Blog Archive: Nov. 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.

Other sites:

Blog archives:

Friday, November 29, 2002

Mysterious goings-on related to the pharmaceutical company Eli Lilly, as reported by today's New York Times:

A Capitol Hill Mystery:  Who Aided Drug Maker?

WASHINGTON, Nov. 28 – Lobbyists for Eli Lilly & Company, the pharmaceutical giant, did not have much luck when they made the rounds on Capitol Hill earlier this year, seeking protection from lawsuits over a preservative in vaccines.  Senator Bill Frist, Republican of Tennessee, tucked a provision into a bill that went nowhere.  When lawmakers rebuffed a request to slip language into domestic security legislation, a Lilly spokesman said, the company gave up.

Now, in a Washington whodunit worthy of Agatha Christie, the provision has been resurrected and become law, as part of the domestic security legislation signed on Monday by President Bush.  Yet in a city where politicians have perfected the art of claiming credit for deeds large and small, not a single member of Congress – or the Bush administration – will admit to being the author of the Lilly rider.

“It's turning into one of Washington's most interesting parlor games,” said Dave Lemmon, spokesman for Senator Debbie Stabenow, Democrat of Michigan, who has promised to introduce legislation to repeal the provision.  “There's a lot of guessing, a lot of speculation as to who did this.”

Jay S. Cohen, MD is a physician and a faculty member at the University of California, San Diego.  Dr. Cohen has written an excellent book called, Over Dose:  The Case Against the Drug Companies.  The title is a bit misleading, because Dr. Cohen's book has a rather narrow focus – namely, exposing problems with drug-dosages as recommended by pharmaceutical companies.  Still, the book does contain some information of a more general nature, and the Journal of the American Medical Association ran a positive review recently.

Thursday, November 28, 2002

Via Pharma Watch:  The Boston Globe has an excellent article about how Parke-Davis (now a part of Pfizer) turned a mediocre drug (Neurontin / gabapentin) into a big money-maker:

“Its share of the market, its sales, really exceed its efficacy”, said Dr. Jerrold Rosenbaum, Mass. General's chief of psychiatry.  “The question is, was the company denying investigators access to negative data when they asked for it?”  [...]

Dr. Alec Bodkin, chief of the clinical psychopharmacology research program at McLean, said Neurontin is still so widely used in psychiatry because “it's the ideal placebo”

And speaking of mediocre drugs, Schering-Plough's antihistamine Claritin (generic: loratadine) was approved for over-the-counter sales in the US.  For an interesting look at Schering-Plough's strategy at promoting the bejeezus out of Claritin, see this excellent article from the March, 2001 issue of the New York Times Magazine.  It's a bit dated, but still worth reading.

Another item related to Claritin:

Ad blitz on for Claritin alternative

As the patent for the popular allergy drug nears expiration, its makers begin a hard push for Clarinex.  Some question whether the new drug will offer benefits to justify its higher cost.

In the past 10 years, Schering-Plough Corp. has spent hundreds of millions of dollars making Claritin one of the nation's most advertised and bestselling drugs, pitching it as an effective allergy solution with minimal side effects.

Never mind all that.  Now Schering needs you to know about Clarinex.

With Claritin scheduled to lose its patent protection this year, opening the door to cheap generic versions, Schering has begun bombarding the airwaves with ads and free trial offers for its newest incarnation, Clarinex.

Clarinex is a derivative of Claritin and works the same way.  Although no studies have been done to show whether it's superior, Schering hopes to persuade patients and doctors to switch to Clarinex during the next eight months, before Claritin's patent expires and the price drops as much as two-thirds.

Wednesday, November 27, 2002

In the United States, Drug Abuse Resistance Education (DARE) is a popular program for school-age children.  It's popular, but it doesn't work.  Some studies show that kids are actually more likely to use drugs if they've gone through a DARE program.  Thus, it's good to see that some people are trying to come up with alternative methods:

Marsha Rosenbaum thinks that “Just Say No” should be replaced with “Just Say Know.”

Her attitude dates back to an encounter she had with “a nice, middle-class Jewish girl like myself,” she recalled, who wound up hooked on heroin.  Rosenbaum interviewed her in prison while working on her doctoral dissertation.

“I will never forget what she told me,” said Rosenbaum, a medical sociologist.  “She said she'd had drug education classes and they told her that if she tried marijuana, she'd become addicted.  But when she and her friends tried pot, it just didn't happen.  So she decided it was a lie.  And she went on to try heroin.”

Concerned that drug education efforts are failing because they often rely on scare tactics rather than solid science, Rosenbaum is pushing a new approach in her booklet, “Safety First:  A Reality-based Approach to Teens, Drugs and Drug Education.”

I'm skeptical that the preservative thimerosal causes autism, but it's a very slimy way that the Eli Lilly pharmaceutical company managed to avoid the lawsuits related to the use of the chemical:

Last week the Senate approved legislation to establish a Department of Homeland Security and it will soon be signed into law by the president.  Buried in this massive bill, snuck into it in the dark of night by persons unknown (actually, it's fair to say by Republican persons unknown), was a provision that – incredibly – will protect Eli Lilly and a few other big pharmaceutical outfits from lawsuits by parents who believe their children were harmed by thimerosal.

