Wednesday, August 31, 2011

Dr. Stahl's Medical Writer Fights Back

Dr. Stahl's controversial post on the evils of pharmascolds and antipsychiatry has attracted nearly as many comments as all of his prior blog posts combined. Most of the comments have been highly critical of his viewpoint. But we have yet to hear a response from the man himself. However, his medical writer, Debbi Ann Morrissette, PhD, has just mounted a spirited rebuttal to my comment. At the end of her comments, she writes that she will try to post it as a comment on my blog, but she fears that it will not show up because, in her words (and her capitalization): "MOST COMMENTS THAT ARE NOT "ANTI-PHARMA" ARE CENSORED THERE AND NOT POSTED WHEN SUBMITTED." Well, I can assure her that I very rarely reject any comments on my blog--unless they use extreme profanity or appear to be libelous. Just to save her the trouble of registering with Google, I will post her entire comments as a regular blog entry below.

The following was originally posted on August 31, 2011 by Debbi Ann Morrissette, PhD, as a comment on Dr. Stahl's blog post, "Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it."

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.
FACT CHECK - KEEPING THEM HONEST
Dr. Carlat posted the following comment but fact checking shows that he has his facts wrong. See fact checking in CAPS below his various assertions:

August 27 comment:

Dr. Stahl: Your rant is long on rhetoric but short on fact.

Your key argument appears to be that increasing regulations on pharmaceutical marketing techniques have led to the drying up of the CNS pipeline. While you provide no evidence to back up your argument, there are many reasons to question this.

CARLAT ASSERTION:
1. Other fields of medicine have seen a boom in new agents--diabetes, oncology, and cardiology are examples. New rules in academic medical centers limiting participation in speaker’s bureaus, access to drug reps, and gifts from drug companies have applied in these fields as well as psychiatry--but appear not to be limiting innovation.

FACT:
ALL FIELDS OF MEDICINE HAVE SEEN A DECLINE. 50% FEWER NEW MOLECULAR ENTITIES (NMEs) WERE APPROVED IN ALL THERAPEUTIC AREAS IN THE LAST 5 YEARS COMPARED TO THE PREVIOUS 5 YEARS (PAUL S ET AL). In 2007, for example, only 19 NMEs (including biologics) were approved by the FDA, the fewest number of NMEs approved since 1983, and the number rose only slightly to 21 in 2008. 21 new drugs were approved by the FDA in 2008, and 24 in 2009 (Paul S, et al, Nature Reviews Drug Discovery 2010, 9:203-214

CARLAT ASSERTION:
2. In psychiatry, many potentially novel agents have been developed and tested during the "pharma-scold" era but have failed in clinical trials because they have simply not worked, not because medical schools have told their faculty not to accept money to tout them. Examples are numerous, and include Substance P antagonist and mifeprestone for depression, J & J's anti-amyloid bapineuzumab for dementia (along with many other anti-amyloid agents from other companies), and Lilly's anti-glutamate agent mGlu2/3 for schizophrenia.

FACT: ALTHOUGH SEVERAL SUBSTANCE P ANTAGONISTS HAVE BEEN DROPPED FROM DEVELOPMENT, CONTACTING THE COMPANIES DIRECTLY REVEALS THAT MIFIPRISTONE IS STILL IN PHASE III; THAT BAPINEUZAMAB IS VERY MUCH ALIVE AN MOVING AHEAD IN MANY LARGE TRIALS WITH WYETH/PFIZER/ELAN/JNJ, AND THAT THE LILLY mGLUR 2/3 IS VERY MUCH ALIVE IN PHASE III

CARLAT ASSERTION:
3. Drug companies have introduced many psychiatric medications over the last two decades, but they have made the business decision to invest heavily in me-too agents, some of which, such as Pristiq and Invega, are embarrassingly blatant patent-extenders with no clear advantages over existing agents. Perhaps if companies had invested more resources into developing truly novel compounds, they wouldn’t be in the pickle they are in.

