US academic psychiatrists and the pharmaceutical industry, and the misinformation, bad research and lies that are propagated as a consequence of these ties.

It points out:

Of the 170 contributors to the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia. Perhaps most important, many members of the standing committees of experts that advise the FDA on drug approvals also have financial ties to the pharmaceutical industry.

It starts off the article with the example of Dr Joseph L. Biederman, professor of psychiatry at Harvard Medical School and chief of pediatric psychopharmacology at Harvard’s Massachusetts General Hospital:

Thanks largely to him, children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration (FDA) for that purpose and none of which were approved for children below ten years of age.

In June, Senator Grassley on the US Senate Finance Committee revealed that drug companies, including those that make drugs he advocates for childhood bipolar disorder, had paid Biederman $1.6 million in consulting and speaking fees between 2000 and 2007.

Another example is Dr. Charles B. Nemeroff, chair of Emory University’s department of psychiatry and, along with Schatzberg, coeditor of the influential Textbook of Psychopharmacology.


Nemeroff was the principal investigator on a five-year $3.95 million National Institute of Mental Health grant—of which $1.35 million went to Emory for overhead—to study several drugs made by GlaxoSmithKline. To comply with university and government regulations, he was required to disclose to Emory income from GlaxoSmithKline, and Emory was required to report amounts over $10,000 per year to the National Institutes of Health, along with assurances that the conflict of interest would be managed or eliminated.

But according to Senator Grassley, who compared Emory’s records with those from the company, Nemeroff failed to disclose approximately $500,000 he received from GlaxoSmithKline for giving dozens of talks promoting the company’s drugs. In June 2004, a year into the grant, Emory conducted its own investigation of Nemeroff’s activities, and found multiple violations of its policies. Nemeroff responded by assuring Emory in a memorandum, “In view of the NIMH/Emory/GSK grant, I shall limit my consulting to GSK to under $10,000/year and I have informed GSK of this policy.” Yet that same year, he received $171,031 from the company, while he reported to Emory just $9,999—a dollar shy of the $10,000 threshold for reporting to the National Institutes of Health.

The author, Marcia Angell, says:

No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine US drug companies that it comes to tens of billions of dollars a year. By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.

The result of this capture of US psychiatric academia by Big Pharma US consumers are lied to, with academic studies of pharmaceuticals often skewed to get a positive result:

Many drugs that are assumed to be effective are probably little better than placebos, but there is no way to know because negative results are hidden. One clue was provided six years ago by four researchers who, using the Freedom of Information Act, obtained FDA reviews of every placebo-controlled clinical trial submitted for initial approval of the six most widely used antidepressant drugs approved between 1987 and 1999—Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor. They found that on average, placebos were 80 percent as effective as the drugs. The difference between drug and placebo was so small that it was unlikely to be of any clinical significance. The results were much the same for all six drugs: all were equally ineffective. But because favorable results were published and unfavorable results buried (in this case, within the FDA), the public and the medical profession believed these drugs were potent antidepressants.

Big Pharma and academic psychiatry is increasingly getting busted for this corruption. Senator Grassley on the US Senate Finance Committee has exposed several academics for mis-reporting their financial ties to Pharma, and several investigative journalists have also covered cases where Big Pharma has admitted lying about the effects of drugs. Melody Peterson of the New York Times, for example, has followed the example of Neurontin, made by Pfizer:

Neurontin, which was initially approved only for a very narrow use—to treat epilepsy when other drugs failed to control seizures. By paying academic experts to put their names on articles extolling Neurontin for other uses—bipolar disease, post-traumatic stress disorder, insomnia, restless legs syndrome, hot flashes, migraines, tension headaches, and more—and by funding conferences at which these uses were promoted, the manufacturer was able to parlay the drug into a blockbuster, with sales of $2.7 billion in 2003. The following year, in a case covered extensively by Petersen for the Times, Pfizer pleaded guilty to illegal marketing and agreed to pay $430 million to resolve the criminal and civil charges against it.

It’s an excellent piece, though it ends by bigging up a book by Christopher Lane called Shyness: How Normal Behaviour Became A Sickness. This book argues that social anxiety was invented by Big Pharma in the 1990s to sell anti-social anxiety drugs. Big Pharma, Lane argues, was essentially medicalizing normal shyness.

It’s certainly true that Big Pharma saw a great opportunity with social phobia, and marketed the hell out of it. Nonetheless, as someone who was diagnosed with social anxiety, and who knows many other people who have suffered from it, I can assure Lane that it is a real condition, one that is extremely life-inhibiting and unpleasant, and worthy of treatment. I say that as someone who never took drugs for the condition, who never saw drug marketing about the condition, and who overcame it without the use of drugs.

It is a real and serious condition, but the stigma in talking about it is quite great, and of course people who suffer from it avoid the public spotlight, so I can well believe it is widely unreported and the real number of sufferers from the condition is greater than we may realize. That’s not to say we should all pop beta-blockers. Far from it.

Comments:

  • Olly says:

    Hi Jules.

    On a related theme, there has been some very interesting chat about the diagnosis of depression. There has been some interesting opinions right from the heart of the psychiatric and psychological establishment that depression has been hugely overdiagnosed, due to messing up the diagnostic checklist, the DSM.

    I have just ordered this book, "The Loss of Sadness" after hearing unanimously good reviews:
    http://www.amazon.co.uk/Loss-Sadness-Psychiatry-Transformed-Depressive/dp/0195313046/ref=sr_1_1?ie=UTF8&s;=books&qid;=1233324277&sr;=8-1

    Also, a very interesting interview below with one of the guys in charge of the DSM-V, the revised diagnostic manual, which is due out in 2011. He suggests that depression may be over-diagnosed by as much as 25%!

    http://www.npr.org/templates/story/story.php?storyId=9323350

    Its a very fluid time for psychiatric diagnosis – there are some big things afoot that may find their way into the DSM-V; a complete overhaul of personality disorder diagnosis, removal of 'generalised anxiety disorder', removing some subtypes of schizophrenia, tightening the depression diagnosis, and substantially changing the sexual disorder categories. Also they may change ADHD back to how it was in the 80s, because the new system developed in the 90s has been a bit of a mess. Lots of other possibilities too.

    Interesting times!

    Olly

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