Now this has nothing to do with homeland security.  Nothing.  This is not a provision that will in any way protect us from the ferocious evil of Osama bin Laden and Al Qaeda.  So why is it there?  Perhaps it has something to do with the fact that the major drug companies have become a gigantic collective cash machine for politicians...

The Wall Street Journal has a very funny article about the proliferation of new, supposed diseases.

And speaking of new diseases, how about “leisure sickness”?

Tuesday, November 26, 2002

Just a quick one today:

Scientific Journal Compromised by Industry Ties

Tobacco, Chemical, & Drug Companies’ Funding Goes Undisclosed, Say Critics

The integrity of a seemingly independent scientific journal is being questioned today by 45 prominent scientists and physicians.  They charge that the journal, Regulatory Toxicology and Pharmacology (RTP), may let the anti-regulatory interests of its corporate patrons trump sound science.  The journal, which has a strong editorial bias against government regulation, is accused of hiding its authors’ and editors’ extensive financial ties to tobacco, chemical, pharmaceutical, and other industries.  The critics told the journal’s publishing house that those undisclosed financial ties pave the way for research skewed in favor of industry.

Monday, November 25, 2002

Now here's something you don't see every day – an opinion piece arguing that the U.S. Food and Drug Administration (FDA) is too restrictive.  I wonder if the author has read David Willman's Pulitzer-prize-winning articles about the FDA.  See, for example, the first article in Willman's Los Angeles Times series: “How a New Policy Led to Seven Deadly Drugs”.  (Though these articles date back to 2000, they're still well worth reading.)

The Dutch are apparently concerned about the safety of the antidepressant Serzone (generic: nefazodone).

More problems with the mental-health industry.  Apparently, most kids in Massachusetts don't get the help they need.  Still, this might be a blessing in disguise, given what usually passes for help these days (i.e., drug 'em up with Prozac, or some such thing).

New treatments for schizophrenia involve long-acting injections of antipsychotic drugs, or even implants that slowly release drugs into the patient's body.  Frankly, I find this very scary, given the serious problems with anti-schizophrenic drugs.  If the drugs actually worked well, then I think such delivery systems might be justified.  But they don't work well.  (See also Robert Whitaker's excellent recent book, Mad in America.)

Sunday, November 24, 2002

Wired magazine doesn't usually cover religion or medicine, but the latest issue has an interesting article titled, “A Prayer Before Dying”.  It's the sad story of Dr. Elisabeth Targ, a Stanford-educated psychiatrist who allegedly showed that AIDS patients can benefit when others pray for them.

The story is sad for two reasons:  1) Dr. Targ succumbed to brain cancer not long after she published her AIDS research, and she suffered quite a bit before she died.  Also, during her illness, she had surrounded herself with a veritable circus of “healers” who had tried to marshall paranormal forces in a fruitless attempt at helping her recover.  2) Dr. Targ's research was deeply flawed, and she knew it.  It's highly ironic that a study of prayer was conducted and published in a deceitful, unethical manner.  Dr. Targ and her colleagues conducted the study in a way that fell just short of outright fraud, though I suppose they probably believed in the overall validity of their results:

[Dr. Targ's] study had been unblinded and then “reblinded” to scour for data that confirmed the thesis – and the Western Journal of Medicine did not know this fact when it decided to publish.


This isn't what science means by double-blind.  The data may all be legitimate, but it's not good form.  Statisticians call this the sharpshooter's fallacy – spraying bullets randomly, then drawing a target circle around a cluster.  When Targ and Sicher wrote the paper that made her famous, they let the reader assume that all along their study had been designed to measure the 23 AIDS-related illnesses – even though they're careful never to say so.  They never mentioned that this was the last in a long list of endpoints they looked at, or that it was data collected after an unblinding.

Actually, the author of the Wired article lets her off fairly easy – too easy, in my opinion.  On the other hand, I suppose Elisabeth Targ is not in any position to defend herself, so perhaps she should be given the benefit of the doubt.

Saturday, November 23, 2002

In yesterday's blog entry, I referenced a New York Times article about how the advertising industry is (further) corrupting pharmaceutical research.  The Times piece was accompanied by a television documentary segment called, “Science for Sale?”.  It was part of a regular show called, “NOW, with Bill Moyers”.  I watched it tonight.  The show was only about 15 minutes long, but it was quite good.  The transcript is available on the PBS (Public Broadcasting Service) website.

Most people are severely lacking in critical-thinking skills

I lived in Ithaca, NY from about 1993 to 1995.  Now, I'm surprised to see that Ithaca is apparently on the forefront of new drug-addiction treatment methods:

Area drug council offering new addiction medication

The Alcohol & Drug Council of Tompkins County will soon be offering a new medication to help those struggling with drug abuse.

Medical staff at the council have undergone the necessary training to prescribe buprenorphine, which was recently approved by the Food and Drug Administration to combat opiate addiction.

The release of the drug, “is a very big deal in our circles,” said Mary Agnew, executive director of the Alcohol & Drug Council.

Will buprenorphine turn out to be wonderfully effective at treating heroin addiction?  Probably not, but I'm guessing that it's going to prove more effective than forcing addicts to attend meetings where members are told to turn their will and their lives over to the care of a Higher Power (NA's third step).

