Monday, January 12, 2009

American Psychiatric News: Guess the CME Sponsor!

Last July, I blogged on a CME conference at the New York Marriott called the “Third Annual American Conference on Psychiatric Disorders.”

The bottom line was that McMahon Publishing was using the conference to make boatloads of money from pharmaceutical companies, charging them $85,000 for each 90 minute symposium, and offering to write up articles based on each symposium for a mere $103,000 each. Well, the conference took place in September, and now, 4 months later, the first of the $103,000 articles have been published.

Shall we have some fun?

Yes, it’s time to play that always entertaining game of commercial CME corruption, "Guess the CME Sponsor!"

We’ll focus on the article entitled “Differential Diagnosis and Management of Bipolar Disorder.” It is published in a "Special Edition" of American Psychiatry News, December 2008, Vol 1, No. 12. I haven't found this article online yet, but here is the journal's website.

First, who wrote the article? We have no idea. Although the “faculty” are listed as Glenn J. Treisman, MD, PhD, and Jennifer L. Payne, MD, the article was presumably ghostwritten by a medical writer hired by American Psychiatry News.

And what about disclosures? There’s already a problem here. Under “faculty disclosure”, Dr. Treisman reports “no financial interests to disclose.” Must be a typo. Because at this December 2008 Pri-Med conference, Dr. Treisman reported being a speaker for both Boehringer Ingelheim and Abbott,
and in this May 2007 CME program, he said he was on Pfizer's speakers bureau as well. In the past, Dr. Treisman apparently spoke for so many companies that he simply disclosed that he was on the “Speakers Bureau for most pharmaceutical companies” according to this Drexel University CME program.

Let’s move onto the article itself. But remember the rules: no peeking at which drug company sponsored the article until we’re done!

The article is built around these two case studies:

1) Chelsea, a 20-year-old college student, uses alcohol and marijuana and presents to a doctor with symptoms of mania. Her psychiatrist diagnoses her with bipolar disorder and comorbid substance abuse, and starts her on valproate. Over the next 1 ½ years, however, Chelsea does quite poorly on valproate, and has four manic episodes with psychotic features. Eventually, she is admitted to the hospital, and Zyprexa (olanzapine) is added to valproate. Four weeks later, Chelsea has improved: her sleep is better and her mood is stable.

2) Greta is a 40 year old married school teacher who presents with symptoms of depression. Her psychiatrist prescribes fluoxetine, but 5 weeks later she has racing thoughts, poor sleep, and her diagnosis is revised to bipolar disorder II. At this point, her psychiatrist switches her from fluoxetine to Symbyax (Zyprexa-fluoxetine combination capsule) and lithium. Three weeks later, according to the article, “Greta has improved. She is sleeping better, is less irritable, is finding it easier to focus at work, and has begun marriage counseling with her husband. Generally, she is statisfied with her treatment.”

Now let’s do our analysis. In the world of bipolar treatment, the major branded players are: Abilify, Geodon, Seroquel, and Zyprexa. Risperdal, valproate, lithium, tegretol, and lamotrigine are also used, but they are all off-patent, and therefore drug companies would be unlikely to support education featuring them.

Would Bristol-Myers Squibb support this program? Doubtful, because Abilify is not mentioned in either case, though it is mentioned in passing as a treatment option in some of the smaller-print commentary. Pfizer or AstraZeneca? Certainly not, because neither Geodon nor Seroquel appear to have entered the treating psychiatrists’ minds.

Eli Lilly? Hmmm. Chelsea finally got better after she was started on Lilly’s Zyprexa. Greta got better on Lilly’s Symbyax. I think we have a real candidate here.

Let’s flip to page 25 of the journal: “Supported by an educational grant from Eli Lilly and Company.”

We have a winner! Those of you in the audience who correctly Guessed the CME Sponsor will receive a $100 gift certificate to McDonalds, which you will tear through during your first day on Zyprexa en route to an average weight gain of one pound per week—but of course we heard nothing about either Chelsea or Greta gaining any weight. Contrast this with Current Psychiatry’s AstraZeneca’s CME advertisement for Seroquel, in which Dr. Goldberg’s patient, Mr. S, gained 18 pounds in one month of Zyprexa treatment.

As usual, nothing inaccurate was said in this article, and I'm sure Symbyax is a perfectly delightful medication for someone out there, although I would never prescribe it because I hate turning patients into blimps. But this article is an advertisement, and should not have qualified as accredited medical education. Shame on Dr. Treisman, the journal's editor, and McMahon Publishing.


Anonymous said...

And by the way, the correct IMHO treatment in both cases described would have been careful tapering off the original offending agent, not adding the atypical antipsychotic. These victims, uh -- or was it patients? -- were suffering from drug-induced reactions, nothing more, nothing less. What an amazing concept -- a drug reaction, not a mental disorder! This seems to be completely off the radar screen. And this is CME? I can't tell you how sickening I think this is. But then I'm a patient advocate, aka "survivor," not a medical professional. But, please . . . Stop thinking that the only solution is yet another or a different med.

Anonymous said...

I personally find Dr Treisman's editorials in to be wonderfully critical of our peers and the intrusions by insurance, although he had one comment that sort of gave a pass to pharma. I just don't see him as a complete lackey for the industry though. This does not fully excuse him for ignorance or lack of attention, but I think you might be a bit hard on him in the end.

