Blog Archive: Dec. 2002

Blog subjects:

  • Pseudoscience in the mental-health industry

  • Unethical behavior among pharmaceutical companies

  • Whatever else strikes my fancy

Note:  This site has absolutely no association with any outside group, and most especially not with the “Church” of Scientology.


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Blog archives:


Tuesday, December 31, 2002

Ex-Supremes singer Diana Ross was apparently arrested in Arizona for “extreme DUI”.  Her blood-alcohol level was 0.20, approximately equivalent to consuming ten drinks in one hour.  Back in May of this year, Ross had undergone treatment at the Promises rehabilitation center in Malibu, California.  I really can't understand why we don't just drop the pretense and admit that rehab doesn't work.  The effectiveness of treatment won't improve until we admit that there is a problem.


A recent study showed that cheap, generic diuretics are probably better at treating high blood pressure than are expensive, branded drugs (I discussed this on Dec. 19th and 20th).  I'm reminded of the case of sepsis treatments, as reported in the Wall Street Journal about seven months ago.  The article isn't new, but it's well worth reading.


Sunday, December 29, 2002

I'm going to be busier than usual for the next two or three months.  I've accepted a temporary job at the local Humane Society.  Blog entries might be shorter and more sporadic.  Sorry.


I'm not quite sure what to make of this article about smoking and mental illness, but it does present some interesting data.


Saturday, December 28, 2002

As if there isn't enough trouble associated with the pharmaceutical industry, now we have the growing problem of counterfeit drugs.


The Daily Yomiuri (Japan) has additional information about deaths associated with AstraZeneca's anti-cancer drug Iressa.  Apparently, AstraZeneca hasn't been conducting post-marketing studies on the drug.


Friday, December 27, 2002

The empire strikes back:

Drug Makers Battle Plan to Curb Rewards for Doctors

WASHINGTON, Dec. 25 — Drug companies and doctors are fighting a Bush administration plan to restrict gifts and other rewards that pharmaceutical manufacturers give doctors and insurers to encourage the prescribing of particular drugs.

In October, the Department of Health and Human Services said many gifts and gratuities were suspect because they looked like illegal kickbacks.  Since then, a few consumer groups, including AARP, have voiced support for the restrictions.  But they are outnumbered by the drug makers, doctors and health maintenance organizations that have flooded the government with letters criticizing the proposal.

In contending that the proposed federal code of conduct would require radical changes, those opposing the change discuss their tactics with unusual candor and describe marketing practices that have long been shrouded in secrecy.

Drug makers acknowledged, for example, that they routinely made payments to insurance plans to increase the use of their products, to expand their market share, to be added to lists of recommended drugs or to reward doctors and pharmacists for switching patients from one brand of drug to another.

This is quite an amazing article.


Speaking of pharmaceutical marketing, see this excellent spoof, written in the style of Green Eggs and Ham, by Dr. Seuss.  (Via Medical Rants.)


Have a prescription for a generic drug?  Better hurry-up and get it filled:

As Patents on Popular Drugs End, Costs for Generics Surge

Prices of generic drugs are rising almost twice as rapidly as prices of brand-name drugs, even as many insurers and the Bush administration are pressing Americans to switch in the name of saving money.

The trend is expected to continue over the next few years as a number of enormously popular brand-name drugs lose their patent protection and drug makers introduce generic versions at high initial prices.


The anti-cancer drug Iressa (made by AstraZeneca) was approved remarkably quickly in Japan.  Maybe they shouldn't have been so hasty:

EDITORIAL: New drug's side effects

Iressa-linked deaths show cancer-treatment risk.

Side effects of the anticancer drug Gefitinib, marketed in Japan as Iressa as a treatment for lung cancer, have been apparently linked to 124 deaths since use of the drug was approved in July, according to a review panel report to the Ministry of Health, Labor and Welfare.

The findings were shocking, since the early reports on the drug had been quite promising.  Physicians were reporting only minimal side effects.


Gee, what a surprise – another herbal remedy bites the dust:

Mushroom Extract Won't Fight Prostate Cancer: Study

NEW YORK (Reuters Health) - Though touted as cancer fighters, supplements containing shiitake mushroom extract are no prostate cancer cure, researchers report.

Out of 61 patients who took the supplements for up to 6 months, none experienced significant improvements, according to findings published in a recent issue of Urology.

“This (supplement) does not appear to work,” said study author Dr. Ralph W. deVere White, director of the cancer center at the University of California-Davis.  He said he became interested in the supplement after hearing encouraging anecdotal reports from Japan, where it is commonly used for cancers, including prostate cancer, and a variety of other ills.

“The reports just seemed so staggering and it was natural, so how could you not test it?” deVere White told Reuters Health.

(See also this article from March, 2002.)


Blog-reader Fred sends along two links to articles about Ritalin (generic: methylphenidate):


Thursday, December 26, 2002

More bad news for Big Pharma.  A recent study in the New England Journal of Medicine provides additional evidence that cox-2 inhibitors (the expensive, prescription drugs Celebrex, Vioxx, and Bextra) are no better than much cheaper, older, over-the-counter medications:

Celebrex's safety called into question

The blockbuster arthritis drug Celebrex doesn't protect the stomach from dangerous bleeding ulcers as well as thought, a study suggests.

Celebrex and two similar new anti-inflammatory drugs are heavily advertised as being safer for arthritis patients based on earlier research that found they caused fewer ulcers and other gastrointestinal complications than older anti-inflammatory medicines.  Together, the three new drugs have annual sales exceeding $6 billion.

But their safety has been called into question recently.  The new study, which focused on arthritis patients at high risk of recurrent ulcers, escalates the controversy involving Celebrex, showing nearly 10% each year would develop another bleeding ulcer.

It will be interesting to see how Pharmacia, Pfizer, and Merck are going to try spinning these results.


And speaking of Pharmacia and Pfizer:

Group sues Pharmacia, Pfizer

Says drug promoted for unapproved use

LOS ANGELES - Pharmacia Corp. and Pfizer Inc. have been sued by a consumer group that says the drug makers are promoting Pharmacia's arthritis painkiller Bextra for a use not approved by the US Food and Drug Administration.