Friday, November 22, 2002

I was just about to go to bed, when I decided to check the New York Times one more time.  Sure enough, they updated their health section, and I found this story (note to non-US readers: Madison Avenue in New York City is home to many of the country's largest advertising agencies):

Madison Ave. Plays Growing Role in Drug Research


Madison Avenue – whose television ads have helped turn prescription medicines like Viagra, Allegra and Vioxx into billion-dollar products – is expanding its role in the drug business, wading into the science of drug development.

The three largest advertising companies – Omnicom, Interpublic and WPP – have spent tens of millions of dollars to buy or invest in companies like Scirex that perform clinical trials of experimental drugs.  One advertising executive calls it “getting closer to the test tube.”

Ad agency executives say they do nothing to distort the research process.  But critics worry that science is being sacrificed for the sake of promotion.  “You cannot separate their advertising and marketing from the science anymore,” said Dr. Arnold S. Relman, professor emeritus at Harvard Medical School and a former editor of The New England Journal of Medicine.  “Ad agencies are not in the business of doing science.”

The New York Times reports that the pharmaceutical industry is pleased with the recent election results:

Drug Industry Seeks Ways to Capitalize on Election Success

WASHINGTON, Nov. 20 — Having spent more than $30 million to help elect their allies to Congress, the major drug companies are devising ways to capitalize on their electoral success by securing favorable new legislation and countering the pressure that lawmakers in both parties feel to lower the cost of prescription drugs, industry officials say.  The industry's hand appears stronger now than at any other time in recent years, a result of its large donations to political parties and candidates and millions of dollars spent on television advertising by industry-financed groups.  The money was spent overwhelmingly on behalf of Republicans, who now control both houses of Congress.

Executives of the major drug manufacturers met last week at the Westfield International Conference Center, near Dulles International Airport in Northern Virginia, to plan ways to turn that influence into legislative victories.

The Ottawa Citizen has a harrowing story about a crack addict who is accused of robbing and killing his elderly mother.  The article concludes with this sentence:  “He [the accused] said he's gone through treatment many times, including a 1½-year stay at Harvest House, a Christian-oriented drug and alcohol treatment centre.”  It doesn't make sense to me why more people don't realize that current addiction-treatment centers don't work and need to be changed.  Cancer treatment gets improved all the time, based on new research.  You might think that there would be an outcry for better, more-effective rehab centers.  In truth, though, there is virtually no support for reform.  The power of denial at work, I suppose.  People got stuck on the 12-step approach and are deluded into thinking that AA is the be-all and end-all of sobriety.

Another bizarre story from Canada:  A man dressed in a Santa Claus costume tried to rob a bank.  Of course, he got caught.  Now he's claiming that Paxil made him do it.  Far be it from me to defend antidepressants, but I doubt it.  On the other hand, there's the infamous Wyoming case, where a previously normal man went completely berzerk after taking Paxil, and ended-up killing his wife, daughter, granddaughter, and himself.

I dunno... this almost sounds like a hoax, but it's being reported straight:

Pot shots fired at junkies' magazine

A women's magazine with a difference will appear in the Netherlands next month.  Its glossy pages are filled with beauty tips, horoscopes, feature stories about sex and cooking and oodles of health advice – but Sister Mainline is aimed at female cocaine and heroin addicts, and its contents have infuriated anti-drugs campaigners across Europe.

Held up as a classic example of “drug chic” publishing, the magazine is partly funded by the Dutch health ministry. Its controversial message is not that hard drugs are intrinsically bad, but that they can be used “sensibly”.

The BBC has a story about a new report issued by IBM's consulting arm.  The report claims that the pharmaceutical industry might be in a slump now, but good things are coming down the pike.  Maybe.  I hope so.  It would be nice to have some really effective breakthrough treatments.  I haven't read the full report, but it sounds a bit too optimistic.  Anybody here remember the outrageous hype that accompanied the discovery of high-temperature superconductors back in 1987?

Thursday, November 21, 2002

OK, just a quick one today.  It's late (1:10 AM), and I don't have time to scan the news feeds.  This next subject doesn't have anything to do with the usual topics covered by my blog entries, but the Flynn Effect is one of the coolest things I've heard of in the last few years.  Why are there so few articles about this in the popular press?  All we hear about is how people are getting dumber, how the pre-college public education system is in a mess in the US, etc.  It's nice to read about how people all over the world might actually be getting smarter – at the rate of about three IQ points per decade.  Amazing, huh?

(By the way, I turn 37 years old today.)

Wednesday, November 20, 2002

The latest disease-of-the-month candidate:  “sensory defensive disorder”.  Comes with the requisite book and magazine article.

Like many people, I used to believe that a low-fat diet is the best way to fight against obesity, high cholesterol, and heart disease.  However, I wasn't so sure after I read an article called, “What if it's all been a big, fat lie?”.  Science journalist Gary Taubes wrote the piece for the New York Times Magazine back in July.  Taubes argued that perhaps dietary fat has been unfairly turned into a scapegoat, and that carbohydrates are actually to blame for the rising obesity epidemic.  Of course, Dr. Robert Atkins had been saying the same thing for thirty years, but most medical authorities dismissed him as a borderline-quack.  Now, increasing numbers of studies are suggesting that low-carb diets are actually safe and effective at promoting weight loss.  The latest study shows that you can actually lose weight, lower your triglycerides, and improve your cholesterol profile by getting a whopping 60% of your calories from fat – and most of the rest from protein.  Who woulda thunk?

