Monday, May 18, 2009

Dispatch from the APA Annual Meeting: The "Product Theater"

I'm writing this from the Press Room in the Moscone Convention Center in San Francisco, where the annual meeting of the American Psychiatric Association is being held. On my schedule this morning was a lecture on genetics in psychiatry by Kenneth Kendler, but once I got there a line was snaking its way into the hallway and I was out of luck. So I decided to go to one of Shire's product theaters.

You may recall that recently the APA voted to phase out industry-sponsored symposia (ISS), but they are now allowing companies to hold promotional educational events called product theaters. This one was entitled "Current Perspectives on Diagnostic and Treatment Challenges of ADHD in Adults," and was presented by Robert Lasser, who is Shire's Senior Director of Global Medical Affairs. That's him in the photo.

Overall, he made a fairly balanced pitch for diagnosing more ADHD in adults and for using Vyvanse. He is a psychiatrist, and knew his stuff. It was definitely a soft sell, compared to the experience of being visited by a Shire drug rep.

We heard the usual information (not inaccurate) about 4% of adults having ADHD, about estimates that up to 20% of patients with depression have ADHD. We heard about the ways that ADHD symptoms manifest in adults, like workaholism, possibly due to job inefficiency, frequent changes of life partners, finishing other people's sentences, low frustration tolerance, etc.... Of course, all of these are non-specific symptoms and can be seen in a huge range of other diagnoses and even in people with no psychiatric problems at all, which was something that was not mentioned. On the other hand, would this have been mentioned by a conventional key opinion leader speaking at an ISS? Probably not.

The one thing that bothered me is that, unlike at any of the other symposia, refreshments were served, consisting of a table with coffee, bagels, and muffins. Nothing extravagant, but I can assure you that there was a long line of people feeding themselves, and that this drew people in. It was not as crowded as Kendler's lecture, but then again Kendler is a world famous psychiatrist lecturing on a topic that we hear a lot less about than ADHD.

Thus far, I would say that the product theaters are a success, in that they are transparently promotional and provide a reasonable forum for us to interact at a high level with industry. I'm willing to bet that in New Orleans, they will not be allowed to provide food, because this places them in a privileged position in relation to the other events.

That's all for now--I'll be posting frequently throughout the meeting!


Gina Pera said...

Welcome to San Francisco, Dr. C. I hope you enjoyed some of that warm, sunny weather this weekend.

As for the 4% figure of ADHD in the population, most experts agree that is extremely conservative.

And yes, many of those symptoms do cut across other diagnoses. The trouble is, most people with ADHD are treated exclusively for those other disorders -- sometimes for years -- before ADHD is even considered. And usually not by the prescribing physician but by the patient reading an article, hearing the suggestion from a friend, a partner, etc.

Seems I recall that one of the Shire execs has an ADHD familial connection. That can make one a little more....committed. Knowing for certain that ADHD is real.

Dr. Michael S. said...

Dr. Carlat:

Nice article, but like the "real" drug dealers, pharmaceutical companies will continue to stay one step ahead of the law.

Consider that as other avenues for promoting medications are being closed off, so-called "health web sites" are being flooded with paid ads and press releases, such as, which just posted a Janssen press release, verbatim, about the FDA approval of Risperdal for bipolar, on a page covered with pharmaceutical advertising.


I don't think the issue of bagels or no bagels at APA sessions is going to affect the juggernaut of pharmaceutical marketing. It's just morphing into another insidious form.

Roy M. Poses MD said...

I agree that at least a "product theater" is obvious, not stealth marketing. But why is it necessary to have marketing directly connected with a medical society meeting at all? The association still effectively gives it some sort of official endorsement.

Gina Pera said...

Well, not only did I see no bagels at the APA today (Tuesday), there was nary a pen, a paper pad, or even a peppermint in the exhibit hall. Sort of reminded me of traveling to Soviet Bloc countries in the 1970s.

What I did see, in the program, was a full slate on personality disorders and especially borderline personality disorder. Wow. There seems to be a real obsession.

Only one lecture on ADHD -- pharma-sponsored, it looks like. And from all reports, excellent. Tim Wilens did a great job, as usual. Don't know the other presenters.

Just amazing, though...sitting for hours through all those ppt slides on personality disorders, BPD -- with all the talk of impulsivity, overactive limbic systems, mood lability, etc. and not one utterance of ADHD. It's like the dx whose name we dare not speak. The Voldemort of the APA.

Maybe I'm missing something. But I don't think so.

The Mind Games sessions was amusing, though -- psychiatric "Jeopardy" with three teams competing: University of Texas, Houston, Albert Einstein, and UPenn. (Albert Einstein won).

If you're looking for a quick lunch, check out the indoor farmer's market on the far end of the Metreon, at the corner of Yerba Gardens and the Moscone Center. You can take it outside and eat in the grass. (The French Bakery is the hit of every farmer's market on the Peninsula.)

James M. La Rossa Jr. said...

Well done, Gina. The French Bakery is a civilized respite from this particularly sleepy and odious APA. I left after 24-hours myself — in typically guilt-ridden form — wondering what I had done to contribute to the undoing of our once-robust field. I get this same sinking feeling when (fiction) writers write about writing. Makes me long for a dog and a deck of playing cards. Ahhh, memories.

Gina Pera said...

Awwwww, come on, Roy. You really want the All-Personality Disorder APA conference? This is 2008, after all, and science isn't a dirty word in this White House. :-)

Honestly, that program was really an embarrassment, IMHO. Not only the unimaginative range of topics but the sheer unreadability of the darn thing. No graphic devices to guide the user as to the time slots, etc.. In fact, no empathy at all for the user (hmmm).

I hear that's one of the big changes the incoming APA prez is aiming for: a more readable conference program.

Glad you enjoyed the bakery, James. It was sort of a depressing atmosphere, wasn't it (and mighty white)? And that's so surprising to me because from where I sit, patients who have languished for years have unprecedented reason for hope.

Now if we can just find the resources to pay for skilled clinicians who understand the term "titrate" and know how to implement multi-modal strategies. Heck, even Jim Carrey was on Larry King talking about neurotransmitter precursors (tyrosine, etc.). If people can't reliably learn about these topics from their doctors, they'll turn to what I suspect will soon be Carrey's infomercial.