Pharmacia makes Bextra, which it markets with Pfizer.  The Congress of California Seniors filed the lawsuit Monday in Los Angeles Superior Court, accusing Pharmacia of using research to promote Bextra for acute pain.  The plaintiffs asked that Pharmacia be ordered not to market the drug for unapproved uses and to forfeit any profit from such actions.


The South Jersey Courier Post reports:

Pharmaceutical advertisements should be taken with a grain of salt

Even if you don't know what they do, you probably know their names: Paxil, Xenical, Celebrex. You may even be able to hum their jingles and recognize their happy-and-healthy spokesmodels.

But what you might not know are all the facts.

A report issued earlier this month by the General Accounting Office found some pharmaceutical companies use misleading advertisements to sell the medicines they make.


The BBC reports that Goldshield, a generic drug manufacturer, is being sued for price-fixing.


My undergraduate alma mater is the State University of New York at Binghamton, which now calls itself “Binghamton University” (I guess they think the new name sounds more distinguished).  Anyway, it's not often that the school gets mentioned in the New York Times Science Section, but there you are:  “The Origin of Religions, From a Distinctly Darwinian View”.


Wired News suggests, “Before flushing that expired bottle of antidepressants down the toilet, consider whether trout really need a serotonin boost.”


Wednesday, December 25, 2002

The Dec. 16th issue of the New Republic has a truly outstanding article about the pharmaceutical industry.  The article is called, “America's Other Drug Problem”, and it's co-authored by two former editors-in-chief of the New England Journal of Medicine.  Unfortunately, the article isn't available on-line.  If your local library subscribes to this journal (the library here does), then it's worth checking out.  As soon as the full text appears on Infotrac, I'll create a local copy here on this website.


A physician named Paul B. Rizzoli, M.D. wrote a letter to the editor of the Boston Globe.  (Dr. Rizzoli was responding to this article, that I had discussed earlier this month.)  He defends the pharmaceutical industry and its marketing practices (some of them, anyway):

New medications are new tools; who better to hear from than the maker? [...]

Does the public really think that physicians are so stupid as to be bought by a dinner, prescribe based on our stomachs or wallets, or controlled by a sales pitch?  Does it make sense that we would put into jeopardy our licenses, years of postgraduate education, residency, and specialty training, and years of patient care and established relationships, all for a dinner or a consultant fee?

Dr. Rizzoli is a bit naïve.  Pretty much all doctors think that they are immune to any possible harmful effects of pharmaceutical marketing.  Maybe he should read this article that appeared in the Wall Street Journal a few weeks ago.


Have you ever wondered about the alleged ability of dogs to locate illegal drugs, to track prison escapees, and to find hidden explosives?  I have.  I've long been suspicious about some of the claims made about the olfactory prowess of such dogs.  Now the New York Times provides some data to support the skepticism:

With Dog Detectives, Mistakes Can Happen

MIAMI, Dec. 23 – When bomb-sniffing dogs indicated the presence of explosives last summer in the cars of three medical students bound for Miami, the authorities detained the men and closed a major thoroughfare across South Florida. No trace of explosives was found in their cars.

Now, a number of scientists and trainers are expressing concern that such mistakes could become more common as thousands of new canine detectives are deployed across the country.

Experts on explosives detection say that when dogs' handlers are excited and stressed, the dogs may overreact and falsely suggest that explosives are present when they are not. [...]

“Dogs want rewards,” [said Dr. Lawrence J. Myers, an expert on dog olfaction at the Auburn University College of Veterinary Medicine], “and so they will give false alerts to get them.  Dogs lie.  We know they do.” [...]

Other factors can also hurt a dog's performance, Dr. Myers said.  He estimates that in any year, 35 percent of detection dogs temporarily lose their sense of smell because of illness, tooth decay or other physical problems.

Weather also affects performance.  Dry, hot weather can cause the mucus in the dog's nose to dry out.  Hot, humid weather brings early fatigue. Extreme cold kills scents, and the wind scatters them.

Creatures of habit, dogs also can become stuck in their ways.  For example, a dog might become fixated on a particular object or smell, Dr. Myers said, citing a police dog in Alabama that began alerting its handlers to Ziploc bags because the police stored drug training samples in them.

(Added emphasis was mine.)


Thanks go out to Fred, a blog reader who sent me some links to articles about Ritalin (methylphenidate), and about other topics.  I haven't really researched the question of whether Ritalin works, and whether it's harmful, so I'll just reproduce Fred's links here, and let others judge:

Fred also recommended an excellent book called, From Placebo to Panacea:  Putting Psychiatric Drugs to the Test.  I know this book.  It's good, but the dense style makes for difficult reading.  Also, much good research has been done since the book was first published in 1997.  Still, the book is definitely worth checking out.  When I read it, I had to request it through inter-library loan.  It's not the sort of book that most public libraries stock.


Authorities in Britain have banned the sale of the herb, kava-kava.  Apparently, you can die from it.  I know that sometimes my criticism of the pharmaceutical industry leads people to assume that I'm in favor of herbal medicine.  This is not the case.  I'm deeply skeptical of all forms of so-called, “alternative medicine”.  Traditional societies were wrong about almost all their theories with respect to matters scientific – why should we expect traditional remedies to work, then?  Of course, we need to keep an open mind, but I won't trust an alternative treatment until it's been proven safe and effective via rigorously designed, double-blind studies (in which case it wouldn't be considered “alternative” anymore, I suppose).  Incidentally, the New Republic ran an excellent article on this subject some time ago.  The article is about four years old, but still definitely worth reading.


Two items about the U.S. Food and Drug Administration (FDA):


Tuesday, December 24, 2002

The Boston Globe continues its excellent coverage of the pharmaceutical industry.  A recent article exposes the increasingly cozy relationship between the U.S. Food and Drug Administration (FDA) and the industry that it is supposed to regulate.  There's also some information there about antidepressants, withdrawal symptoms, and suicide risk.  No excerpt here, so you'll just have to take my word for it – it's a good article.