And speaking of big, fat lies, remember how pharmaceutical companies kept telling us that targeted drug discovery, proteomics, combinatorial chemistry, genomic research, etc. were going to bring about a golden age of pharmacology?  Guess not:

Decline in New Drugs Raises Concerns

FDA Approvals Are Lowest in a Decade

New drugs to treat and cure sick patients are coming into the market in the United States at the slowest rate in a decade, despite billions invested by pharmaceutical companies on research and a costly expansion by the federal agency that reviews new medicines.

The decline in the number of new drugs is most pronounced in the category considered by the Food and Drug Administration to have the greatest promise for patients – those listed as breakthrough “priority” drugs and “new molecular entities” that are different from any others on the market.

The slowdown is troubling to many because it is largely unexpected.  The drug industry now invests three times as much money in research as it did a decade ago, and the FDA has already undergone a major revamping to become more efficient and prompt -- an expansion funded largely by user fees from the drug makers.  Yet the number of industry applications for innovative new drugs is down significantly, and the average time needed by the FDA to review applications is moving up.

The net result of both trends is a steep drop in the number of new drugs coming to the market to help cure and treat illnesses, and growing disappointment among many patients and their families and advocates.

Apparently, herbal remedies don't work so well at treating the symptoms of menopause.  I'm not surprised.  I don't trust “traditional remedies”.  Just because some tribe in the jungles of Upper Slobovia claims that periwinkle leaves cure diabetes doesn't make it so.  Oh, sure, it could be true, and maybe it's worth investigating, but I'm not going to believe it until I see data from well-designed, double-blind, placebo-controlled studies.  Non-traditional medical treatments have to play by the same rules as everyone else.  Of course, if they prove their worth, then I suppose they're not non-traditional anymore.

Apparently, the governor of New Jersey is none too happy about having his state be used as a dumping ground for New York's most-difficult psychiatric patients (see also yesterday's blog entry).

I have not previously written about Ritalin (generic: methylphenidate) on this blog.  Mostly, it's because I don't know enough about it to have an informed opinion.  Unlike some people, I am not fundamentally opposed to the use of psychiatric drugs – I am merely opposed to the use of drugs that don't work.  I'm reasonably certain that antidepressants don't work, and I have grave doubts about antipsychotics.  Drugs for attention-deficit hyperactivity disorder (ADHD), though, are a category unto themselves, and one of these days I will make the effort to read-up on them.  In the meantime, though, I'll just point out that the New York Times Magazine recently ran an article about the use of Ritalin in children as young as three years old.  Unfortunately, the article is long on human drama and short on hard facts, but it's still somewhat interesting.

Insight magazine has an article about suicide and antidepressants:  “Medical Research to Die For”.  British psychiatrist David Healy has been saying for years that selective serotonin reuptake inhibitors (SSRIs) lead to a higher risk of suicide.  Perhaps he's right.

Via Pharma Watch:  about a year ago, eleven major medical journals pledged that they would clean up their act with respect to publishing research papers that might be biased by authors' ties to pharmaceutical companies.  A year later, we can ask – how well has this pledge worked out in practice?  A commentary in the British medical journal the Lancet suggests, not very.

Tuesday, November 19, 2002

More evidence that the mental-health industry is in a shambles:

As reported by the Wall Street Journal, Cara Kahn – an ex-game-show contestant – is stretching her 15 minutes of fame.  She's shilling for Wyeth, the pharmaceutical company that makes the antidepressant Effexor.  Kahn is traveling around the country and speaking on college campuses.  Ostensibly, her purpose is to educate students about depression.  Some schools, though, are wise to this ploy:

Harvard University declined Wyeth's invitation to host a depression forum.  “It's a slippery slope I do not believe that universities should take,” says Steven Hyman, Harvard University provost and formerly director of the National Institute of Mental Health.  “Colleges that participate probably are not consciously colluding to market the product of a company, but they are dependent on the resources of the company.”

Monday, November 18, 2002

Two excellent articles from the Boston Globe:

  • Doctors are dispassionate, rational men and women of science, right?

  • The Costly Case of the Purple Pill” – a detailed, well-written case study of the Prilosec/Nexium problem, and how it's indicative of larger problems within the healthcare industry.

Sunday, November 17, 2002

A reader alerted me to these two articles in the British journal Pharmaceutical Marketing.  Both pieces were written by Emma Sargeant, the managing director of 4D Communications (a medical marketing company):

Reading these articles, I felt a bit like a soldier who had stumbled upon a briefcase containing the enemy's code book and battle plans.  OK, maybe that was a bit of an exaggeration, but here's the point:  The articles describe the process by which pharmaceutical companies use ostensibly-unbiased educational programs as a guise to promote their drugs.  I'm struck, once again, by the Machiavellian tactics used by Big Pharma, and by the shamelessness with which the marketing strategies are described.  Here, for example, are some quotes from those articles:

  • “Medical education enables you to create an environment for effective selling.”

