You can access this article here, but you will first have to register at http://www.cmezone.com/. I believe this was originally published in CNS News (November 2006), and is now being emailed to various physicians as a free CME activity.
To get a feel for how very good the ghost-writer is, you have to know that the generally accepted first-line treatment for anxiety disorders is one of the antidepressants, either one of the SSRIs or the SNRIs. The sponsor of this article, Schwarz Pharma, unfortunately does not market one of these first-line treatments, being saddled instead with Niravam, which is alprazolam orally disintegrating tablet. It's a fancy version of that old standby, Xanax.
Our ghost-writer starts the article with the usual information about how common anxiety is, and how important it is for primary care doctors to seek it out. This lays the groundwork for the crucial treatment section.
The "Treatment of Anxiety Disorders" section opens with Table 4, above. What's the first medication you see? Alprazolam. So what? There's nothing tricky here, it's simply an alphabetical listing of medications. Well...it is unless you consider the two major classes of medications for anxiety to be "antidepressants" and "benzodiazepines." If they had used this classification, the first drug listed would have been clomipramine, followed by escitalopram, and so on. Alprazolam would have been lost in the middle of the chart somewhere.
But this is minor stuff; it gets more interesting. Under "pharmacotherapy," the first paragraph is a glowing tribute to the power of benzodiazepines. Sentence number one:
"Benzodiazepines have been used extensively for the treatment of anxiety disorders since the 1960s; newer benzodiazepine formulations, such as extended release tablets and orally disintegrating tablets, offer alternative dosing and delivery options."
Thus, our ghost mentions the sponsor's drug right away. Next on the agenda: address the concern that patients can become addicted to benzos. Our ghost quickly describes two studies showing that most patients don't get addicted. Whew! I was beginning to worry that I might have to start my anxious patients on SSRIs after all.
Later, ghost covers both buspirone and SSRIs/SNRIs tepidly.
Buspirone: "Buspirone has been demonstrated to have efficacy in the treatment of GAD, but not in other anxiety disorders or depression." Later we hear about a head-to-head between alprazolam and buspirone in which alprazolam worked more quickly and produced fewer side effects.
SSRIs and SNRIs: One mechanical statement of efficacy ("...most agents in this class now have FDA approval for several anxiety disorders") followed by two gory paragraphs about how awful SSRIs are when it comes to drug-drug interactions (Niravam doesn't share this liability, of course).
There are many more instances of the Power of the Tweak, but I'll let you discover the rest. I wouldn't want to deprive you of your own thrill of discovery!