Sunday, December 22, 2002

I'd like to step away from my usual blog subjects to talk a bit about Wall Street and the stock market.  The New York Times reports on the fall of one-time über-analyst Jack Grubman.  Mr. Grubman specialized in the communications industry, and his pronouncements could move stock prices.  Unfortunately, evidence suggests that his opinions were, shall we say, less than scrupulously honest.  Many investors lost considerable amounts of money by following Grubman's recommendations:

Customers of Salomon Smith Barney who heeded Mr. Grubman's bullish advice on WorldCom stock had mixed reactions to the news that he was close to settling with regulators.  Henry Hochman, 88, a resident of Boynton Beach, Fla., said he lost almost $10.7 million in WorldCom stock that he held and that he had pledged and guaranteed to a charity.

Mr. Hochman said that his son had advised him to sell some of his WorldCom shares before they declined, but he held on because Mr. Grubman advised it.

Asked how he felt about a pending settlement by Mr. Grubman, Mr. Hochman said: “I'm broke.  I have to start saving pennies now.  I can't live the way I was accustomed to living.  It has affected my health.  Smith Barney told me this was the best of the telecom companies.  Whatever Grubman wrote sounded very good.”

Quite frankly, Mr. Hochman (and other investors like him) are fools, but not exactly for the reason you might expect.  There's a general feeling that if only those rascally stock analysts weren't corrupt, then we could trust their advice.  Wrong, wrong, wrong.

We shouldn't trust stock recommendations under any circumstances (with one possible exception, described further down).  Economists, finance professors, and other academic researchers have proven that stock prices are fundamentally unpredictable.  This theory is called the “efficient markets hypothesis”, or simply, “market efficiency”.  There's a great deal of evidence in favor of this view of securities pricing, but somehow the man in the street hasn't gotten the message.  (Maybe that's because it's not in Wall Street's interest to spread the word.)

Discussing the specifics of market efficiency is beyond the scope of a single blog entry.  Probably the best source of information on this topic is a book called, A Random Walk Down Wall Street, by Princeton economist Burton Gordon Malkiel.  I've included an excerpt of the book here.  The excerpt is a section titled, “Are securities analysts fundamentally clairvoyant?”.  Perhaps the Mr. Hochmans of the world should have read, A Random Walk before investing a single penny.

The efficient markets hypothesis does have one possible exception to the unpredictability rule.  Ironically, a corrupt analyst may be able to predict stock movements.  If someone has inside information – data that is not available to the general investing public – then such a person may be able to predict changes in the stock price.  Say, for example, that you know (through whatever means) that the Justice Department is about to bring charges against the chief financial officer of Acme, Incorporated.  If this knowledge is not (yet) available to investors, then Acme's stock price hasn't reacted to the news.  It's a reasonable bet that the stock price will plunge as soon as the information becomes public.  You could, potentially, make a killing on Acme stock by short-selling it, or buying put options.  (Of course, this would be illegal, though.)


And speaking about corruption, the New York Times reports on the continuing saga of the Neurontin scandal:

Top executives at Warner-Lambert, a large drug company that has since been acquired by Pfizer, approved a detailed plan by subordinates to market Neurontin, an epilepsy medicine, for unapproved uses, according to internal company memorandums unsealed yesterday in a whistle-blower case.

Under federal law, doctors can prescribe drugs in whatever way they believe is best for their patients.  But it is illegal for pharmaceutical companies to market their products for uses that have not been approved by the Food and Drug Administration.  [...]

The company also hired advertising agencies to help write the medical journal articles, according to documents.

The company hired doctors to speak to their peers about Neurontin;  the doctors were expected to present positive messages about the drug and were paid fees of $500 to $2,000 a speech, according to memorandums and invoices from advertising agencies that organized the events. [...]

The United States attorney's office in Boston is conducting criminal and civil inquiries into Warner-Lambert's marketing of Neurontin.  In addition, 47 states are jointly pursuing their own criminal and civil investigations of the matter.


Saturday, December 21, 2002

The Wall Street Journal recently ran an excellent article about how pharmaceutical marketing influences physicians.  Doctors usually consider themselves sophisticated, intelligent people (with some justification, perhaps), but their arrogance can paradoxically lead to astounding naïveté:

Doctors Aren't Immune To Pitches by Drug Firms

Wall Street Journal - SCOTT HENSLEY

Doctors underestimate their susceptibility to the sales pitches and perks offered by drug companies, and that isn't good for patients.

The latest twist in the continuing debate focuses on promotion posing as continuing medical education.  Most physicians say they can separate selling from science.  Marketing, they believe, is a black art that sways only lesser mortals.

Yet a growing body of academic research shows that doctors are vulnerable to drug-company influence.  Add the increasing volume and sophistication of industry promotion to that predisposition, and the result should have patients wondering whether a ghost writer is at work behind their doctor's prescription pad.


Friday, December 20, 2002

Another day, another good article about the recent hypertension brouhaha.  The Globe and Mail, a Canadian newspaper, writes:

Who will take on the pushers?

“I think the drug companies will continue to persuade doctors to give us the $2 drug [instead of the 10-cent diuretic],” says Marcia Angell.  “They'll give them lots of free samples and lots of gifts and goodies.”

Dr. Angell, who is former editor-in-chief of The New England Journal of Medicine, is a leading critic of the unholy alliance between the drug industry and the medical profession.  The industry's first and foremost aim is not to sell the most effective treatments, but to market high-profit branded medications.  And that has produced plenty of bad medicine along with the good.

“What this study underscores is the necessity of comparing new drugs with old drugs,” says Dr. Angell.  “But the Food and Drug Administration allows the drug companies to get away with comparing their new drugs with placebos.”

Unlike most clinical trials, this one was funded largely by the National Institutes of Health, an independent U.S. government body.  Independent research on this scale is rare because of the high costs.  But independent research also tackles issues the industry never will.  Drug companies have nothing to gain by finding out that their expensive pills can be replaced by cheap generics.

Marcia Angell rocks.