  • “A key factor for a successful and cost-effective medical education programme is ensuring that individual activities form part of a cohesive strategic programme.”

  • “In practice, medical education tends to drive PR [public relations], as key messages from medical education programmes can lead to PR spin-offs”

  • “You may be asking, why does a chapter on effective medical education start with opinion leader development?  It is because opinion leader and product champion development is increasingly being recognised as one of the most important aspects of pharmaceutical marketing and the key to effective medical education programmes.  [...]  It may sound obvious, but the key place to start is by the careful identification of the people you should be working with.  The key is to evaluate their views and influence potential, to recruite them to specially-designed relationship-building activities and then provide them with a programme of appropriate communications platforms.  If you don't adopt such an approach, you risk wasting money on the wrong people.”

  • “Opinion leaders are people whose views are respected by others, whilst product champions are those who will endorse your product or supporting issues (so-called 'concept' champions).  In the ideal situation the two will overlap extensively, ensuring that you have a credible pool of support from respected individuals.  In practice you will generally need to work on this...  In one direction you will be working with key opinion leaders to make them well-disposed to your product.  In the other, you will need to help product champions, who may be further down the influence ladder, to raise their profile, and so develop them into opinion leaders.”

I realize that the articles are long, but they provide an important glimpse at the mindset of drug-company marketers.  Think about that the next time you get a prescription from your doctor.

Saturday, November 16, 2002

For twenty years or so, medical researchers have been telling us that there is a very strong link between the mind and the body (contrary to the assumption made by previous medical authorities).  A number of recent reports, though, call into question just how strong that link really is:

  • A few days ago, I referenced this BBC article which claims that a positive outlook on life won't help you overcome cancer.

  • The New York Times ran an interesting article a couple of weeks ago:  “In Search of Good Health?  Try a Bad Attitude.”  Apparently, cancer patients who attend support-group meetings might feel better emotionally, but their underlying disease doesn't improve.  This reminds me of research showing that Alcoholics Anonymous doesn't really help people stay sober – or maybe it hurts as many people as it helps, so the result is a wash.

  • A recent Danish study showed that psychological stress doesn't lead to increased incidence of cancer – at least not directly.  People who are stressed seem to engage in more risky behaviors, like smoking, which can cause cancer.

I'm all in favor of having people strive for happiness and an optimistic outlook on life, but let's not get carried away.  It seems that “alternative” medicine, in particular, is always eager to recruit patients by claiming that a positive attitude can cure all your ills.

Bernie Hoar is a 64-year-old liver-transplant recipient.  He needed a transplant because he had drunk himself into cirrhosis.  Luckily, he seems to have stopped drinking, and has been living with the new liver for 10 years.  Somehow, I don't feel good about this story.  As the article points out, there is a severe shortage of donor organs in this country.  My feeling is that if you ruined your original liver through your behavior, you shouldn't get a chance at ruining a second one.  Or, at the very least, you should be put at the bottom of the priority list for organ transplantation.  Nobody gets cirrhosis from a few drinks here and there, or from a couple of months of heavy drinking.  Cirrhosis results from years and years of day in, day out drunkenness.

Friday, November 15, 2002

Long, but interesting article in the British medical journal the Lancet (via Pharma Watch):

The pharmaceutical industry as a medicines provider

by David Henry and Joel Lexchin

[...]  The pharmaceutical industry claims to have invested $30.5 billion in research and development in 2001, which would make it the largest direct funder of medical research in the USA.  The nature of this research is changing.  Increasing numbers of studies seem to be concerned with marketing issues – e.g., establishing equivalence with existing products rather than trying to develop superior drugs.  In the USA, studies are done increasingly by for-profit contract research organisations, rather than by academic medical centres (60% in 1998 vs 20% in 1991).  Concerns relate mainly to loss of independence in the implementation and reporting of research.  Studies have shown that industry-sponsored research is more likely than independent research to have results favourable to the study drug.  [...]

Pharmaceutical companies may choose diseases that offer the largest return on investment, such as chronic disorders with a high prevalence in developed countries.  The enormous earnings from drugs for raised cholesterol concentration, depression, and musculoskeletal disorders confirm the success of this strategy.  Widening the indications for existing drugs is a useful means for pharmaceutical companies to enhance revenue further, but can distort benefit-to-harm ratios when increasing numbers of individuals with mild disorders take the products.

Thursday, November 14, 2002

Another reason to avoid neuroleptic drugs:

Schizophrenia Drugs Linked to Heart Attack Risk

LONDON (Reuters) - Drugs used to treat patients with schizophrenia can increase the risk of heart attack, American researchers said Friday.

Scientists at the University of Pennsylvania in Philadelphia found that schizophrenics who had been prescribed drugs were more likely to have experienced heart problems than patients with other illnesses.

“Our findings clearly link patients with treated schizophrenia to higher rates of cardiac arrest, ventricular arrhythmia (irregular heart beats) and death,” said epidemiologist Sean Hennessy.

