Current Psychiatry Publishes Covert Industry Ad

Current Psychiatry has been publishing a series of deceptive ads that appear to be patriotic calls for freedom of the press, but which in reality are stealth endorsements of industry-funded CME, paid for by drug companies and medical education companies.

I've reproduced the ad to the left here, but you can read it in its full, large-fonted glory here.

"IN THE UNITED STATES," the ad begins, "THE PRESS CANNOT BE CENSORED. THE INTERNET CANNOT BE CENSORED. POLITICAL ADVERTISING CANNOT BE CENSORED." Here's the kicker: "WHY ARE SOME MEMBERS OF CONGRESS AND ACADEMIA TRYING TO CENSOR MEDICAL COMMUNICATIONS?"

(By the way, the sensationalized all-caps style is theirs, not mine.)

Then there are a few paragraphs of gibberish stating that information is important for quality health care (that's true, that's why I went to medical school and keep up on the medical literature) and how "Congress and academia are seeking to restrict the content of CME" and how this somehow amounts to "restrictions on how much information consumers and doctors can know about current and new treatments...."

At the end, in small italicized print, we read: "This message is brought to you as a public service by the Coalition for Healthcare Communication."

To find out who is the "public" benefiting from their "service", surf on over to their website. It is simply a repository of political ammunition for medical education companies who are on their last ditch stand defending their business model, which depends on getting drug companies, rather than our doctors, to pay for CME.

I am hardly the first physician to be outraged by this stealth ad. Michael Herbert, a primary care doctor and blogger, posted this analysis of the ad that is so nicely written it became an "editor's pick" of OpenSalon magazine.

Entitling his article "The Secret Defense of CME," Dr. Herbert concludes his piece thusly:

"Unsurprisingly, this campaign underscores what is wrong with CME funding. You can’t tell where the money is coming from. This makes it difficult to interpret the message, or measure the bias. If Big Pharma and drug marketers can’t defend their CME practices without disguising them in cryptic constitutional arguments, it is hard to see them presenting CME in a way that would allow doctors to clearly evaluate bias.

This is not an ad for freedom of speech. It is an ad for secrecy. And secrecy in a scientific discipline is not a good thing."

Dr. Herbert saw this ad in American Family Physician, and I assume the thing has metastasized throughout the medical literature. I urge readers to write letters to their professional journals in protest of this sneaky screed. I know I will.

Tired of Being Depressed? Shire's Solution: Call it ADHD

Suddenly, a third of my patients with depression have ADHD, according to promotions by Shire. In a coordinated series of journal ads, CME newsletters, and a specially prepared "depressionandadhd.com" website, psychiatrists are being encouraged to further expand the diagnostic territory treatable by Shire's products (which include Adderall XR, Vyvanse, and Daytrana).

While I was aware and increasingly annoyed by this latest promotional gimmick, I thank psychiatrist Paul Natvig for alerting me to a rankly deceptive advertisement in the current issue of Psychiatric News.

"Could it be ADHD?", asks a male model with a 5-day beard and an insouciant pout reminiscent of Tom Cruise in one of his rare blue moments. "ADHD was diagnosed in 1 out of 5 men with depression*" continues the ad, referencing a 1996 study published in an obscure journal, Psychiatric Research (Alpert J et al., 1996;62:213-219). The problem is that if you actually read the paper, you find that only about 1/9 depressed men, or 11%, actually met criteria for current ADHD. In order to arrive at the more alarmist 1/5 figure, Shire included "sub-threshold" ADHD in the total.

And what about the really astounding claim that "32% of adults with a depressive disorder" have ADHD? This is a figure pulled from the National Comorbidity Survey Replication, the controversial study that concluded that half of all Americans eventually develop a psychiatric disorder. This study sent lay interviewers to interview a sample of about 9000 people in the U.S., and they used a checklist to diagnose DSM-IV disorders. But since the interviewers were not clinicians, they were unable to accurately determine the clinical importance of the symptoms reported by the sample. The study tried to correct for this problem by having clinicians interview a subset of the sample, but many believe that the final reported prevalence rates were still vastly inflated.

The fact is that if you are hell-bent on finding "ADHD" in patients with major depression, you can. Patients with depression typically have symptoms such as distractibility, poor focus, and difficulty finishing tasks, all of which intersect precisely with ADHD criteria. Shire is hoping that we will start to put our depressed patients on stimulants. In my practice, this rarely helps. Such patients often develop insomnia and agitation, and sometimes paranoia.

On the plus side, Shire's stockholders develop lucrative portfolios, greater self esteem, and meals out more often. Maybe my depressed patients should just skip the stimulants and contact their brokers to buy some shares.