Tuesday, March 4, 2008

Deceptive Surveys: Latest Marketing Tactic in the Antipsychotic Wars

You probably don't receive the throwaway journal called "Psychiatry 2008," but if you did, and if you turned to page 61 of the February issue, you would read about a new survey on treating schizophrenia. Entitled "Communicating About Health: A Mental Health America Survey of People with Schizophrenia and Providers," the survey was released by Mental Health America, a patient advocacy groups that receives funding from drug companies. (For some background on the influence of industry on patient advocacy groups, see this excellent study in New Scientist magazine.)

At any rate, this survey was conducted with 250 people with schizophrenia, and 250 psychiatrists, who were selected from two online "panels" created by a marketing research company called "International Communications Research."

The results of the survey? 1. Psychiatrists don't pay nearly enough attention to the physical health of their patient as they should. 2. Most patients have at some point stopped their medications because of side effects. 3. The potential side effect of antipsychotics of most concern to psychiatrists was diabetes.

I know what you're thinking: "This survey could not have been funded by Eli Lilly." And you'd be right, because Lilly markets Zyprexa, an antipsychotic associated with weight gain, elevated cholesterol, and diabetes. Nor would such a survey be underwritten by either AstraZeneca (Seroquel) or Janssen (Invega, Risperdal), because these antipsychotics are also implicated in the metabolic syndrome, though not as severely as Zyprexa.

Actually, this survey was funded by both Wyeth and Solvay, the companies which teamed up to market bifeprunox, an antipsychotic in development whose main marketing point is that it doesn't cause diabetes or weight gain.

Next question: If Eli Lilly decided to fund its own survey, what would they make certain the results would be? It would have to be something downplaying Zyprexa's bad side effects.

Well, we have an answer in this new Lilly-funded survey about schizophrenia that was released by yet another industry-funded patient advocacy group, The World Federation for Mental Health. This survey of 982 caregivers concluded that: 1. Relapse is a terrible thing in schizophrenia; 2. Efficacy is the top treatment priority; and 3. You have to focus on the long-term management of patients. The words "side effects," "diabetes" or "weight gain" are not even mentioned in this survey.

File this one under: Addicted to deception.


Supremacy Claus said...

Dan: Can you point to any decision by any psychiatrist or patient that was influenced by these polls? A single case would satisfy me.

You are quite selective and misleading in your postings, too. You pick on trivia. You skip massive damage done to clinical care by left wing ideologues, the land pirates, and their doctor collaborators.

Anonymous said...

I don't know if anyone has said this in print in our own literature or in just casual media comments, but I'll put myself out there as the proverbial whipping boy for the deluded masses as of March, 2008:

Second generation antipsychotics, otherwise called atypicals, or for me most appropriately called novel antipsychotics, will be exposed to be one of the more fraudulant chapters of psychiatry if we as the front line providers continue to allow the pharmaceutical pushers of these drugs to broaden the darkening horizon of indications for these drugs. It is beyond scandulous what is going on here in looking for applications to treat depression with an antipsychotic. These companies will push for anxiolytic indications by 2010, and when the poisons these meds flagrantly show themselves to possess jade the public beyond reproach, we, as the prescibers, will bear the brunt of this backlash.

If I am wrong, I will gleefully be happy and apologize to any and all I have offended by this prediction.
But, if I am right, I just want to know who is going to apologize to me when our field crumbles. I have come to hate the phrase "biochemical imbalance". I may be ranting, but for me my gut has been right moreso than wrong.

Good luck, good times, good day.

Supremacy Claus said...

TF: What about patients? Some respond, and repeated attempts to stop these medications fail. If none ever gets offered any medication, because all are "poisons," that care is outside standards today.

These medications are only tools. To deprive patients of their benefits, is like forcing people to walk to Ohio, through bear country. One may eventually get there, but in rough shape, weeks late, when compared to jet travel.

Shouldn't the patient get offered and make the choice, and not the eccentric ideologues here?

Anonymous said...

SC: Physicians accept two basic premises to their oath as providers: first, do no harm, and second, go from least to most invasive.

Turning to antipsychotics for disorders that do not involve serious thought disorders like psychosis or mania is like giving insulin to a newly diagonosed diabetic, or, perhaps this analogy is more on the mark, giving opiates to a patient presenting with pain. It's too much, too fast, and in the end, I would like to hear a physician argue that an ssri or snri, heck, even a benzodiazepine, is as risky or more than a novel antipsychotic TO TREAT DEPRESSION OR ANXIETY. That is the issue here, not denying patients appropriate treatment options, just being responsible and use a logrithm that makes sense and is defendable to colleagues.

You know, I don't care that Dr Carlat wants anonymity; I have offered spontaneously in vague terms who I am in this dialogue: WHY CAN'T YOU? At least I document my position in this debate; is it wrong to know who your challenger is to validate his or her position?

Supremacy Claus said...

TF: Have you tried anti-psychotics in any non-psychotic, depressed patients, for example, someone agitated, struggling to not jump from a window, sidling towards one in the office on the fifth floor to look out from it?

You have done what, increased the Prozac, or explored the psychodynamic origins at this point, to avoid the harm of these poisons?

Try to focus on the points of the argument, less on personal remarks.

Anonymous said...

Having thought about this all day, as I was off, I have decided to not participate in this comment section any longer if people can hide behind rhetoric and innuendos without responsible transparency.