I sure wish that somebody would discover a drug (or drugs) that would be safe and effective at treating psychiatric illnesses.  Some people are opposed to psychotropic drugs in principle.  I'm not one of those people.  It would be great if we could treat psychosis, depression, obsessive-compulsive disorder, etc. with the same ease that we now treat high blood pressure, or strep throat, or hypothyroidism.  The sad truth of the matter, though, is that today's psychiatric medications don't work very well, if at all.  And sometimes they actually make matters worse.

Two excellent books on this subject are, Mad in America, and Blaming the Brain.  If you think that we're living in some kind of golden age of psychopharmacology, then you should read these books.

I don't think I've ever read the Japan Times before, but this is actually a pretty informative and humorous article (and yes, it's in English):  “Instruments of Pain”.  The article reports on research showing that pain is surprisingly influenced by social factors.  Specifically, having an accommodating and sympathetic spouse can actually worsen one's perception of pain.  I really wonder whether something similar might be happening in cases of fibromyalgia, chronic fatigue syndrome, Gulf War syndrome, chronic Lyme disease, post-traumatic stress disorder, and other alleged diseases that might not actually be diseases at all.  The people who claim they're feeling sick might be telling the truth, but perhaps their conditions result from the sympathy extended by friends, family, and society at large.  Just speculation on my part.  Now I'll probably get angry e-mails from people who think I'm callous, and full of it to boot.

Uh oh – looks like pharmaceutical company Schering Plough is in trouble:

Schering-Plough shares down on news of subpoenas

BOSTON - Schering-Plough Corp.'s top executive will retire within months, the pharmaceutical company announced hours after disclosing it had received new subpoenas from federal prosecutors probing its sales and marketing practices.

Shares of Schering-Plough fell 4 percent after the Kenilworth, New Jersey-based company announced on Wednesday Richard J. Kogan's retirement and the two additional grand jury subpoenas from the U.S. Attorney's office in Boston.

It will be interesting to find out all the gory details behind those subpoenas.

Wednesday, November 13, 2002

TAP Pharmaceuticals is caught in yet another flap:

Cancer drug pitched in support groups

In the ferocious scramble to boost sales of its lucrative anticancer drug Lupron, TAP Pharmaceuticals representatives – with the approval of some doctors – targeted potential customers in a particularly vulnerable setting:  prostate cancer support groups.  [...]

The documents filed in the TAP case in US District Court in Boston provide a unique window into the lengths to which drug companies will go to market their products.

“Obviously, they're buying good will,” said George Annas, chairman of the Health Law Department at the Boston University School of Public Health and an outspoken critic of drug company ethics.  But he said there's no excuse for marketing directly to prostate cancer patients, especially in a setting where many of them might be scared and “easy to take advantage of.”

As a proud contrarian and a crotchety middle-aged man, I was tickled pink (well, almost) to learn that having a negative attitude isn't as unhealthy as we've been led to believe.  The BBC reports a new study showing that cancer patients don't receive any health benefits from having a positive outlook on life:

Attitude 'irrelevant' to cancer fight

There is little evidence of a link between a positive mental attitude and a person's ability to survive cancer, researchers have found.  [...]

[The study authors] concluded: “People with cancer should not feel pressurised in adopting particular coping styles to improve survival or reduce the risk of recurrence.”

Health psychologist Dr Jill Graham of the Cancer Research UK unit at St Thomas's Hospital, London, said: “Early research in this area suggested if you had a fighting spirit you would live longer.

“But these studies were very small. Since then we have done much more comprehensive work and looked at much larger studies of women.

“The latest research says that if you're feeling down and depressed you shouldn't panic as it won't affect your recovery or cause a relapse.

“One study looked at women patients who were profoundly depressed for three months or more.

“It was found that they were at no greater risk of cancer returning nor did it lessen their chances of long term survival.

“I think this is really good news for women who no longer need to panic that if they feel very low it will bring the disease back.”

The Boston Globe has a good editorial about the need for more-aggressive action “...against drug advertisements that provide false, misleading, or inadequate information.”

Formerly-fat meteorologist Al Roker claims that obesity is a disease, just like alcoholism.  I'm skeptical on both counts.

Tuesday, November 12, 2002

The Boston Globe has an article about newly-released documents pertaining to the Neurontin scandal (Parke-Davis was caught promoting the epilepsy drug for unapproved uses).  As the article says, “The documents, made public as part of a federal lawsuit against Pfizer, which bought Parke-Davis in 2000, provide a rare look inside a pharmaceutical company's marketing strategy.  They also raise questions about the objectivity of the nation's [Continuing Medical Education] courses and about whether drug companies hire outside firms to do surreptitiously what they're not allowed to do themselves – promote drugs for uses not approved by the US Food and Drug Administration.”

If this article in the New York Post is right, then Big Pharma should be worried about the increasing competition from generic drugs.

Interesting article in the New York Times about myths surrounding suicide.  Among the findings:  alcohol abuse is correlated with suicide (actually, this isn't new).  This article makes me wonder, once again, whether being told that one is powerless over alcohol (A.A.'s first step) is ultimately a beneficial or a harmful strategy.  If you really and truly believe that you're powerless over your addiction, you might be tempted to take drastic actions.  I realize that A.A. tries to put a positive spin on this whole “powerlessness” principle, but I remain unconvinced.