FACT: THE SUBSTANCE P ANTAGONISTS WERE NOVEL, AS WERE THE CRF1 ANTAGONISTS, NEUROKININ 2, NEUROKININ 3, BETA 3 AGONISTS, AND MANY OTHERS THAT FAILED TO SHOW CONSISTENT EFFICACY. AGOMELATINE IS NOVEL AND FACES AN UNCERTAIN FUTURE IN THE US BECAUSE OF POTENTIAL HEPATOTOXICITY. OVER A DOZEN NOVEL MECHANISMS WERE ADDED ON TO ANTIPSYCHOTICS TO TEST COGNITIVE IMPROVEMENT, FROM 5HT6, TO NICOTINIC AGONISTS, AMPAKINES, MANY MORE. THE FACT IS THAT INDUSTRY IS PUNISHED FOR PURSUSING TRULY NOVEL COMPOUNDS AND REWARDED FOR ME TOOS.

The reason that some companies are pulling out of CNS drugs is not because of the Carlat Blog (though I’m flattered that you believe I have so much clout) but because the brain is incredibly complex mechanism and we yet to work out the basic neurobiology underlying mental illness. As a psychiatrist, I prescribe drugs all the time and I know both their promise and limitations. Far from being “anti-psychiatry,” I would welcome novel drugs to ease my patients’ suffering.

Please show us some evidence for your position. That would be better than more low blow ad hominem attacks on those of us who are trying to improve the pharmaceutical industry by making it more ethical.
By Daniel Carlat on Saturday, August 27, 2011

THIS MAY BE A BIT THIN SKINNED ON DR. CARLAT'S PART AND IS FACTUALLY INCORRECT. DR. STAHL'S POST STATED THAT THE SITUATION DELIGHTED ANTIPSYCHIATRY AND PHARMASCOLD BLOGS BUT HE DID NOT MENTION ANY PERSON, AND STATING THAT THOSE BLOGS (AS WELL AS SOME OF THE COMMENTS ABOVE ON THIS BLOG) HAVE ANTIPSYCHIATRY, ANTIMEDICATION AND ANTI-PHARMA COMMENTS IS SELF EVIDENT, AND DOES NOT COMPRISE AN AD HOMINEM ATTACK.

ALSO, CORRECTING ERRORS HERE BY DR. CARLAT IS NOT AN AD HOMINEM ATTACK. ON THE OTHER HAND, CALLING DR. STAHL THE ENEMY, ACCUSING HIM OF GOING OFF THE DEEP END, HAVING BLOGGERS ACCUSE HIM OF BEING MENTALLY ILL, SAYING THAT HE HARMS PATIENTS BY DIAGNOSING MENTAL ILLNESS AND TREATING WITH MEDICATION ON THE OTHER HAND, ARE AD HOMINEM.

I WILL TRY TO POST THIS SET OF FACT CHECKS ON THE CARLAT BLOG, BUT MOST COMMENTS THAT ARE NOT "ANTI-PHARMA" ARE CENSORED THERE AND NOT POSTED WHEN SUBMITTED, SO IT PROBABLY WILL NOT BE SEEN THERE.

23 comments:

Bernard Carroll said...

Dr. Stahl should apologize for this intemperate post by Dr. Morrissette, especially the smear concerning Dr. Carlat: CALLING DR. STAHL THE ENEMY. He didn’t.

Meanwhile, please don’t try to create the appearance that mifepristone is going anywhere for treatment of psychiatric disorders – that is farcical and Dr. Morrissette should know better.

As long as Dr. Morrissette has the ear of Dr. Stahl, perhaps she can persuade him to respond to the comment I posted on the NEI blog concerning criminal convictions of pharmaceutical companies.

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

Dr. Morrissette said "...MANY OTHERS THAT FAILED TO SHOW CONSISTENT EFFICACY." This confirms my supposition that Pharma is pulling out of the mental health business only because there are no novel agents to go with that are promising, not because of the activity of industry critics.

And Bernard Carroll's point about the criminal convictions has been either ignored or explained away by those people who think that the industry is getting a bad rap.

One person on a Medscape blog, for instance, referred to the Justice Department as a bunch of "thugs."

Funny because the first of these convictions (for mismarketing of neurontin) came in 2004 when a business-friendly Republican named Bush was in charge.

SteveM said...

