Issues
The Pill Game
Has big pharma duped psychiatry?
First let me list my industry associations: A 400-year supply of pens with drug names from attending three American Psychiatric Association annual meetings, a green Remeron magnetic paper clip holder (with matching paper clips) from two meetings ago, and a pink brain-shaped lollipop, courtesy of Novartis, that I keep as a memento of last year’s 2003 APA meeting. At this year’s 2004 meeting held last week in New York, the GSK people were handing out 500-page PDR psychotropic prescribing guides, but first I had to take the psychiatric challenge.
But I’m already diagnosed, I protested to the guy guarding the PDR pile. I’ve been through the challenge, already. No dice. So over to an interactive computer game I went to play a version of clinical Jeopardy. When I got my second question in a row right, I started doing my end zone dance. Meanwhile, I was carrying on a conversation with a GSK rep as a wise-cracking cartoon face on a video display commented on the action.
You’ve got to think like a drug company, the video face chided when I got a question wrong. Soon (thinking like a drug company) I was racking up right answer after right answer. Better than the shrinks! I exulted to the video face and the GSK rep, totally pumped over the roll I was on. When I finished with only two wrong answers, the computer lit up like a pinball machine, and the GSK rep graciously gave me my ticket to redeem my goody bag, which as well as the PDR also included an aqua wall clock emblazoned with Paxil in orange letters (my personal Clockwork Orange), with images of different strength tablets in the 3, 6, and 9 positions. The clock now graces the world headquarters of McMan International overlooking my pens, paper clips, and brain lollipop.
I can’t wait to see what I’ll bring home next year.
But it wasn’t all fun and games. Over five days, I attended 19 lectures and symposia, all of them spanning either 90 minutes or three-hours, involving (with two or three exceptions) multiple speakers. Most of the sessions I attended focused on treatment and by far the majority of these zeroed in on meds. Refreshingly, three of the symposia were largely devoted to their side effects, all the more startling when one takes into account that these were industry-sponsored. So are the drug companies getting more honest? Not quite. At a symposium on optimizing antipsychotics treatment, the side effects of the newer-generation atypicals were candidly discussed, but at all times it was taken for granted by the speakers that these side effects were far more benign than the older generation drugs. Last year, two studies seriously challenged that notion, with a third producing mixed results and a fourth (Eli Lilly-sponsored) giving the nod to one of he relatively new kids on the block. None of the five speakers referred to those studies.
As the sessions wore on, I began getting the impression that despite listening to some of the most brilliant practitioners in the profession, I would not like to get treated by them. Yes, some of the speakers referred to talking therapies (the theme of this year’s meeting was dissolving the mind-brain barrier), but most of them seemed intent on demonstrating their complete lack of ability to think outside the medicine cabinet. None of them suggested, for instance, that when the standard meds options fail it would be a good idea to make enquiries about the patient’s nutrition (better late than never). The evidence linking mood to eating right or using nutritional supplements may not be as good as we would like, but it is far more robust than the virtually nonexistent data concerning the three-meds or more combinations most of us find ourselves on. As for long-term treatment, only Mark Frye MD of UCLA talked about the value of a support group.
The APA requires speakers at its annual meeting and other venues to list their relevant industry affiliations. Five or six companies seem par for the course, and can go as high as 14 or 15. Money amounts are not revealed, but we know they can easily add up to six and seven figures. Yet, my indebtedness to the drug industry puts these guys to shame, paper clips and all. You see, thanks in large part to my mood stabilizer (and to an antidepressant I used to be on), instead of a mind in pieces I now have peace of mind, as well a life worth living. A hundred grand or two is chump change next to that.
But I also know that my sanity and quality of life are far too important to leave all the heavy lifting to my medication. This generation of meds is simply not good enough for that, even in the hands of expert clinicians. Much more is needed to get well and stay well. Most patients know this, often from bitter experience, but do their psychiatrists? After attending last week’s APA meeting, sometimes I wonder.
May 19, 2004, reviewed March 1, 2008
Speaking of Thinking Outside the Medicine Cabinet
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