Pharmaceutical companies aren't supposed to throw cocktail parties for doctors.  How to get around this rule?  Simple: just don't call it a cocktail party.

Monday, November 11, 2002

Another example of pharmaceutical money corrupting the medical system:  “A hospital apparently agreed to continue prescribing an expensive prostate cancer drug as long as its manufacturer agreed to pay for, among other things, a Christmas dinner and golf tournaments.  According to the federal grand jury testimony of a former TAP Pharmaceuticals sales representative, the chairman of the urology department at Lahey Clinic once asked for a $2,000 grant for a clinic holiday party to be held at a fancy Boston restaurant.”

Incidentally, this isn't the first time that TAP Pharmaceuticals has been involved in a scandal:

A Whistle-Blower Rocks an Industry

Doug Durand's risky documentation of fraud at drugmaker TAP is prompting wider probes

In his 20 years as a pharmaceutical salesman, Douglas Durand thought he had seen it all.  Then, in 1995, he signed on as vice-president for sales at TAP Pharmaceutical Products Inc. in Lake Forest, Ill.  Several months later, in disbelief, he listened to a conference call among his sales staff:  They were openly discussing how to bribe urologists.

The Boston Globe has an interesting (but kind of scary) article about a pharmacological approach to preventing post-traumatic stress disorder (PTSD).  I really don't think that this is a good idea, especially given the problems surrounding the diagnosis of PTSD.  Derek Summerfield argues that the disease might not exist at all.

Interesting book review in Forbes magazine:

Addictions come in waves.  For a stretch of time a disproportionate number of people in some social class or nation fall prey to a substance like alcohol, cocaine or opium.  Several decades later the epidemic has passed and a period of relative temperance sets in.  The U.S. saw a wave of crack addiction in the 1980s that has to some degree faded.  London had the equivalent in a rage for gin that seized its poor in the 18th century.  A new book by Jessica Warner, a history professor at the University of Toronto and a research scientist at the Centre for Addiction & Mental Health, tells the tale.  Craze:  Gin and Debauchery in an Age of Reason (Four Walls Eight Windows, $25) is the affecting and at times amusing history of an addiction epidemic from an earlier age.

Thursday, November 7, 2002

My non-blog-related obligations are really piling up, so my next update will probably take place on Sunday night, about four days from now.  I really enjoy finding cool stuff and writing about it here (and the rants are cathartic), but sometimes I need to prioritize my responsibilities.  Sorry.

Just a few quickies for today.

Back in June, journalist Heather Ogilvie wrote a good article about some of the myths surrounding alcoholism and drug addiction.  Yeah, I swiped the full text from an electronic database (InfoTrac), but it was for a good cause.  (I also have another, similar article that I Xeroxed from Vogue magazine – of all places – and I'll have to scan it in and post it here.  The Vogue piece is even better.)

We already knew that government sponsored anti-drug advertisements don't work very well.  Now it turns out that government-sponsored anti-teen-sex programs don't work very well, either.  'Course, let's not allow unpleasant facts to stand in the way of good intentions.

A couple of days ago, I wrote a blog entry about an excellent new book I had just finished reading – Authentic Happiness, by Martin Seligman.  Today, I heard about another book that looks promising, and sort-of covers the same material, though in a completely different style.  I'm going to be in my local Barnes & Noble bookstore tomorrow, and I'm definitely going to look for How to Ruin Your Life.  Even just reading the table of contents feels like a swift kick in the pants.

Wednesday, November 6, 2002

Didn't pharmaceutical companies tell the American public that benzodiazepine tranquilizers were safe and non-addictive?  Well, what happened?  Valium and its cousins were the supposed psychiatric wonder-drugs of the 1960s (kind of like Prozac was in the late-1980s through the 1990s).  Still, there was skepticism even back then.  See, for example, research conducted by M. Jagger and K. Richards (1967):

What a drag it is getting old
“Kids are different today,”
I hear ev'ry mother say
Mother needs something today to calm her down
And though she's not really ill
There's a little yellow pill
She goes running for the shelter of a mother's little helper
And it helps her on her way, gets her through her busy day

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

Seriously, though, when I have some more time, I'll have to look for some references to early (overly optimistic) claims made by drug companies in proclaiming the benefits of benzodiazepines.

Tuesday, November 5, 2002

Authentic Happiness (by psychologist Martin E. P. Seligman, Ph.D.) is among the best non-fiction books I've read in the last five years.  I'm not exaggerating.  I have just finished reading this book, and I came away impressed with the quality of Seligman's reasoning and the weight of the scientific evidence that he presents in support of his thesis.  Authentic Happiness is not a lightweight work of platitudes and self-help pseudoscience, like you might expect from the title.  If you haven't read it yet, I highly recommend it.

The reviewer for Canada's Globe and Mail newspaper had this to say:

Pursuing happiness

POSITIVE PSYCHOLOGY:  Dr. Martin Seligman appeals for 'rational optimism'.

Here's a revisionist idea:  Maybe the pills aren't working.

We are inundated with data about depression and antidepressants.  We think and write continually about our own unhappiness.  Since 1981, there has been a 353% increase in prescriptions for antidepressants in Canada, although the population has risen only 1% each year.  But we don't seem to be getting any happier.