"FACT CHECKING" Dr. Morrissette is like shooting dead fish in a barrel.

Re: Carlat assertion #1

The FDA addressed this assumption in posted documentation:

http://www.fda.gov/downloads/AboutFDA/Transparency/Basics/UCM247465.pdf

http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SummaryofNDAApprovalsReceipts1938tothepresent/default.htm

They clearly show that except for several outliers, NME approval numbers have been fairly constant over time.

Re: Carlat assertion #2

MIFIPRISTONE, is indeed still in clinical trials. Of 25 active studies, most are for abortion. One for psychosis with psychotic depression and a few for PTSD. None for depression specifically.

BAPINEUZAMAB, there are 6 open clinical trials listed at clinicaltrials.gov. Two are Phase II. Is that "MANY"?

Re: Carlat assertion #3

Re: ”THE FACT IS THAT INDUSTRY IS PUNISHED FOR PURSUSING TRULY NOVEL COMPOUNDS AND REWARDED FOR ME TOOS.”

Uh…well yeah. Because Pharma is in business to make money. And the market punishes failure for strictly financial reasons. Not because of ANTIPSCHIATRY cheerleaders on the periphery.

Re: “DR. STAHL'S POST STATED THAT THE SITUATION DELIGHTED ANTIPSYCHIATRY AND PHARMASCOLD BLOGS”

Is a juvenile assertion that has no merit. ANTIPSCHIATRY and PHARMASCOLD BLOGS generally have nothing to say about neuro-science research.

Their arguments are about how psychotropics are utilized after they hit the marketplace. To think that anyone would reject a cure for schizophrenia because it was developed by a Pharma company rather than conjured up by a witch doctor is ridiculous.

BTW, I like Dr. Morrissette’s general over-the-top tone though. Because it allows me to use the word “splenetic” in a relevant context.

jon leo said...

Over the past decade the psychiatry community has said that mental illnesses are caused by chemical imbalances, that the drugs work well, and that the cause of these conditions lie with faulty genes, etc. However, in many peer-reviewed studies, scientists have now shown that the drugs don't work very well, that the chemical imbalance theories are not true, and that there are no known genes for mental illness. It is hard to see how Dr. Stahl could fault the general public for being skeptical after all this. In Psychiatric Times, Ronald Pies just wrote an essay not just claiming that the chemical imbalance theory was false but that psychiatrists knew this all along. Why they didn't want to explain to the general public that the company marketing programs that saturated the airways for the past decade were false is unclear. It would not have been hard to set the record straight - one press release from a professional organization could have cleared things up. Dr Stahl believes that the antipsychiatry crowd is anti-scientific and does not care about people - the ad hominem attack. But there is another possibility, namely, that there are many idividuals who have looked at the science, and who do care about people, and that based on the science have concluded that this is not the best way to treat people.

Altostrata said...

Dr. Stahl embarrassed himself and his proxy Dr. Morrissette continues to dig the hole deeper.

If his work didn't have so many implications for misapplication of psychiatric drugs, I'd say let the poor man commit reputation suicide in peace.

As I've said before, the reason there are so many critics of psychiatry is that there are so many dissatisfied customers out there. Nothing kills a bad product like good advertising. By overpromising regarding the medications and reaping billions, pharma threw clinical psychiatry under the bus.

Research psychiatry, however, was a willing accomplice. Too bad being under the bus is so darned uncomfortable and unremunerative. May I offer you 60mg of Celexa with a Seroquel chaser?

Sara said...

I love it when nasty people write in all caps. It's the equivalent of yelling and anything they say is belied by the format in which they say it. If they had anything truly meaningful and constructive to say they wouldn't have to resort to all caps. The flailing (and ad hominem attacks) that goes on by the biopsych paradigm defenders is quite frankly a joy to behold by those of us who think a lot of psychiatric treatment needs some serious rethinking. Let them keep embarrassing themselves and maybe fewer people will pay attention to them.

Dr John said...

Someone please give me a good definition of "anti-psychiatry"? What in hell does that mean? Is anyone who is critical of psychiatry and its dogma of mental illness is just a brain disease anti-psychiatry?

