Wednesday, October 10, 2007

Primary Psychiatry: Pharma's New Mule

Granted, everyone’s entitled to make a buck, medical publishers included. This almost always involves doing some advertising for drug companies. There’s nothing inherently wrong with this, as long as the advertising doesn’t infiltrate the content of the articles. This firewall between marketing and editorial content is crucial, and some journals are very good at maintaining this separation—journals such as Lancet and New England Journal of Medicine come to mind.

And then, on the other hand, there is Primary Psychiatry.

The September issue of Primary Psychiatry is the encapsulation of the worst of the worst of what might be called "greed journalism." Rather than serving as a medical journal, Primary Psychiatry has become a mule for various sponsoring pharmaceutical companies, heaving promotional CME programs into our offices. An almost exquisite example of journal as marketing vehicle, the September issue is the very Mona Lisa of CME corruption.

It arrived in my office “polybagged” with three industry-funded educational activities. Polybagging entails wrapping the journal in plastic wrap and throwing in stuff that drug companies want you to see. The September issue contains:

1. A DVD funded by Bristol-Myers Squibb, coyly entitled, Akathisia: Problem of History and Concern of Today. BMS markets Abilify, widely acknowledged as the atypical most likely to cause akathisia—an inconvenient truth for BMS, because this drives down Abilify’s market share. Thus, BMS paid i3CME (you remember them--the producers of the great Lindsey DeVane fiasco) to find speakers who would play down this liability, and they got exactly what they paid for in these Three CME-usketeers: Prakash Masand, Naveed Iqbal, and Tim Lambert. Abilfy’s association with akathisia is conveniently not mentioned by any of these key opinion leaders. Instead, we hear that Risperidal, Zyprexa, Clozapine, and even Seroquel (!) can cause it. If you can stomach watching this biased presentation, you'll quickly discover that its promotional message is: (1) Akathisia is more common with first generation antipsychotics; (2) There’s no real difference between the atypicals; (3) It’s often caused by SSRIs rather than atypicals; (4) Don't worry, prescribe Abilify.

2. The second prize is a newsletter called “Wake up!”, produced by Steven Stahl and funded by Cephalon. An 8-page advertisement for Provigil, it contains articles written by a Who’s Who panel of industry-funded psychiatrists, including Wallace Mendelson, famous for his ghost-written trazodone-bashing article in the Journal of Clinical Psychiatry (2005;66:469-476; see my New York Times op-ed on his work for Sepracor here). For those who don’t know, Stephen Stahl, founder of the company Neuroscience Education Institute, is one of the more industry-conflicted psychiatrists in the profession, right up there with Charles Nemeroff. The “wake up!” newsletter oozes Cephalon and Provigil, with exhortations to diagnose more people with "excessive sleepiness" and to treat them with Provigil and other meds. Cephalon pays Stahl tens of thousands to say good things about Provigil, and then pays Primary Psychiatry even more to mule the newsletter to 60,000 physicians.

3. Finally, the actual journal is covered with an overwrap advertisement for an Eli Lilly-sponsored educational event on bipolar disorder. No, I didn't spend any more of my precious time enduring that telesession. I'm assuming it will argue that patients with bipolar disorder are at a higher risk for diabetes regardless of which medication they use, so don't worry about slamming them with Zyprexa.

The "Pharmatorial" content doesn’t end with the plastic goody bag. Inside the journal, synergizing nicely with a three-page ad for Lilly’s Cymbalta, is an entire section on pain in psychiatry, including an article on "Psychopharmacology of Chronic Pain." The author, Michael R. Clark of Johns Hopkins, is listed as having “no affiliation with or financial interest in any organization that may pose a conflict of interest.” This fib can be checked out by going to Google and typing in “Michael Clark, M.D. and disclosures.” The first page of results shows that Dr. Clark has been the course director of two CME conferences on pain management this year, supported by educational grants from Lilly, King Pharmaceuticals, and Cephalon.

It isn't easy being a mule. But the money helps.


Anonymous said...

I walked out of psychiatry over 2 1/2 years ago. I suffer from bipolar disorder type one and have for several years. I have no desire to return to a psychiatrist anytime soon

CL Psych said...

Great post! If you have the time, it would be helpful if you could scan some of these commercial pieces and post them online. As more people see these shameful promotions, more disrepute will be cast upon those who participate in the process.

Anonymous said...

I'm an aspiring psych nurse...your posts are truly eye-opening.

Anonymous said...

I am a psychiatrist who has been in practice for 25 years. I must admit that early on in my career, I naively accepted free meals, assorted gifts, and money for lecturing. As time has passed, I have grown increasingly disgusted by our profession's involvement with big pharma and I no longer accept ANYTHING or meet with any pharmaceutical reps. I now believe that any involvement of this kind is totally incompatible with truly being a physician dedicated to one's patients. Of course, the larger problem may be the very nature of our health care "system" (which is actually a commercial for-profit industry instead of an organized system of care), since it tends to favor such profiteering at the cost of true patient care.
I'm glad that people such as yourself have the guts to speak out on this! Keep it up!
Gary Seltman, MD
Goshen, IN

The Neurocritic said...

Not that I know anything at all about Primary Psychiatry, but they did publish Recent Regulatory Changes in Antidepressant Labels: Implications of Activation (Stimulation) for Clinical Practice by Peter R. Breggin, MD. I was trying to determine the impact factor (or reputation) for this journal, because they published a case report on long-term ketamine infusion for depression, which I found alarming.