Tuesday, January 4, 2011

"Current Psychiatry": Now Binging on Industry Cash for CME

Current Psychiatry is a controlled circulation "throwaway" journal that comes to all psychiatrists free of charge. It's well-written, often useful, but editorially it has unfortunately become a mouthpiece for the promotional aims of its advertisers. Recently a few examples attracted my attention. 

1. This CME Supplement was packaged with the November 2010 issue. It is called “Effective Strategies for Patients With Complex Depression in Psychiatric Practice." It's supported by AstraZeneca, maker of Seroquel, and the supplement's three articles are well-masked ads for the use of Seroquel in treatment-resistant depression. There are lots of subtle promotional strategies here, but check out especially pages 10 and 11. Here, you find a paragraph on atypicals pretending that they all have the same side effects (the crucially hidden point is that Seroquel causes more weight gain and sedation than most other atypicals). On the next page, they are no longer shy about delineating side effects of specific drugs--each of which is a competitor of Seroquel. File under: "Sin of Omission".

2. Another promotional CME Supplement was published in October 2010, and is entitled  "Differential Diagnosis and Therapeutic Management of Schizoaffective Disorder." It is supported by Janssen, the maker of Invega, which was recently the first medication FDA approved for--you guessed it--schizoaffective disorder. I haven't read it yet, but this is a de facto  advertisement simply by virtue of the choice of topic. Janssen makes the only approved product for schizoaffective disorder, and in order to advertise it, they paid off Current Psychiatry to write a huge article about the disorder. It doesn't need to be "biased;" it just needs to be focused on a topic that is of inherent commercial benefit to the supporter. In my opinion, this violates the ACCME Standards of Commercial Support. 

3. Finally, in the current issue, there is this article (not a CME article) introducing Lurasidone (Latuda), the latest FDA approved antipsychotic. The authors have no disclosures, which is surprising, because the article is a glowing endorsement of Latuda. The relentlessly advertorial flavor begins with the opening tag-line ("A new atypical antipsychotic offers once-daily dosing and is well tolerated and considered weight neutral") and reaches a fever pitch at "Table 2", which claims that Latuda stimulates certain brain receptors (true) and therefore improves cognition (false).

I don't know what's going on with Current Psychiatry lately. Each of its CME supplements (and even some of its non-CME articles) are so commercially biased that it would take an army of Carlat clones to keep up with lodging formal complaints with ACCME. Anyone up to the task?  


David M. Allen M.D. said...

According to what I've read ALL journal supplements are not subject to peer review and are basically pharma ads, so this is not just the case with Current Psychiatry.

In general, throwaway journals are far more subject to drug company biases that others, if that's even possible.

Any article whose title starts with something like "New Strategies for Treating..." and which then goes on to tout the latest me-too drug should be considered highly suspect in all the ways you describe and more.

Joseph P. Arpaia, MD said...

In my opinion with CME you get what you pay for.

A throwaway journal needs to be just that, or recycled if that option is avialable.

Daniel Carlat, M.D. said...

I agree that industry bias is often present in throwaway journals, though not always--Psychiatric Annals comes to mind as quite objective.

The point of my post was more that I am disappointed with Current Psychiatry's radical shift toward allowing industry manipulation, because in general their articles are a cut above the rest in terms of readability and practicality. Dr. Nasrallah, the editor in chief, has a political axe to grind, as is clear from his editorials. It seems that he feels that the rising distrust of industry marketing relationships with doctors poses a danger to medical progress. I believe precisely the opposite is the case.

Anonymous said...

Another unfortunate fact about the Latuda article is that it's co-written by a psychiatry resident. Makes me wonder about the quality of postgraduate education being provided at the University of Kansas. Anyone who says that 5-HT7 and alpha-2C binding causes "improved cognition" with a straight face is either (a) uninformed about what "cognition" truly is; (b) on the payroll of Sunovion; or (c) Stephen Stahl.

To me, knowing that it's pregnancy category B is a much stronger selling point than any so-called benefit on cognition.

Joel Hassman, MD said...

Glad you mentioned the editor's position before I forward this comment. As you noted in your commentary, the periodical has some value, as it is one of the few that has articles about non-pharmacological interventions. That said, non-clinician readers should know that the December issue was 92 pages numbered, but only 35 of them were articles, the rest advertisements, and 90% + for meds.

It is really an advertisement section with some articles as puff. Does this little observation bother any one else besides me? I am beginning to wonder do I need to read the throw aways that come to me each month?

After all, the more things change, aren't they the same at the end of the day? Kind of makes you realize the drugs I learned about in residency are what I should turn to as initial interventions.

And, it will be a while before I write for Latuda. As it has been for Fanapt and Saphris, that my bolder colleagues' prescribing habits are beginning to voice some questions of these meds' value, outside samples!

by the way, glad you are still running this blog, three weeks since the last post?

Stephany said...

I'm not a professional, but I am a mother and mental health advocate and I am alarmed (but not surprised) how antipsychotics are being mainstreamed to the general public as antidepressants. It causes me grave concern for people who do not know the drugs (such as Seroquel) is actually an antipsychotic with all of its side effects.

Thanks for the enlightening post, would it be possible to scan the journal ads for viewing?

Anonymous said...

Nasrallah and Stahl are on the payroll of Big Pharma! Why are you so surprised? The problem is that Big Pharma is largely puling out of psychiatric drug research. No end points of progress, whopping placebo effects, no biological markers for psychiatric "disease" and so we only have "me too" drugs to market to our patients. Neuroscience has not produced any breakthrough drugs of late so we are left to spin city psychiatry!

Anonymous said...

I noticed that all three of the authors of the November piece on Seroquel report commercial relationships with AstraZeneca. In addition, one of the so-called "peer reviewers" also reports a commercial relationship with AstraZenenca! Hey! Business is business.

moviedoc said...