Australian researchers have proven that there is no such thing as the curse of Tutankhamen.  Well, that is a relief.


Some music connoisseurs claim that audio equipment made from old-fashioned vacuum tubes sounds better than more-modern amplifiers that are made with solid-state components.  I think these people are nuts.  I doubt that any of them could tell the difference in blind listening tests.  Reminds me of those pretentious wine snobs who can't even reliably tell the difference between red wine and white wine.  What a bunch of clowns.  You always kind of suspected that those people were frauds, didn't you?


The latest disease of the month:  “hurried woman syndrome”.


Thursday, December 19, 2002

Thanks go out to Medical Rants for linking to my blog.  There's some good stuff there, such as an interesting discussion of the recent ALLHAT hypertension study – an analysis that goes beyond what was reported in the popular media.  The author has credibility, since he's an honest-to-God physician.


I've been really busy all day.  Didn't have much time to scan the news feeds.  Noticed this Reuters article, though.  Looks like 2002 wasn't exactly a banner year for Big Pharma:

New drug approvals slump as R&D labs hit buffers

LONDON, Dec 18 (Reuters) - The global pharmaceutical industry has had a dismal year, with new drug approvals at the lowest level in over a decade and no sign of productivity picking up in 2003.

Despite record research and development investment, so far in 2002 a mere 15 novel drugs have been approved by the U.S. Food and Drug Administration (FDA), the main gatekeeper to the $400 billion-a-year medicines market.

Even if a few more get under the wire this month, 2002 is unlikely to match last year's already poor total of 24.  In 1996, by contrast, a bumper 53 new drugs got a green light.

And there is little hope the drought will end anytime soon...


Finally, I just re-read this excellent article by British psychiatrist Joanna Moncrieff.  The article is based on a talk that Dr. Moncrieff delivered at a Critical Psychiatry Network conference in April of this year.  The author presents a concise, skeptical look at the history of psychotropic medications.  Here's an excerpt:

I started looking at anti-depressant research, because I felt intuitively and logically that the idea that a drug can cure depression is a very strange one.  There are thousands and thousands of trials of anti-depressant drugs, so it is very difficult for any one person to have a real over-view and a very thorough knowledge of all this research.  However, it seems to me, and there are quite a few other people saying this in the scientific literature at the moment, that there are various problems with anti-depressant trials, which probably mean that the effects of anti-depressants have been over-estimated...


Wednesday, December 18, 2002

Wow, a major piece of bad news for Big Pharma.  A large, well-designed study has revealed that older, cheaper, generic drugs are actually better at treating hypertension (high blood pressure) than are the newer, more-expensive, branded drugs.  This is a very important result, and is sure to cause tremendous consternation among the big players in the pharmaceutical industry.  I can almost hear the product managers weeping and gnashing their teeth as I write.  Heh.

Business Week magazine actually has a good article about this study.  Excerpts follow (but the whole article is worth reading):

For Hypertension, Cheaper May Be Better

A study says low-cost diuretics are safer and more effective than newer drugs.  Will science be heard above Big Pharma's marketing blitz?

A huge, long-awaited federal study of patients suffering from hypertension proved what many experts have long suggested – that inexpensive diuretics are much better than far more popular, and costly, medicines for lowering blood pressure and preventing heart disease.  The $120 million study, reported in the Dec. 18 issue of the Journal of the American Medical Association, followed 42,418 patients aged 55 and older for eight years. It's by far the largest and longest head-to-head study comparing different hypertension drugs.

The results, if acted on, could make a big difference in the nation's health bill. [...]

Advocates, however, will be fighting a battle against well-heeled drug companies that make a lot more money from brand-name ACE inhibitors and calcium-channel blockers than generic diuretics.  A 1998 study by researchers from Massachusetts General Hospital in Boston found that calcium-channel blockers were the most heavily advertised of any drug in the New England Journal of Medicine, while it was difficult to find a single ad for diuretics.

SPREADING THE WORD.  The study's investigators say they're now determined to get the message out that diuretics should be the first line of treatment against hypertension.

Let's hope that the medical community responds to the new information, and doesn't succumb to the counter-offensive that is sure to follow from Merck, Pfizer, etc.  You just know that they're not going to take this lying down.  It will be very interesting to see how this all plays out over the next year or so.


After I finished writing the blog entry above, I noticed that the New York Times has two very good articles on this subject (i.e., the hypertension study).


Great – that's all we need – a new way for marketers to get inside our brains.


More evidence that herbal remedies are over-rated, at best.  I'm not surprised that echinacea doesn't work.  What surprises me are people who think that ancient “wisdom” is a reliable source of information on health matters.  I'm not opposed to conducting rigorous clinical trials on topics of alternative medicine – after all, we need to keep an open mind – but I wouldn't expect much.  Let's face it:  the ancients were wrong about almost everything else – why would we expect them to somehow have intuited profound knowledge of diseases?


The New York Times has an interesting essay on harmful drug interactions.


Tuesday, December 17, 2002

Louis Peters is a brave man and my hero for today:

Driver opts for jail over 'faith-based' treatment

ACLU takes on case against sentencing

Louis Peters was given a choice.  Attend AA meetings or spend 30 days in jail for a drunken driving conviction.

Mr. Peters chose jail.

His reason?  Mr. Peters said he is agnostic and Alcoholics Anonymous urges people to give themselves over to a higher power.

He objected to the religious tone of the meetings – so much so that he has filed a lawsuit in U.S. District Court in Toledo that contends the Perrysburg judge who sent him to jail violated his constitutional rights by trying to force him into a faith-based treatment program.

The American Civil Liberties Union Foundation of Ohio, Inc., argues on Mr. Peters' behalf that the judge's sentence amounted to a violation of the First Amendment's prohibition against government establishment of religion.  Many people commonly refer to this as the separation of church and state.

“We consistently see holdings that the 12-step [Alcoholics Anonymous] program is fundamentally religious,” said Raymond Vasvari, legal director for the ACLU's Cleveland office, who spoke for Mr. Peters.  “To compel someone to choose between jail and saying he believes in a higher power is a violation of the Establishment Clause [of the First Amendment].”

