Friday, May 18, 2012

The Drug Business

In his book Psychiatryland, psychiatrist Phillip Sinaikin recounts reading a scientific article in which it was debated whether a three-year-old girl who ran out into traffic had oppositional-defiant disorder or bipolar disorder, the latter marked by “grandiose delusions” that she was special and cars could not harm her.

How did the once modest medical specialty of child psychiatry become the aggressive “pediatric psychopharmacology” that finds ADHD, pediatric conduct disorder, depression, bipolar disorder, oppositional defiant disorder, mood disorders, obsessive-compulsive disorders, mixed manias, social phobia, anxiety, sleep disorders, borderline disorders, assorted “spectrum” disorders, irritability, aggression, pervasive development disorders, personality disorders, and even schizophrenia under every rock? And how did this branch of psychiatry come to find the answer to the “psychopathologies” in the name of the discipline itself: pediatric psychopharmacology?

Just good marketing. Pediatric psychopharmacology is a billion-dollar business that sustains Big Pharma

New drugs made the pharmaceutical industry only $4.3 billion in 2010 compared with $11.8 billion in 2005—a two-thirds drop. Doctors have a growing fear of prescribing new drugs with unknown side effects, the government is cracking down on illegal marketing and private and government insurers are less willing to cough up money for an expensive new drug—particularly when a cheap and reliable generic is available.

“Children are known to be compliant
[and the elderly SOYMB] patients and that makes them a highly desirable market for drugs,” says former drug company sales rep Gwen Olsen, author of Confessions of an Rx Drug Pusher. “Children are forced by school personnel to take their drugs, they are forced by their parents to take their drugs, and they are forced by their doctors to take their drugs. So, children are the ideal patient-type because they represent refilled prescription compliance and ‘longevity.’ In other words, they will be lifelong patients and repeat customers for Pharma.”

Kids who start out with psychiatric diagnoses are usually shuttled into government programs that will pay for psychiatric drug “cocktails” that can approach $2,000 a month. What private insurer would pay $323 for an atypical antipsychotic like Zyprexa, Geodon, or Risperdal, when a “typical” anti-psychotic costs only about $40?

Not all medical professionals agree with the slapdash cocktails. Panelists at the 2010 American Psychiatric Association (APA) meeting assailed Pharma for drug combinations and called the industry nothing but a “marketing organization.” In a symposium about comparative drug effectiveness, a Canadian doctor castigated the FDA’s Jing Zhang for his agency’s approval of drugs for “competitive reasons” rather than for patient health or effectiveness. Research presented at the 2010 APA meeting also questioned the psychiatric cocktails. When twenty-four patients on combinations of Seroquel, Zyprexa, and other antipsychotics were reduced to only one drug, there was no worsening of symptoms or increased hospitalizations (except in one case), and patients’ waist circumferences and triglycerides improved (a large waist circumference and high levels of triglycerides [fat] in the blood heighten one’s risk of developing diabetes and cardiovascular diseases). The drug cocktails were not working and were making patients worse by creating new medical problems.

When the atypical antipsychotics Zyprexa, Geodon, Risperdal, Abilify, and Seroquel, for use in stabilizing schizophrenia, came into being in the 1990s, no-one knew exactly how they worked, how long they would work, or what the final effects of their wide use would be (as with many withdrawn drugs, FDA gives approval on the basis of information from short-term trials). But they could make a lot of quick money easily compared with old-fashioned products; they had government’s backing, and everyone was doing it!

Yet there were voices of dissent about the atypical revolution if people chose to listen. A National Institute of Mental Health study of children ages eight to nineteen with psychotic symptoms found Risperdal and Zyprexa were no more effective than the older antipsychotic Moban, but it caused such obesity that a safety panel ordered the children off the drugs. In just eight weeks, children gained an average of thirteen pounds on Zyprexa, nine pounds on Risperdal, and less than one pound on Moban. Other studies, like one on Risperdal in the British medical journal Lancet and one on Zyprexa, Seroquel, and Risperdal in Alzheimer’s patients reported in the New England Journal of Medicine, also found that atypicals work no better than placebos. One study in the British Medical Journal found that Seroquel not only did not relieve agitation in Alzheimer’s patients, but that it “was also associated with significantly greater cognitive decline” than placebos. As with Risperdal, the drug made patients worse.

“The problem with these drugs is that we know that they are being used extensively off-label in nursing homes to sedate elderly patients with dementia and other types of disorders,”
testified FDA drug reviewer David Graham, MD, during a congressional hearing. Graham is credited with exposing the dangers of Vioxx and other risky drugs approved by the FDA. “But the fact is, is that it increases mortality perhaps by 100 percent. It doubles mortality,” said Graham. “So I did a back-of-the-envelope calculation on this, and you have probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications...With every pill that gets dispensed in a nursing home, the drug company is laughing all the way to the bank.”

Who produce the medicines we have, who finds the cures, who funds the research to find all these medicines and cures. It is no longer the government or the people who fund or run the research. The researches are so complex and the system made so expensive that it by default falls into the monopoly of pharmaceutical companies that have grown into large corporations that eat money and breathe money. These are not altruistic charitable non-profit organisations for the betterment of human life. It is their investors they serve, looking for the greatest profit from the least possible investment. For profit there has to be a product, and for that product there should be a market. That is the golden rule.

Adapted from here 

1 comment:

Daniel Haszard said...

The atypical antipsychotics (Zyprexa,Risperdal,Seroquel) are like a 'synthetic' Thorazine,only they cost ten times more than the old fashioned typical antipsychotics.

These newer generation drugs still pack their list of side effects like diabetes for the user.All these drugs work as so called 'major tranquilizers'.This can be a contradiction with PTSD suffers as we are hypervigilant and feel uncomfortable with a drug that puts you to sleep and makes you sluggish.

That's why drugs like Zyprexa don't work for PTSD survivors like myself.
-Daniel Haszard FMI