Dr Carlat, I will continue to read your blog but will dialogue with you through your own email site as needed. I still believe your blog is an essential element to challenge this content and process of misinformation and manipulation by nefarious participants in the mental health care system; this is not directed to the writers here, but what Dr Carlat writes about.

It is in my humble and personal opinion that allowing participants in this commentary to invite debate but not be honest and direct in their role to it is disingenuous and should not be encouraged. It's your site, so you'll do as you want.

Thank you for allowing me to participate these past several weeks. As I always close,
good luck, good times, good day.


Supremacy Claus said...

If Therapy First is a real name, your parents had a great sense of humor or were dirty hippies.

Anonymous said...

Please allow me to catch up after a few weeks of blogless solitude as I just read that Therapy First is no longer commenting due to Supremacy Claus' "directed' remarks. First, though TF's blanket reference to novel antipsychotics as "poison" is pushing it, his underlying point -- that the atypicals could be marketed someday as anxiolytics -- is valid. Though my opinion is just that, we all lose when someone like TF signs off. And the entire blog is degraded by off-hand, personal remarks, such as "your parents had a great sense of humor or were dirty hippies;" no matter how tongue-in-cheek it was meant.

Because of chat room shenanigans these days between kids, schools and parents are grappling with formalizing written rules on internet conduct in order to prevent emotional fallout from potentially hurtful anonymous "chats." Let's not fall prey to the same syndrome. I hope that TF will reconsider. His expertise will be greatly missed.

Supremacy Claus said...

James: The facts abandoned the Left 100 years ago. Thus only personal attacks remain. These include the extermination of 100 million people to persuade. Failing to persuade by facts, the Left wants to parse for personal attack.

I suggest, it will be hard at first, as any new activity can be. But TF can research facts and cite the facts of personal experiences. Try the facts for persuasion, for a change of pace. Let the Left have a nice day.

I find your response more inappropriate than his. You propose censorship. Set an example for me. Post your resume for parsing for personal attack. For example, if you are a lawyer, you belong to the world's most powerful criminal cult enterprise, one controlling the three branches of government of an empire class hegemon. As a convicted felon has little, so your lawyer utterances would have even less credibility. Beyond credibility, the lawyer is besieging the $2 tril health care budget for plunder. A lawyer would be a mortal enemy of clinical care.

Lawyer utterances are for lawyer rent seeking. PC is case. If you are a lawyer, have a nice day.

Anonymous said...

Supremacy Claus: Being 'right' is what seems to drive you. You play the lawyer, here -- not me. If I have a degree and you don't, it matters little or nothing (to me). If experience teaches us anything, it teaches us that knowing the words is just the start. You're obstructing our search for a valid methodology to talk about medicine by using words like "extermination" in the same context. The 20th Century is defined by that word. Why go there in a discussion about psychiatry? Seeming to have all the answers does not make you right. Seeming to have all the answers does not warrant a response. Suffice it to say that this wouldn't be the first time you fell out of favor.

Anonymous said...

I see TOO TOO many negatives in current treatment options. ernest shackleton had a few "psychotic" shipmates aboard the endurance, and they managed to provide help and support in one of the more demanding human situations people can be exposed to. who's to say that within the first day of admission to a psychiatric ward that someone is in need of medication, or even treatment for that matter. we are very much interconnected and the majority of these people are of a young age 19-24. is this not a time that most things about life roles and self importance are learned? i feel terribly sad for patients whos opportunities in life are dampened because of the effects of this drug. i would suspect that due to the nature of this medication that much more subtle side effects occur that people are just too good to complain about. if there is anything that could spark new musicians, philosophers, mathmeticians, pastors, and good people i would argue it would be reforming or even doing away psychiatric care -if even just allowing them to read up (hey read this) before forcing treatment on them. far fewer people would struggle the way that these people have to once they find mental wellness then realize that the medication that they have been on changes them, for potentially the worse. and yes you're right. i am not a psychiatrist and i do not have all the answers, but someone somewhere is not providing everyone with all that could be known about these drugs. it is my hope that in psychiatric emergencies that only positive actions take place for paitents, and dare i say maybe even for their surroundings.

Anonymous said...

Atypical anti-psychotic makers sold thier drugs to nursing homes for dementia patients. With the elderly population, pneumonia and premature death are much higher occurences than other age segments. And this was done with intent by one company.

Such activity is stopped only when it has to be forced to stop.

Anonymous said...

I've never had trouble weaning from Effexor, etc. I guess Prozac works well, as does Cymbalta. Cymbalta works great for pain, too. Watch out for muscle cramping though. Just switched to Pristiq bcs of those. We'll see. Meds are very much a fact of life around our house and we appreciate the good they do, what with the high blood pressure, heart disease, depression, arthritis, trigeminal neuralgia, allergies, ADD, menapause, and the big daddy of mood disorders, bipolar disorder I. And that is just for two of us! HAH. Whatever, is what I say to you all. Do the best you can, suck it up, and make the best of it. Oh yeah, and pray for better prescription drug plans -better living through chemicals!

Good luck and God bless Guys--it will be okay.

Anonymous said...

I think you all are all pretty "lofty." So to speak, on this subject. Here's what I think. Drugs help if they are being prescribed by an intelligent, informed, ethical, caring, and responsible medical provider. I trust my psychiatrist to know exactly what he's giving me and to follow up, which he does and has for 10 years. The pharmaceutical companies can package poisons any way they want. My doc keeps a close eye, understands the pharmacology, and knows my needs. Period. That is where the responsibility lies. The rest if just chaff.