Pharmaceutical Industry Influence

Primer

Pharmaceutical Industry Influence is an important issue that all psychiatrists must be aware of. The pharmaceutical industry and psychiatry have been inextricably tied since the beginning of the psychopharmacology revolution in the 1950s.

When considering the influence of the pharmaceutical industry and the role of medications, remember the first maxim in medicine: Primum non nocere (“First, to do no harm”).[1]

Opioids

In the early 1990s, pharmaceutical companies began heavily marketing opioid medications, pushing doctors to prescribe opioids and to treat pain as the “fifth vital sign.” Even though evidence was beginning to go against this, pharmaceutical companies nonetheless continued to push for heavy marketing of opioids.[2] As physicians and journals began to accept this marketing, they also began to cite incorrect evidence in prominent medical journals such as the New England Journal of Medicine, building misinformation and further driving opioids into the healthcare system.[3]

Antidepressants

Discoverer of the First Neuroreceptor on SSRIs

“I am alarmed at the monster that Johns Hopkins neuroscientist Solomon Snyder and I created when we discovered the simple binding assay for drug receptors 25 years ago … The public is being misinformed about the precision of these selective serotonin-uptake inhibitors when the medical profession oversimplifies their action in the brain and ignores the body as if it exists merely to carry the head around!”

– Dr. Candace B. Pert (discoverer of the first neuroreceptor, the opioid receptor[4]) Letter to the Editor of TIME Magazine, October 20, 1997

Unpublished Data

Paroxetine

  • Independent analysis of Study 329 demonstrated serious harms and a lack of efficacy for acute and longer-term use of paroxetine and imipramine for adolescents with major depression.
  • This example of the RIAT initiative reveals that the current methods of trial conduct, analysis and publication are unacceptable.
  • Published conclusions about efficacy and safety of drugs without independent analysis cannot be accepted as trustworthy.
  • It is essential that primary trial data and protocols for all clinical trials be made available for independent analysis.

Stimulants

Father of ADHD on Current Diagnosis and Treatment of the Condition

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous … This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

– Dr. Keith Conners[5], child psychologist and father of the modern view of ADHD. New York Times: The Selling of Attention Deficit Disorder

Second Generation Antipsychotics

Olanzapine

The advent of second-generation antipsychotics lead to concerns that it placed patients at an increased risk for metabolic syndrome. These concerns were initially played off and attributed to an innate risk between diabetes and schizophrenia.[6] However, evidence continued to increase, and there have been multiple law suits in the US since then regarding the metabolic side effects.[7]

Quetiapine

Seroquel was initially approved only for schizophrenia and bipolar disorder, but its off-label use became pervasive, from depression to insomnia to ADHD. It reached up to $4.5 billion in sales during its height, and became one of the most commonly prescribed medications in the world. A major lawsuit was fought over whether weight gain data was hidden from physicians and patients by AstraZeneca.[8][9]

Pediatric Bipolar Disorder

Regulatory Capture

Clinical Practice Guidelines

Reform

“t is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.“

– Dr. Marcia Angell, Drug Companies & Doctors: A Story of Corruption

Resources

Articles

Advertisements

Books

Research

References

1) Ghaemi, S. N. (2008). Toward a Hippocratic psychopharmacology. The Canadian Journal of Psychiatry, 53(3), 189-196.
2) Mularski, R. A., White‐Chu, F., Overbay, D., Miller, L., Asch, S. M., & Ganzini, L. (2006). Measuring pain as the 5th vital sign does not improve quality of pain management. Journal of general internal medicine, 21(6), 607-612.
3) Leung, P. T., Macdonald, E. M., Stanbrook, M. B., Dhalla, I. A., & Juurlink, D. N. (2017). A 1980 letter on the risk of opioid addiction. New England Journal of Medicine, 376(22), 2194-2195.
4) Brady, L. S., & Herkenham, M. (2013). Candace B Pert.
5) Frances, A., & Carroll, B. J. (2017). Keith Conners. BMJ: British Medical Journal (Online), 358.
6) Kohen, D. (2004). Diabetes mellitus and schizophrenia: historical perspective. The British Journal of Psychiatry, 184(47), s64-s66.
7) NYT: Lilly Settles With 18,000 Over Zyprexa
8) CBS News: Seroquel Trial: Allegations of Sex-for-Secrets; AZ Wants Papers Sealed
9) Seroquel Products Liability Litigation (UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION) MDL DOCKET NO. 1769