A.A. and its various spin-offs are clearly religious organizations.  What other conclusion could one possibly draw after reading AA's third step?  “[We] [m]ade a decision to turn our will and our lives over to the care of God as we understood him”.

I certainly wouldn't prevent anyone from attending 12-step groups of their own free will, but people should know that A.A. and N.A. have a very low success rate (contrary to popular belief).  Also, lots of unwilling people get coerced into attending these groups.  Sadly, there are not enough Louis Peterses in this world.

Incidentally, psychologist (and lawyer) Stanton Peele has written a whole book on how to avoid being forced into attending religious support groups.  The book is called, Resisting 12-Step Coercion.


The New York Times has a good article about celebrities who become spokespersons for specific diseases.  Of course, as you would expect, pharmaceutical companies are usually the driving force here:

In America, there is scarcely any disorder, no matter how lowly, that has not had its image enhanced thanks to a celebrity spokesman.  Anemia and its cures have been championed by Danny Glover, rheumatoid arthritis by Kathleen Turner and bladder control by Debbie Reynolds.  Rare syndromes have found spokesmen in Ben Affleck (ataxia-telangiectasia) and Rob Lowe (febrile neutropenia).

The public does not always understand that many of these celebrity champions are paid players in the marketing strategies of pharmaceutical companies, who pull the strings to make them dance before the public and news media. [...]

“We have handed it off to the M.B.A.'s, who in positioning competing companies say, `Hey I remember that marketing class I took at Wharton;  I bet we can get a leg up with a celebrity,' ” Dr. Caplan said. [...]

Mr. Greenberg maintained that any celebrity, no matter how famous, is available to endorse a drug for almost any disease, no matter how unpleasant, for a price.  “The joke around here is, `If someone is willing to pay off the debt of the Vatican Bank, I can get the pope to do a commercial for them,' ” he said.


Monday, December 16, 2002

The Boston Globe has been doing an outstanding job lately of covering the pharmaceutical industry.  The Globe's latest muckraking article is called, “Drug firms and doctors:  the offers pour in”.  Here's an excerpt:

With investigations into the [pharmaceutical] industry's sales tactics growing, and a new voluntary code of conduct in place that stresses educating rather than entertaining doctors, Dr. Fierman, Dr. Ann Potter, and Dr. Gregory Harris – like many of their colleagues throughout the medical profession – said sales representatives now rarely offer the most lavish gifts that were routine in past years:  theater tickets, golf trips, and resort weekends.

Instead, drug makers are paying for or offering more consulting opportunities, even for one evening, continuing medical education courses, and dinners billed as educational events with specialist speakers.  At the Globe's request, the three doctors kept track of pharmaceutical-related invitations and offers they received over a five-month period.  The material was enough to overflow a 1-foot-square, 2-foot-high box.


Bernard Sorrentino apparently kllled his wife, then tried to use a “Prozac defense” in his trial.  The tactic failed, and he was convicted of murder.  Good.  Far be it from me to defend antidepressants, but I'm usually very suspicious of criminal defendants who say, “it's not my fault – the SSRI made me do it.”  On the other hand, the Wyoming case should give one pause.


The consulting arm of IBM is very bullish on the long-term prospects of the pharmaceutical industry.  Maybe.  I'm all in favor of having companies develop effective, safe, life-saving medications.  But I'm not as optimistic as the IBM people.  For a different perspective, see this article from the New Republic (yeah, this is a repeat post – I originally referenced this article about six weeks ago.)


Saturday, December 14, 2002

The Miami Herald has an article called, “Is Madison Avenue our new M.D.?”.  The article expresses some skepticism about the claims made by advertisements for antidepressants.  I'm always glad to see the media questioning the tactics of Big Pharma, but the article doesn't go nearly far enough.  The journalists seem to adopt the easy way out – waffling, hedging, and taking the middle of the road.  Still, I suppose it's better than the era of about ten to twelve years ago, when photos of Prozac capsules used to appear on magazine covers, and journalists would routinely write gushing endorsements.


USA Today has an article about the interesting, new field of positive psychology.  The article is a bit superficial, though.  For a more-comprehensive treatment, see the book, Authentic Happiness, by psychologist Martin E. P. Seligman, of the University of Pennsylvania.


Three fired workers are suing the Eli Lilly company over the aftermath of the unsolicited-Prozac-in-the-mail scandal.


Pharmaceutical company Bristol-Myers has apparently been cooking the books pretty badly.


Thursday, December 12, 2002

The New York Times reports, “The largest pharmaceutical companies have increased their promotional spending so much in the last four years that each dollar spent on marketing no longer brings in the profits it once did, according to a new report by Datamonitor, a market analysis firm.”


Apparently, the FDA is going to start cracking-down harder on deceptive pharmaceutical advertising.


Wednesday, December 11, 2002

Just a quick one today.  The Psychiatric Times (of all places) has a good article about how antidepressants are essentially glorified placebos.


Tuesday, December 10, 2002

Blog updates are going to be a bit sporadic for a while.  I have a lot of other commitments at the moment.  For news related to the pharmaceutical industry, your best bet is the Pharma Watch blog.  I don't know of any blogs related to problems with the mental-health industry.  If anyone knows of one, drop me a line at alexc@aya.yale.edu.


The antidepressant Effexor (generic: venlafaxine) is apparently more toxic than had previously been recognized.


Now here's something you don't see every day:  an article suggesting that people who drink too much can moderate their intake of alcohol, without having to turn their will and their life over to the care of God (AA's third step):

Can drinking be done responsibly?

[...]

Another man opened his talk to the group [Moderation Management, or MM]:  “I am not an alcoholic.  I don't like the word alcoholic, and I'm not going to put that label on myself.  The mantra of Alcoholics Anonymous is 'I am powerless,' and I am not going to get up and say, 'I have no power or control over my life.' ”

Like AA, members of MM, founded nine years ago by Audrey Kishline of Washington state, remain anonymous.  But the two groups are different.