Dr Leo very plainly describes the mis-truths psychiatry as a body has passed on as valid truths over the last decade in regards to meds, imbalances and genes all of which most Americans if you ask still believe. I do ask all my pts when I first meet them and they almost always believe in chemical imbalances and primary genes for mental illness and that meds work great. How do you think they came to these conclusions?

Why are there no anti-gastroenterology or anti-ID or anti-cardiology nut jobs out there causing trouble and just stirring things up in the way they are blamed for in the "anti-psychiatry" world? How come the people on top don't ask themselves this question.

People just want the truth and you can't blame them if they are pissed off when they don't get it. Painting them with the "anti-psychiatry" broad brush is an obvious ploy that you really don't want to confront any of this or that maybe people actually have good reason to be "anti-psychiatry".

Thank goodness as Dr Leo said there is another possibility, namely, that there are many individuals who have looked at the science, and who do care about people, and that based on the science have concluded that this is not the best way to treat people. I guess that must be "anti-psychiatry"?

marilynmann said...

@Dr John

There is a group of "anti-cardiology nut jobs" known as The International Network of Cholesterol Skeptics. http://www.thincs.org/

Debbi Ann Morrissette, PhD said...

I have, (of course!), been following the discussion on our NEI blog as well as on Dr. Carlat's blog. I have seen many comments indicating that Dr. Stahl (and by extension NEI?) is only interested in promoting this drug or that drug, depending on the current pharmaceutical "sponsor". I would like to point out just a few more facts.
We here at NEI, including Dr. Stahl, are not believers that psychopharmacology is the end-all be-all for treating psychiatric disorders. We have consistently indicated that an integrative approach, including both pharmacological and non-pharmacological treatments, is likely to provide the best chance for a good outcome for most patients. Our primary focus is to provide education about the neurobiology of mental disorders as well as the mechanisms of action of ALL of the pharmacological agents used to treat such disorders. We provide knowledge of both the therapeutic actions of drugs as they are currently understood AND the potential molecular basis for side effects so that clinicians can determine which drug might work best for the individual patient. Drug X made by Lilly might be a great choice for this particular patient, but not so great for a different patient. Perhaps Drug Y made by Wyeth is best suited for that particular patient. We give as much information about BOTH Drugs X and Y (and Drugs A through W, too!) so the clinician can make an informed decision for the individual patient. We also provide education on non-pharmacological interventions (see for example our upcoming webinar on cognitive behavioral therapy http://www.neiglobal.com/Default.aspx?tabid=929). Recent articles we have published on our site and in our newsletter include information on Assertive Community Treatment, cognitive behavioral therapy, and recovery in mental disease. Where exactly is the Pharma bias in that? There is none.
It is true, there is much we do not yet understand about the functioning of the brain and what goes wrong in mental illness. We are still in our infancy in terms of understanding the roles that genetics and epigenetics may play in our propensity for certain diseases and in the response of the individual patient to a particular treatment. However, our knowledge is increasing rapidly. Old hypotheses about the neurobiological substrates of disease may be challenged as new data accumulate -that is the nature of science. In the meantime, we need to work with what we do have -as imperfect as those pharmacological agents (and non-pharmacological treatments) may be. As our understanding of the brain and the influence of genetic and environmental factors increases we'll have a better "big picture" view of what goes wrong in the individual patient and how to fix it. In searching for that "big picture" there will inevitably be failures and successes. The bottom line is: we need to keep trying and like it or not, Pharma is our ally in this effort.

Bernard Carroll said...

Dr. Morrissette just said The bottom line is: we need to keep trying and like it or not, Pharma is our ally in this effort. There is an old saying: When you sup with the devil use a long spoon. To quote Jerry Avorn again, “Marketing departments of many drug companies don’t respect any boundaries of professionalism or the law.”

Asslete said...

Dr. Morrissette,

Thank you for joining us in this discussion and tempering the rhetoric from the NEI Blog that raised our collective ire. I am happy to engage in mutual discussion/debate on both the promises and perils of biologic psychiatry. However, Stephen’s initial blog and your all CAPS follow-up was frighteningly mindful of one in the throws of the first two stages of Kubler-Ross’ grief. The hyperbolic denial and anger surprised me; especially coming from someone who prides himself on effective communication strategies.