Not exactly Dr. Hassman. I count at least 31 pages of so-called "labels," gratuitous but obligatory fine print, the result of mis-regulation and FDA ineptness. This "prescribing information" just perpetuates the illusion that FDA is protecting the public and is probably rarely read outside a courtroom where it is probably more often used to protect the manufacturers. How many trees could we save?

Becky Murphy said...

I am a mother of a son who was used to trial many of the neuroleptic drugs that have recently been approved for use in children. The outcome was, shall we say less than beneficial for him. To know that NAMI and CABF among others, are now telling parents of the wonders the neuroleptic medications (and of their safety)in the treatment of it appears any and all types of distress in their children.

This blog post is just a validation that big pharma misses no opportunity to influence perceptions and practice. The average psychiatrist is just as susceptible to advertised hype as average person. Thank goodness not all psychiatrists are "average."

One more point on publications subject to "peer review" vs. not.
Being "peer reviewed" is, in light of research misconduct and Conflicts of Interest, in recent history, not going to have the same meaning peer reviewed has had up until now. Peer Reviewed publications that do not remove articles (renounce) based on flawed and biased drug trials, etc. will be exhibiting the same lack of ethics and integrity this post speaks about.

Also, although neuroleptics were originally used to treat schizophrenia, calling them "antipsychotics" IMHO is misleading given the reality of the long term efficacy of them used for schizophrenia.

Joel Hassman, MD said...

Excuse me, MovieDoc, but the pages used for non-article publication are advertisements, even if, and get ready for this quantity non clinician readers, 4 of the SIX pages for one ad re Lexapro or Fanapt include the FDA supplement.

Do advertisers on TV pay less for the 10-15 seconds of warnings they spout off that should take 30 seconds to read in coherent english? No, the ad is the ad, the content is the content.

And your rebuttal defends what?

Almost two thirds of this publication is non clinical material? Which is why it gets defined as a throw away!

pacificpsych said...

The influence of pharma extends down to every phrase currently used in drug-psychiatry. For example:

"Complex depression"...i.e. the human condition?

"Schizoaffective", i.e. schizophrenia.

"Strategies"...is this war or medicine?

"New [strategies]"...Classic NewSpeak.

Deconstructing psychiatric jargon is fun. :)

moviedoc said...

Dr. H: My comment defends nothing; it attacks your misleading statement and a misguided regulation. Ad or not, TV, throw-away or keeper journal, inclusion of the "label" creates an illusion of solving the problem with pharma, and wastes time, money and paper in the bargain. Furthermore the label is arguably just as "clinical" as the articles. Incidentally, you get those journals you love so much to hate because you requested them. Remember that card you signed and returned? Every subscriber like you and me generates more money for the publisher, and costs more for advertisers, all of which probably results in higher prices for the drugs.

Pacificpsych: Deconstructing psychobable is a blast, but I suspect that schizoaffective predates pharma use of the term, and Jay Haley, et al, gave us strategic psychotherapy in the 1970's or before. I suspect the word "strategy" generalized from its military origins even before that, although I could not find evidence in my Oxford English Dictionary (to which, BTW, Dr Wm. Minor, a notable insanity acquittee, was a major contributor).

pacificpsych said...

You're right, Moviedoc. Schizoaffective was introduced in 1933. I looked it up on Wikipedia :) which I trust more than any psychiatry journal...

Freud used to use war-like terms, too.

Nonetheless, despite these less than brilliant examples I used above, the entire discourse of modern psychiatry is permeated by DSM/bio/Pharma NewSpeak lingo. The manipulation starts from there.

Joel Hassman, MD said...

Hey Moviedoc, explain why I keep getting these throwaways when I do not fill out the cards anymore. It just shows they do not want to lose subscribers once they get your name.

You are right about the generating money for the publisher though. So the pharmaceutical industry can control what is published by these "journals".

By the way, what have I written that is "misleading", and clarify why that would concern you if you are aggravated by the excess of advertisements? Or, perhaps you are defending pharma?

Face it, there is no need in a clinical publication to run 4 pages of a PDR printout for physicians, it just makes docs have to read about the drug for 4 more pages to try to subliminally indoctrinate us to us the med! And why is no one asking that question?

Does anyone else rip out the ads before they read these throwaways if the table of contents look interesting? I know I do!

moviedoc said...

Dr H: I don't bother to rip it out, I tune it. What doc you know reads the PDR stuff (labels)? They're attached to every letter and sample. I'm surprised they don't print them on the pills. But they are not advertising, and the drug makers wouldn't include them but for stupid regulations.

1boringoldman said...

Dr. Lincoln, the author, is on the faculty of the University of Kansas, Wichita which has a non-profit drug trial facility, the Clinical Research Institute [the President is the former Chairman, the CEO is the current Chairman]. They did one of the clinical trials on Lurasidone. My guess is that the PHARMA connection is with CRI, rather than individual staff doctors.

moviedoc said...

Is Journal of Clinical Psychiatry a throw-away? Pharm Ads: 11.5 pp, not counting the card stuck to the cover (~1 p); Labels (PDR, physician info) 30 pp.
I guess the ration is better than in CP.

Dr John said...

I have never filled out a card of any kind and get a host of psychiatric journals like Current Psychiatry and yes The Journal Of Clinical Psychiatry. All end up in the trash which makes it very heavy. I tip the cleaning lady on a regular basis. I wish they were soft in texture and could be used at the toilet.

I believe the terms "psychiatric journal" and "throwaway journal" to be interchangeable.

Uma said...

So like, how many different types of depression are there? 1. Complex Depression 2.??
We must know how many different types there are because they have already formulated meds for each type, right?