“The goal of AA is to abstain from alcohol,” said Frederick Rotgers of Metuchen, clinical psychologist and chairman of the national Moderation Management Network.  “The goal of Moderation Management is to get healthier, not necessarily to stop drinking.  MM's philosophy is to find what works for you.  In our view, abstinence is the end point of a continuum of healthy relationships to alcohol.”

[...]

30 percent of those who seek help in MM use the group as a gateway to abstinence, some by joining AA, others on their own.  That's fine with MM, which is supportive of abstinence for those it serves – people with alcohol abuse – if abstinence is what works.

“Some people conclude moderation is too complicated, too hard,” Rotgers said.  “To moderate you have to plan.  You have to identify situations where you have to be particularly attentive.  We have tips on how people can count their drinks, for instance.” [...]

“There isn't a formula [for treating problem drinking],” Rotgers said.  “Let's assume what we're dealing with is a disease, which is another myth we propagate in this country.  There is no other disease where we insist the patients be treated with a single approach.  Look at hypertension.  How many different medications are there?  How many different ways are people with high blood pressure offered to help deal with that problem?”


Sunday, December 8, 2002

In a stunning new development, the psychiatric establishment has apparently discovered that patients respond better when they are allowed to provide input about their own treatment.  This news was reported in a recent issue of the British Medical Journal.  I've reproduced the whole article below:

People with schizophrenia must have a say in their treatment

People with schizophrenia in England and Wales should be involved in all decisions on their care and should be offered psychological as well as drug treatment.  These are two of the recommendations in guidelines published by the National Institute for Clinical Excellence (NICE) this week.

The guidelines outline what was judged to be best practice for health professionals caring for individuals with schizophrenia, after review of available evidence by a group of health professionals and people with schizophrenia.

The first recommendation – “health professionals should work in partnership with service users and carers, offering help, treatment and care in an atmosphere of hope and optimism” – emphasises the need for shared decision making and informed consent in all aspects of schizophrenia care.

The chairman of the guidelines committee, Tim Kendall, who is also joint director of the National Collaborative Centre for Mental Health and medical director of community health, Sheffield, commented:  “The very collaborative process used in developing the guideline has resulted in a strong recommendation for the humanity we need to bring to the care of people with schizophrenia.”

The guidelines recognise that the nature of schizophrenia can make it difficult for people to make informed decisions about their treatment, but they advise health professionals to make all efforts necessary to ensure that a service user can give meaningful and properly informed consent before treatment is started.  The guidelines recommend that any medicine used in treatment should be chosen jointly by the person with schizophrenia and the clinician.

The guidelines recommend greater use of psychological treatments and more appropriate use of drugs for schizophrenia.  Oral atypical antipsychotic drugs, at the lower end of the standard dose range, should be considered in the choice of first line treatments for individuals with newly diagnosed schizophrenia.

The use of moderate doses of antipsychotic medicines was recommended, with the aim of avoiding the use of high doses and loading doses that are sometimes used at the moment.  People with schizophrenia should take only one antipsychotic drug at a time, except in rare cases.  Dr Kendall pointed out that nearly half of people being treated with neuroleptics are currently taking more than one drug.  There is no evidence that this is beneficial for most people, he warned.

Psychological treatments – particularly cognitive behaviour therapy and family interventions – were recommended as an indispensable part of the treatment for people with schizophrenia and their families.  The guidelines recommend that anyone with psychotic symptoms should be offered at least 10 sessions of cognitive behaviour therapy.

My reaction to this is:  well, duh.  Of course people respond better when they have some say over their fate.  Researchers S. Priebe and T. Gruyters came to the same conclusion in a paper published in 1999, as summarized below:

Here's a novel idea... Tailoring treatment to the Client's wishes

Researcher Stephan Priebe has a radical idea when it comes to the treatment of folks diagnosed as schizophrenic:  solicit the client's ideas and then conduct treatment according to those ideas.  In this pilot study of clients described as “resistant to treatment,” following the client's recommendations led to significant changes in client's self-rating and assessment of treatment.  Moreover, in contrast to what was expected, the clients wishes were, “surprisingly modest” including such things as changing medications, altering their participation in various treatment offerings, or arranging a special meal.  Hmm.  Amazing that an article like this needs to be written.  The fact that such a simple point needs to be said points out what the profession really thinks of the people who get the diagnosis.

Author Robert Whitaker wrote a whole book about how psychiatry tends to dehumanize – and sometimes even brutalize – patients.  The book is called, Mad in America, and is an excellent overview of what's wrong with the psychiatric establishment.  Incidentally, maybe the addiction-treatment industry should realize that its own coercive practices need to be reformed.

Getting back to the original British Medical Journal article I reproduced above, I'm also glad that antipsychotic drugs are being de-emphasized, though I wish the guidelines had gone further.  Antipsychotic drugs are not nearly as effective as commonly believed, and may end up doing more harm than good (e.g., by causing tardive dyskinesia and by making full recovery less likely).

For another good article about non-drug-based approaches to treating schizophrenia, see:  “New hope for people with schizophrenia”, from a journal called, Monitor on Psychology.


So, apparently the whole Bigfoot thing was a hoax from the get-go.  True believers, of course, remain unfazed.


Essayist Barbara Ehrenreich has written a humorous anti-carbohydrate rant in the Progressive.  (If you haven't read Gary Taubes's article “What if it's all been a big, fat lie?”, then you might want to read it first.)  I hope that Ehrenreich had her tongue in her cheek when she wrote the political parts of the article.


Saturday, December 7, 2002

In an unusual display of candor, Forbes magazine has a web-based slide show entitled, “Celebrity Drug Pushers”.


Medication errors are a serious problem.  Incidentally, if doctors are so smart, then why can't they have enough self-discipline to improve their handwriting?  As the article shows, bad handwriting kills people.


The BBC has a report on a different study of deaths from prescription drugs.  This article focuses on deaths of children.


Friday, December 6, 2002

More trouble for GlaxoSmithKline's antidepressant Seroxat (called Paxil in the U.S.):

60 MPS BACK CALL FOR SEROXAT REVIEW

Gloucester mp [Member of Parliament] Parmjit Dhanda has demanded a Government rethink on the controversial drug Seroxat - and this time he has the backing of 60 other MPs.