Dr. Stahl has certainly done much good. He took complex constructs and distilled them into stories and pictures that allowed both novices and experts alike an easier way to conceptualize receptors and neurochemistry. Kudos for sure…the work was groundbreaking. However, the downside to this approach was that such a simplification of these complex structures led unintentionally (or perhaps some would argue, intentionally) to aligning with Pharma for economic gain…and to coyly make claims under the “hypothesis model” that have not born out via compelling data.

Whether it is 5HT-7 and Latuda or Histamine and Provigil…the conceptual explanation at times led to hype that far outweighed the benefits I saw in clinical practice.

I’ve been at this for 22 years now and still long for the day that Psychiatry becomes more biologically legitimate. However, CATIE and STAR-D helped demonstrate that the last 15 years of me-too SSRIs, and Atypical Antipsychotics showed little real benefit from medication (and sometime placebo) 30 years their senior…it is little wonder Pharma is taking a hiatus from our field. It is time for Psychiatry to take a meaningful pause as well.

-We don’t need to pathologize shyness as social phobia.
-We don’t need a 6-fold increase in ADHD for no compelling reason other than Shire's promotionalism combined with parents unwillingness to accept the bell-curve and the fact that little Timmy may not be that bright.
-We don’t need that same 6-fold increase in “bipolar disorder” for little reason other than most SSRIs have gone generic, so it makes better business sense to promote atypicals and call the irritable guy, Bipolar, instead of accepting that maybe, he’s just an asshole.

We need to paint emotional angst with far less of a broad brush. Let’s narrow the playing field. Let’s first quantify true biologic pathology. In the meantime, let’s focus more on CBT, and like-minded social therapies. I am quite pleased to learn that Dr. Stahl is supporting such a platform.

Anonymous said...

Dr. John, I enjoy reading your comments and I appreciate the balanced introspection you bring.

I, for one, would like to know which university conferred a PhD on Dr. Morrissette. If this is how candidates are trained to use facts at her school, I would recommend that no one go there.

Also, when commenting on conflict of interest in psychiatry, most people here, in the New York Times, and elsewhere make their case against the academic research psychiatrists who are in bed with pharma. While this clearly is a HUGE problem, I will have you know that there is a COMMUNITY-based geriatric psychiatrist in tiny little Manchester, New Hampshire, who made approximately $47,000 doing speakers' bureau sales pitches for JUST ONE pharmaceutical company. I know this because I looked it up on that company's doc payment database. It's not just the academics. It could just as easily be the local psychiatrist in your town. You'll never know unless you check, so check. $47,000 is a lot of money, particularly when it is from just one manufacturer. Who knows how much he is making from the others. I would not accept a drug recommendation from him, nor would I allow him to prescribe for a family member. Anyone taking $47,000 bribes from a pharma company is on the take and looking out for number one. Conflict of interest in psychiatry is far from dead. It may be tempered by public outrage, forced corporate transparency, and professional embarrassment, but it is far from gone.

Anonymous said...

Hi Marilyn,

As an FYI, I have greatly enjoyed your posts as they always seemed very rational and logical.

Therefore, I was taken aback when you inferred that The International Network of Cholesterol Skeptics are a bunch of nuts.

I just don't understand this need to demonize people who in my opinion are asking some legitimate questions as to whether the medical establishment is wrongly blaming cholesterol for everything under the sun. How is that any better than calling folks antipsychiatry who Dr. John rightfully points out have some very legitimate issues?

Isn't science about questioning and having discussions about the various issues without name calling? Isn't that how progress is made?

Anyway, see this article by a thoracic surgeon who definitely doesn't sound like a nut. The issues sound very familiar to what has been raised in psychiatry.

http://www.spacedoc.com/statin_scam

"I'm not sure that the statin makers intended to swindle in the beginning but they also were not about to give up on a $30 billion annual market easily. There are many sincere, well intentioned and deeply convinced physicians that will continue to support the theory that dietary cholesterol and saturated fats cause heart disease.

