Big Pharma Psychs Out the Shrinks

Just about everyone by now knows how the drug industry works to poison the minds of American doctors—not that many of them have resisted drinking the Kool-Aid, which comes in the form of ego-tripping awards, junkets, dinners, research funding, and cash in exchange for endorsing or prescribing the most lucrative drugs. But even against this backdrop of sleaze, the latest news on the ties between Big Pharma and Big Psych could take your breath away.

It turns out that not just some, but most of the shrinks who wrote the American Psychiatric Association’s most recent clinical guidelines for treating depression, bipolar disorders, and schizophrenia—which together account for $25 billion in prescription drug sales annually—had financial ties to drug companies, according a study to be published in Psychotherapy and Psychosomatics, as reported in the Boston Globe.

Summarizing the findings, which were compiled by researchers largely from public records, the Kaiser Daily Health Policy Report states:

According to the study, 18 of the 20 authors of the guidelines had at least one financial tie to drug companies. Twelve authors had ties in at least three categories, such as consulting, research grants, speaking fees or stock ownership, the study found. In addition, the study found that all of the authors of schizophrenia and bipolar guidelines had relationships with the drug industry, while 60% of the authors of the depression guidelines had such connections. According to the study, more than 75% of the authors received funding for research from drug companies. In addition, one-third of the authors served on the speakers’ bureaus of drug companies, the study shows.

As anyone who’s suffered from any kind of mental health problem knows, treatment for these kinds of problems is a highly inexact science. A shrink can’t give you a blood test or an MRI to figure out precisely what’s wrong with you. So it’s often a case of diagnosis by prescription: If you feel better after you take an anti-depressant, it’s assumed that you were depressed; if you don’t feel better, well, then maybe they’ll try you on an anti-anxiety pill, or a low dose of a bipolar drug, and see how that works.

One of the researchers for the study put it this way: ”the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence.” For this reason, she argues, it’s particularly important that the guidelines issued by psychiatry’s leading professional organization be compiled “on the basis of an objective review of the scientific evidence”—and not on whether the doctors writing them got a big grant from Merck or own stock in AstraZeneca.

Perhaps there’s another reason why these conflicts of interest are so extreme in the field of mental health. You would expect that after news like this, confidence in the psychiatric profession would drop through the floor, and patients would begin to take their shrinks’ diagnoses with a boulder of salt. But many psychiatric patients are desperately ill, highly vulnerable, and not in any position to be skeptical medical consumers.

A growing body of evidence suggests that the drug companies purposefully push doctors to push drugs on exactly these types of patients—the ones who are  least equipped to push back. Look at the recent case of pharmaceutical giant Eli Lilly, which agreed to pay a record $1.4 billion dollars to settle charges that it illegally marketed the anti-psychotic drug Zyprexa as a treatment for Alzheimer’s and other forms of dementia in elderly patients. This despite the fact that the drug was not only unapproved for this “off-label” use, but had also been shown to cause obesity and diabetes. (You can watch a Zyprexa drug rep explain it all in this video.)

Now, $1.4 billion might sound like a tough punishment, until you find out that Lilly’s total sales of Zyprexa have topped $37 billion. And at least some of those sales were thanks to doctors who, with guidance from Lilly drug reps, wrote thousands of prescriptions for patients with virtually no ability to defend themselves. Can you imagine an easier group for the drug companies—and their shills in the medical profession—to victimize than old people with dementia?

After spending some time reporting on the drug industry, I can easily picture Big Pharma’s executives sitting around in their board rooms, planning which wretched, unprotected group of patients they’re going to target next. 

Then again, maybe I’m just paranoid. I’m sure there’s a pill for that.

This post also appears on Unsilent Generation, James Ridgeway's blog on the politics of aging.