He has tabled a Parliamentary Early Day Motion (EDM) calling, for the second time, on the Department of Health to look at both the labelling and availability of the anti-depressant.

The World Health Organisation puts Seroxat at the top of its league table of drugs which cause major withdrawal problems.

More than 1,000 users in Britain are taking legal action against manufacturers Glaxo SmithKline (GSK) claiming they have become addicted to it.


Have you heard about the cruise-ship epidemics?  Apparently, we're up to number four now.  I'm starting to wonder whether this might be largely psychogenic, like clusters of rashes among schoolchildren.


Vaccine development is apparently out-pacing drug development.


A woman named Eliza Johnston is on a crusade to convince people that bipolar disorder (manic depression) can be cured through a change in diet.  Ms. Johnston apparently found that her psychiatric troubles went away after she stopped eating sugar, wheat, and dairy.  Sounds unlikely to me.  There are at least two other plausible reasons why she felt better.  At the same time that she changed her eating habits, she also stopped taking her psychiatric medications – drugs that she herself realized could have been doing more harm than good.  Furthermore, as the article noted, “The actual act of doing rather than being the passive recipient of treatments such as taking medication, is very appealing to people and important for improved mental health.”  (emphasis added)


Is the drug company Pfizer deliberately making it more difficult for patients to split pills?  (For reasons that have never been clear to me, drug companies often charge the same price for different dosages of a given drug, thus providing an incentive to save money by splitting pills.)


Looks like another medical myth bites the dust:  crack-babies aren't doomed from birth, after all.


Thursday, December 5, 2002

Just a quick one today – no time.  The Associated Press has another article about deceptive drug ads.  It's similar to the longer New York Times article I cited in yesterday's blog entry.  Apparently, the U.S. Food and Drug Administration (FDA) can't keep up with the pharmaceutical advertisers.


Dr. Michael Lascelles of Sydney, Australia has also referenced a number of good articles lately on his Pharma Watch blog.  Check it out.


Wednesday, December 4, 2002

Drug companies lie:

Investigators Find Repeated Deception in Ads for Drugs

WASHINGTON, Dec. 3 — Some companies have repeatedly disseminated misleading advertisements for prescription drugs, even after being cited for violations, and millions of people see the deceptive commercials before the government tries to halt them, Congressional investigators said today.

The investigators, from the General Accounting Office, said Pfizer, for example, had continued to make misleading claims in advertisements for its cholesterol-lowering drug Lipitor, despite several letters from the Food and Drug Administration in the last four years.


The main reason not to use antidepressants is that they don't work.  Here's another reason to avoid them:

Antidepressants Linked to Premature Birth

Dec. 3, 2002 — Using the most widely prescribed type of antidepressant medication during pregnancy may increase the risk of premature delivery, suggests a new study.  But the risk is still low, and the drugs don't seem to cause birth defects.

In reviewing records of 432 births over two years, researchers for a Seattle-based healthcare provider noted that several women treated with the popular selective serotonin reuptake inhibitors (SSRIs) anytime during pregnancy delivered babies early, before 36 weeks.  The babies also had lower birth weights than babies of women who had depression but were not being treated with SSRIs.

SSRIs include Prozac, Zoloft, and Paxil, which together account for more than $3 billion in annual prescription sales in the U.S.


The New York Times is reporting on a supposedly positive trial of a new way to deliver an old drug:

Patch Raises New Hope for Beating Depression

It was the first type of antidepressant, and for many people the monamine oxidase, or MAO, inhibitor remains the best hope for relief from major depression.

The trouble is that the side effects can be so serious that MAO inhibitors are rarely prescribed.  When taken with certain foods, for example, they may bring on sudden and severe hypertension.

The problems, however, may soon be resolved.

A study reported in November in The American Journal of Psychiatry suggests that by administering the MAO inhibitor selegiline in patch form, patients can receive the antidepressant benefits of the drug without the usual side effects.

In research conducted at six sites, 42 percent of the subjects treated with the patch recovered from major depression within six weeks, and many showed great improvement much sooner.  In the study, neither subjects nor researchers knew who had received the dummy medication.

Sorry, but I'm not buying it.  Forty-two percent doesn't impress me.  In any given clinical trial, you can expect roughly one-third of participants to experience a very strong response to a placebo.  Given sufficient massaging by the drug company sponsor, 42% wouldn't be too out of the ordinary, even assuming that the selegiline did virtually nothing to directly alleviate the depression.  Furthermore, the article states (toward the bottom) that some people experienced redness around the patch.  This would cause a de facto unblinding in the double-blind design.  It's well known that study participants tend to respond even better when they know that they are taking the active drug, rather than a placebo.

If this patch makes it to market, I predict that it will become the next “big thing” – for a while.  After that, people will gradually start to become disillusioned with it, as is slowly happening with oral antidepressants.


Pop diva Whitney Houston has finally revealed what most people have long suspected anyway:

Whitney Houston admits she's abused drugs in the past, but says she's gotten beyond that time through prayer.

The Grammy-winning singer also discusses the pressures of stardom and her decade-long marriage to Bobby Brown in an interview with Diane Sawyer on “Primetime,” scheduled to air at 9 p.m. EST Wednesday on ABC.

When Sawyer asks her, “Is it alcohol?  Is it marijuana?  Is it cocaine?  Is it pills?” Houston responds, “It has been at times.”

“All?” Sawyer asks.

“At times,” Houston says. “Uh-hm.”

The 39-year-old concedes she's “addicted to a few things.”

“Making love,” Houston says. “I don't like to think of myself addicted.  I like to think... I had a bad habit... which can be broken.”

OK, so part of the interview is the usual inanities spewed by celebrities (she's addicted to sex, too?), but at least Houston didn't credit her recovery to a stay at the Betty Ford Center, followed by attendance at Alcoholics Anonymous meetings.  And she didn't claim that she has a life-long disease.