By the way, this is not Furious Seasons, so allowing some of the more extreme of the usual commentators from there to try to turn this site into a bash fest will be a mistake. Medications have a place in treatment, note not the ONLY one, but the above comment is inappropriate, in my opinion.

As I said before, being a patient or an advocate brings you a place in the debate, but does not bestow expertise. Also, this author does practice moderation, so chose your words carefully in rebuttals.

Nice post though.

Anonymous said...

LOL, these posts crack me up. Then I realize how sad this situation truly is and I feel like crying. Guess I really am a manic depressive ;)

Rosie said...

What if case number 2, Greta, instead of having racing thoughts and poor sleep from Prozac, had actually murdered her daughter as Paula Pinckard did in Colfax Lousiana.

The M.D.'s who testified in her trial said that, if Pinckard had not taken the Prozac, her condition might not have manifested itself. She was given a light sentence of 3 years because of the Prozac angle.

Here is a link to this case:

So we are talking about serious adverse reactions here. We need to get a grip.

Steven Reidbord MD said...

I really enjoy these Guess the Sponsor posts, although this one was too easy. Picky point: Tegretol is the Novartis brand of carbamazepine, also available generically.

And for a change I disagree (a little) with therapyfirst. Sara correctly notes that bipolar symptoms are sometimes drug reactions. Greta's case could be a straightforward "manic switch" reaction to fluoxetine. The best treatment for that would be to stop the med. However, in the case of Chelsea, it would be hard to account for 1.5 yrs of mania and psychosis by the use of alcohol, cannabis, or valproate... but ongoing recreational drug use (e.g., meth) could do it.

Anonymous said...

With all due respect, therapyfirst, if more clinicians had better expertise, advocates would be unnecessary. :-)

Anonymous said...

Per Steve R'd and Gina P's comments, I have no issue with the role of disruptive meds and healthy advocacy in this matter. Meds can cause problems, and Sara's point of tapering is correct, and, this field needs all the responsible and vocal advocacy it can access. But, that is my concern: Responsible advocacy. There are people out there in this vague, elusive medium that are out to eliminate any consideration for medication.

That needs to be refuted as much as this lame biochemical imbalance model that deems a meds only approach. The biopsychosocial model, folks. Works for me and the patients receptive to a multifaceted approach.

Thanks for the refuting comments. Maybe I read too much into the original comment in the first place. Dissention has a healthy place, I do believe this.

By the way, I would love to read CMEs that talk about psychotherapy and other non-pharmacological interventions in the field. Until psychiatrists reject the limitations forced on us by managed care and other third party payment sources, we have forced these limits on ourselves. To bring it back to this posting, that is a prime focus by Dr Treisman in his columns I noted.

You as patients and advocates want less pharmacology as first line interventions? Go after insurers too! After all, they pay for meds a lot easier before they will pay for therapy.

Steven Reidbord MD said...

TF, now I agree with you completely. :-)

Anonymous said...

TF wrote:
You as patients and advocates want less pharmacology as first line interventions? Go after insurers too! After all, they pay for meds a lot easier before they will pay for therapy.
No, that's not what I would like, personally speaking.

I would like people other than masters-level therapists to serve as mental-health gatekeepers. Moreover, I would like all new mental healthcare professionals to receive solid training in recognizing neurocognitive disorders before they ever leave grad school.

I'm not sure what we can do about the profit motive, in keeping patients who could be helped by psychopharmacology stuck in useless (or worse) talk therapy. That's an inherent danger among clinicians who can't prescribe.

Anonymous said...

I don't understand why what I wrote about 4-5 days ago in response to Ms Pera's above comment was not printed. Her comments demean the basis to mental health care, and I know she has an agenda to push pharmacology for her own gains as much as any alleged patient gain. To allow what she stated was no worse than what I said.

I'll say it again, using Steve R's comment as a frame: Ms Pera, now I disagree with you completely.

Frankly, Dr Carlat, I am disappointed you did not call her on the content as well. Or, by your silence, do you infer agreement with what she says?

I mean, really, her comment about non-master's level people being gatekeepers, and expecting all "new mental healthcare professionals to receive solid training in recognizing neurocognitive disorders.." is exactly why this field is crumbling. Sorry, these are skills that require expertise due to an extensive training, ie psychology PhD or psychiatry MD.

Let's just dumb down the educational requirements so a high school graduate can diagnose. Oh, I forgot, that is what managed care is about these days!

Guess I won't see this comment either. Truth is painful, isn't it.

Dr. Deb said...

Very enlightening.

Side Effects Death said...

Confessions of a Pharma-Insider

John Virapen used to be the executive director of the Swedish branch of Eli Lilly & Company, one of the biggest internationally active pharmaceutical companies. He engaged in the development of aggressive marketing strategies, which included to massive corruption in more than one occasion. He participated in the resolute distribution of drugs, which cause massive and dangerous side effects – like the death of the patient. Or the death of uninvolved bystanders caused by patients under the influence of antipsychotic drugs.

This book tells a true story.

Read the original eBook by John Virapen
you can download the book by John virapen also as ebook in english from that website:

Anonymous said...

If you want to know who to blame for CME issues related to this and other articles on this site, look no further than the characters that own this brand new CME company ostensibly refered to as "asante global" whooo, big name for such a small corupt company....

These guys had the nerve to high tail it when things got hot at their old company and restart the same old tired way of doing business. I suggest we all drop in on one of their patented "cases and commentary" cme promotional events.

Just look at where they are held...that's right Marriott!

By the way, American Psych News is defunct.