They will continue to believe that cholesterol lowering medications will successfully treat and prevent heart disease in spite of the fact that a study published in The American Heart Journal ( January 2009 ) analyzing 137,000 patients admitted to hospitals in the United States with a heart attack demonstrated that almost 75% had "normal" cholesterol levels.

This fact continued to bother me during my surgical career. The idea that a normal substance, namely cholesterol, would cause heart disease never resonated with me. I would see patients coming back for second coronary bypass operations a few years after their first, having had normal cholesterol levels the entire time. In the operating room I had made the observation that there seemed to be inflammation around the coronary arteries that I was bypassing.

Through brilliant and massive marketing the makers of statin drugs have skillfully influenced science and controlled public policy so that prescribing statin drugs has become the standard of care. Anyone questioning or disagreeing with these policies is labeled as a heretic, disregarded and ridiculed. "

AA

Anonymous said...

Why is she shouting? She should turn the "Caps Lock" button OFF.

David Behar, M.D., E.J.D. said...

I confirm that Dr. Carlat censors all substantive rebuttals of his extremist and irresponsible views.

He faces weak advocates only, and lacks the courage to take on any real world clinician.

His views are ipse dixits, like those of a two year old, thoroughly contradicted by the data showing no patient has ever been harmed by industry involvement with educational activities such as conferences, dinners, and grand rounds.

The facts abandoned the left 100 years ago. All that remains is personal attack and invectives as in Dr. Carlat's inappropriate remarks about Stahl. These amount to nothing more than expressions of emotional frustration by an inability to overcome the facts, the insurance company origins of the witch hunt, and its racial prejudice. Dr. Carlat just does not want dark skinned people on Medicaid to receive expensive brand name medication. Worse, he is in denial about his racial bias and animus.

Dr. Carroll has gone off the deep end as well. The criminal convictinos of pharmacueitcal companieswere pretextual, and should have been resisted. I may buy shares of every drug company to get personal standing. I would then seek the personal destruction of every prosecutor to protect one of the few areas of success in American business.

Those fines consumed the research budgets of a dozen innovative drugs, and fully deterred those companies from doing business in the US. Dr. Carroll's gloating is disgusting and morally reprehensible because of the damage done by the lawyer predators to clinical care and medical progress.

John M. Nardo MD said...

"It is true, there is much we do not yet understand about the functioning of the brain and what goes wrong in mental illness... However, our knowledge is increasing rapidly. Old hypotheses about the neurobiological substrates of disease may be challenged as new data accumulate -that is the nature of science. In the meantime, we need to work with what we do have -as imperfect as those pharmacological agents (and non-pharmacological treatments) may be. As our understanding of the brain and the influence of genetic and environmental factors increases we'll have a better 'big picture' view of what goes wrong in the individual patient and how to fix it. In searching for that 'big picture' there will inevitably be failures and successes. The bottom line is: we need to keep trying and like it or not, Pharma is our ally in this effort."

@ Dr. Morrissette

Future-Think has been the refrain from neurobiology for the last 25 years - broad statements about what we don't know or what might be better when we know more pepper our literature mercilessly. Of course we'll know more when we know more. But clinical medicine is not about what we might know later. Neither are pharmaceutical revenues. Both are about what we know now. In the period being discussed since 1987, Pharma has given us variations on two central themes - SSRIs and Clozaril derivatives. Both were already around in 1987. They've exhausted those avenues and found no other new directions of major note. So having nothing to sell and no new direction to turn, they're moving on to greener pastures. What's so complicated about that?

Dr. Stahl explains the Pharma exodus as being caused by a group he lists in his post [sarcastically]. Says who? As people are trying to tell you here and in the NEI comments, that explanation doesn't pass muster. It sounds like the opinion of someone who's frustrated that the future he thought was so promising in 1987 hasn't lived up to his or anyone else's expectations.

And as for the group he lambasts. They're angry about the consciously withheld information about side effects, the inflated claims of efficacy, the stealthy invasion of psychiatric literature, and the paying of psychiatrists to function as detail men [KOLs] among other things. The disappointment in Pharma's deceitful marketing behavior runs even more deeply than the disappointment in the product of the last twenty five years.