Studies show that most alcoholics / addicts recover on their own.  It's high time (so to speak) that some celebrities came out and became role models by admitting that they kicked their habits without any treatment.  That's exactly what President Bush has said about his heavy drinking.  So why, then, do so many people still cling to the erroneous belief that recovery can't occur without conventional treatment and 12-step meetings?


Tuesday, December 3, 2002

AlterNet.org often has good articles.  Here's one about marketing that masquerades as science:

Every day it seems there's a story touting a “promising” new medical product or treatment.  Unfortunately, many of those news stories are based on public relations spin machines going into overdrive on behalf of the company that sells the product – whether it's a pharmaceutical company, a chain of diet clinics or a plastic surgery practice selling a new technique.

Do reporters know that so much medical news is actually unpaid advertising?  The most effective industry influence is so well-hidden that many reporters and producers are totally unaware of it.  The role of pharmaceutical companies and other health care industry interests in shaping news coverage of medical products and treatment is as invisible as it is pervasive.


U.S. News and World Report has a fairly long article about problems with the mental-health industry.  The article focuses on children with severe mental illness, and the difficulties that parents encounter when trying to get help for these children.  The article describes two brothers who were diagnosed with bipolar disorder and who take a number of psychiatric drugs.  Maybe these drugs help, as claimed in the article, but my guess is that the children's behavior would vary over time anyway – so how can anyone be sure that the drugs are really responsible for the improvement?


Psychiatrists are highly trained men and women of science, who apply rigorous, objective standards when diagnosing patients, right?  Ahem.  New research shows that despite all the effort that the psychiatric profession has put into creating a diagnostic manual, individual psychiatrists still put their own spin on things:

A study in the Journal of Experimental Psychology: General (Vol. 131, No. 4) suggests something that most clinicians probably already suspected:  While the Diagnostic and Statistical Manual (DSM) may be atheoretical, clinicians are anything but.

Nancy Kim, PhD, who recently completed her doctorate at Yale University, and Woo-kyoung Ahn, PhD, a professor of psychology at Vanderbilt University, found that even after years of experience with the DSM, clinicians still use their own theories to help them decide whether a patient belongs to a particular diagnostic category.

Specifically, they found that the more central a symptom is to a clinician's theory, the more weight the clinician gives it when deciding whether a hypothetical patient should receive a diagnosis, and the easier it is for the clinician to remember the symptom later.

“It seems to be a very powerful pull for people to use their theories,” says Kim.  “The fact that this doesn't go away, even in experts, doesn't really surprise me.”


Monday, December 2, 2002

I hope everyone had a nice Thanksgiving (all the Americans, anyway).  Now it's back to business.

Incidentally, I always welcome people to send me suggestions on what to include in the blog.  Read any good articles lately?  Have a comment or criticism?  Feel free to drop me a line at alexc@aya.yale.edu.


Andy Rooney is a commentator on the American television program, 60 Minutes.  I don't usually find him to be funny, but he made a good observation on tonight's show:

A woman who inherited a lot of the money from the Eli Lilly pharmaceutical company has given $100 million of it to a poetry magazine.  I haven't understood poetry since they changed the rules so it doesn't have to rhyme anymore.  They call it free verse.  Robert Frost said, “Writing free verse is like playing tennis with the net down.”

I'm happy for Poetry magazine but maybe this woman should have thought about giving the money back to some of the people who paid too much for Eli Lilly's products in the first place.


And speaking of Eli Lilly, the company has apparently settled another Prozac lawsuit:

A two-year-old Prozac negligence lawsuit, set for trial Tuesday, has been settled out of court by defendant Eli Lilly and Co. and the Pennsylvania plaintiffs.

The case was brought by Diane and Melvin Cassidy, of Monroeville, who in July 2000 picketed outside Lilly's corporate headquarters in Indianapolis, handing out fliers proclaiming, “Lilly, how many people are maimed or dead on your drug today?”

The Cassidys' lawsuit, filed in federal court in Pittsburgh, charged that Diane Cassidy's doctor prescribed the antidepressant Prozac to her for weight loss and that the drug caused suicidal thoughts that led her to slash her wrists and overdose on a painkiller.  She suffered intracranial bleeding from the painkiller, which left her paralyzed on one side and mentally impaired, according to the lawsuit, which sought $4.84 million in tangible damages.

I dunno... sounds a little fishy to me.  Still, the Paxil case in Wyoming is similar and is not easily explained or dismissed.  This Guardian article is very interesting, and describes the case in some detail.  Briefly, a man with no prior history of violence went completely bonkers soon after starting his Paxil prescription.  He killed his wife, his daughter, his grand-daughter, and then himself.  Perhaps there is some link between antidepressants and violence.  British psychiatrist David Healy has been saying so for years.

But, getting back to the original Prozac article, the really interesting part comes later:

The settlement comes the same week that a fresh Prozac lawsuit was filed against Lilly, in U.S. District Court in Georgia.  It raises a new charge in the more than decadelong litigation over Prozac:  that Lilly has failed to publicize research showing some people are “poor metabolizers of Prozac” and a test can reveal if a patient might be affected.

The Georgia product-liability and wrongful-death suit, in which Vickery is assisting the plaintiff, was brought by William H. Shell, the widower of LaVerne M. Shell.  She shot herself to death at age 63 in November 2000, 11 days after starting on a prescription of Prozac to treat migraine headaches.

The lawsuit charges that a human enzyme dubbed CYP2D6 normally metabolizes or breaks down Prozac and similar drugs in the body, but fails to do so in a minority of people.  In their bodies, the active ingredient in Prozac builds up to high levels, putting them at risk of violence and suicide, the lawsuit says.

“Lilly is negligent in failing to make this information public, to convey it to doctors, or otherwise to take reasonable measures to implement appropriate patient screening techniques,” the lawsuit says.

The metabolization issue is gaining currency among some activists who publicize side effects from the Prozac class of antidepressants and other drugs.

Self-employed businessman Jim Harper of Glendale, Calif., who runs a Web site called Prozactruth.com, said he hopes to soon offer a DNA test through his site that can tell if a person is a poor metabolizer of Prozac and related drugs.