Late last year, the NY Times reported that Eli Lilly suppressed information concerning Zyprexa's links to obesity and elevated blood sugar. According to Lilly's own internal documents, sales reps were instructed to play down in conversations with doctors information which showed 30 percent of patients on the drug gain 22 pounds or more after a year on the drug, with some reporting gains of 100 pounds or more.
This year, the FDA slapped AstraZeneca on the wrist for misstatements about Seroquel and diabetes and other risks, and Pfizer for claiming that Geodon was more effective than the old generation Haldol.
Recently, psychiatrists have begun owning up to the fact that they may risk killing their patients by placing their patients on weight-gaining antipsychotics long term. The impetus came from a currently ongoing series of NIMH-underwritten series of trials involving patients with schizophrenia taking antipsychotics, known as CATIE.
The early results for the most part indicate no major surprises, namely that the new generation of antipsychotics are no more effective than the old generation of antipsychotics, and that some of the new antipsychotics cause a hell of a lot of weight gain. Over the long-term, virtually all the patients dropped out of the trials.
These findings were so old-hat that I did not bother to report it in my email Newsletter.
The true news value in the CATIE studies was only that the psychiatrists themselves interpreted the studies as news. This became evident at last year's APA annual meeting, and came in loud and clear at this year's APA. "Am I a Psychiatrist ... or an Endocrinologist?" read the title to one industry-supported symposium. "Antipsychotics and Metabolic Risk: A Clinical Issue at the Forefront of Contemporary Psychiatry," read one of the talks from this symposium.
Were psychiatrists finally starting to wake up?
Yes, there may be valid clinical reasons to place patients on antipsychotics over the long term. But antipsychotics, new or old, are basically dumb meds. They block dopamine in all the dopamine systems of the brain, not just where they are needed, resulting in a high cost of doing business. A study reported in the American Journal of Psychiatry this year actually found that 12 patients with schizophrenia felt worse, not better, on antipsychotics.
Dumb meds call for smart meds strategies. Unfortunately, past performance indicates that psychiatrists have only been about as knowledgeable as what drug reps tell them. Maybe that is changing. At the very least, psychiatrists can start by listening to their patients