Neither Dr. Stahl's hostility nor your more measured entreaty to look to a hopeful future addresses Pharma's gross misbehavior - the things that your real opponents are up in arms about. Most aren't out to destroy Pharma. They're determined to make Pharma act in a manner that would allow us to feel comfortable in being allies.

You and Dr. Stahl have each misread your opposition as coming from primarily destructive idealogues "out to get you." Look again. Your growing opposition is from people focusing on actual things that have actually happened in epidemic proportions - over and over. The zealots Stahl blames are, in fact, in the minority...

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

Dr. Behar,

Your post is devoid of any specific arguments or facts, and consists of nothing but polemics and personal attacks on Dr. Carlat, and I can see why Dr. Carlat may not have posted your previous entries.

I'm sure you can explain away Eli Lilly's "Zyprexa documents," the findings of Senator Grassley (A Republican on the right,BTW), and the death of Rebecca Riley, but some of us know better.

Bernard Carroll said...

Aw, shucks, Dr. Behar. Do I really deserve all those compliments? I am happy to leave the gloating to you as you act out your chilling plot for “the personal destruction of every prosecutor...”

Bernard Carroll said...

An implicit assumption in Dr. Stahl’s original post is that academics are putting out great stuff and their reports are reliable. The disaffection of Pharma with psychiatry couldn’t possibly be due to the academics screwing up, could it?

Well, a new report in Nature Reviews Drug Discovery (September 2011) puts a searchlight on this smug assumption. A companion commentary hammers home the message: more than 50% of published results from academic laboratories cannot be repeated in an industrial setting, and so drug discovery targets proposed from academic centers cannot be relied upon for corporate research initiatives.

The research areas considered in this review were oncology, women’s health and cardiovascular. There is no reason to think that it would be any different in psychopharmacology.

David Behar, M.D., E.J.D. said...

The plea bargain is a tool for over-criminalization, for lawyer plunder of innocent productive entities, and has no validity as a measure of blameworthiness. Corporations do not even have their feelings hurt by such plaeas bargaining. They pass on all costs to the consumer. The pipeline is from the wsallet fo the working person to the government lawyer rent seeker., worthless vermin doing nothing of any benefit to anyone but themselves. But corporations do learn from thse huge fines. They learn to move drug development to China.

If Dr. Carroll started seeing patients, he would be less sarcastic. Off label use and promotion is the single biggest source of immediate medical innovation and progress at no additional cost. Rather than being punished, it should be rewarded with tax incentives and grants to research and validate the expansions of drug uses.

Zyprexa is not an anti-psychotic. It is a tranquilizer that quiets many disinhibited brain disorders. Nausea from chemotherapy, hiccups for weeks, tics, depression, suicidal ideas, aggressiveness and anger, evil intents. The clinician has been using these drugs for off label indications, and the government should encourage it by rewarding research into effectiveness.

Dr. Carroll, Dr. Carlat, others of their left wing hate speech, witch hunting ilk, the overreaching know nothing prosecutors of the Justice Department are mortal enemies of my patients. I will defend my patients until these enemies are stopped. All my lawyer adversaries have been driven from their specialty or the state, or the profession. I want to see these DOJ federal thugs fully deterred.

that very difficult woman said...

I have a hard time believing that "pharmascolds, scientologists, and the antimedication crowd" are responsible for shutting down big pharma, as Dr. Stahl implies. In the 60's these folk were called the "antipsychiatry" crowd. Didn't shut big pharma down then. Maybe recession, downsizing, and the gap between basic research and drug making are more powerful forces?

Parwathy Narayan said...

Although medications have helped me a great deal in my stability, I believe alternative medications are important, such as spirituality, exercise, yoga, meditation, etc. It all works in conjunction...medications, therapy, and alternative methods for holistic healing. In Psychiatry, we are too quick to resort to medications alone to band-aid a symptom.

Pearly Home Remedy said...

It is hard to see how Dr. Stahl could fault the general public for being skeptical after all this. In Psychiatric Times, Ronald Pies just wrote an essay not just claiming that the chemical imbalance theory was false but that psychiatrists knew this all along. Why they didn't want to explain to the general public that the company marketing programs that saturated the airways for the past decade were false is unclear.