Many doctors and scientists are becoming (or remaining) skeptical about better living through chemistry.  It is being quietly suggested that there may be another approach, and it's not a moment too soon – for many of us have become like the rats in those classic experiments on “learned helplessness,” who were given random electric shocks, gave up trying to escape them and finally just passively accepted them.

Surely psychologists should have genuine permanent help to offer.  Instead, we have simple-minded self-help books and heavily marketed antidepressants that are slowly being revealed as disappointments.

But there is one American psychologist who is trying very publicly to change the self-destructive way we look at the world.

[rest of article snipped]

I received my MBA degree from the S.C. Johnson Graduate School of Management, at Cornell University.  The Johnson School was named in honor of floor-wax tycoon Samuel Curtis Johnson, Jr., who had donated $20 million to Cornell back in 1984 (I'm not sure what the business school was called before then).  Imagine my surprise at finding this article:

A corporate icon battles alcoholism

Samuel C. Johnson is one of the United States' richest men, the reigning patriarch of the business family that gave the world Johnson Wax, Raid bug spray, and Glade air freshener.

But when he steps onto a Vancouver stage on Nov. 12, he will be Sam Johnson, recovering alcoholic, an aging man troubled by the fact he never said “I love you” to his long-deceased father.  [...]

[Johnson said:]  “You fall into these traps and I fell into the alcohol trap.  It was kind of a gradual process, it creeps up on you until you don't realize what has happened.  The family finally confronted me and said 'You've got to fix this.' ”

After that meeting in 1992, he checked into the Mayo Clinic and emerged as a member of Alcoholics Anonymous.

The article states that ol' Mr. Johnson made a movie about himself and his family.  Now he's touring the world, showing the movie to people, and talking about his alcoholism.  He even made a stop at his namesake (my alma mater).

Ever wonder why nobody ever comes forward and says, “Yeah, I used to drink a lot, but I quit.  I did it on my own.  I didn't go to rehab or to any meetings.  I didn't turn my will or my life over to the care of God.  I just used some willpower.”?  And yet, that's the way the vast majority of people overcome their addictions.  I don't mind saying that I'm usually irritated by people who get sober and then start proselytizing about their particular path to sobriety.  And in any case, there's something almost Jerry-Springerish about so many people publicly wallowing in their own filth.  Well, OK – maybe that was a bit harsh.  Still, these kinds of public confessions make me feel uncomfortable, especially when they're used to push 12-step programs.

Elderly people tend to use a lot of medications, so it's not surprising that the AARP (American Association of Retired Persons) should be concerned about the state of the pharmaceutical industry.  The AARP Bulletin ran a series of interesting articles about the prescription-drug industry.  OK, I know that this is a lot to digest for one blog entry, but there you go:

Monday, November 4, 2002

Here's a hint to the doctors out there:  If you're going to accept drug-company largesse, don't let your patients see you doing it.

Two good articles via Dr. Michael Lascelles's Pharma Watch (Australia) blog:

The Houston Chronicle reports on an encouraging trend among doctors and medical students.  If we can believe the article, more and more people are refusing to accept gifts from pharmaceutical companies.

Reuters news service reports on a lack of new blockbuster drugs being developed by drug companies.  What the article doesn't mention, though, is that the patent system is one of the reasons for this drought.  An earlier article in the New Republic makes this point.

Back in September, I excerpted part of a news story about a crisis in the nation's mental-health system.  The National Council on Disability had released a report stating that, “The U.S. mental health system is... unable to provide even the most basic services and supports to people with psychiatric disabilities... The fundamental problem:  emphasizing medicating people over fostering ways to help them lead productive lives”.  Now, another government agency has released another report that slams the mental-health industry:

America's system for treating and rehabilitating people with mental illness is in financial and bureaucratic disarray and is plagued by complexities that make it nearly impossible for many patients to receive needed care, according to a report issued Friday by a presidential mental health commission.

The commission's chairman, who called the report an “indictment” of the nation's mental health care system, said that a massive shift in priorities was needed to improve care for mentally ill adults and children.  The report paints a picture of a system plagued by fragmented services and inadequate funding, often losing patients in a maze of complexity.

Interestingly, this latest story makes no mention of how the commission views psychiatric drugs.  What particularly appealed to me about the earlier report was the fact that the Council on Disability was so critical of relying on psychiatric drugs.  It's far easier to write a script for Prozac or Risperdal and send a patient on his way, than it is to really find out what specific life factors are contributing to the patient's malaise.  More about this below.

The New York Times has a long and depressing (but nonetheless interesting) article about the psychiatric emergency room at New York City's Bellevue Hospital.  (Boy, I bet that anybody who works there will quickly accumulate a lifetime supply of stories to tell at cocktail parties.)  The article describes two patients:  a man who stabbed his wife, and a woman who hears voices.  Both patients seem to be very disturbed, and they both receive prescriptions for an antidepressant.  Quick and easy.  Even if you believe that antidepressants work better than placebos (which I don't believe), you have to wonder how much of a dent these drugs will make in the patients' problems.  To be fair, the article states that patients are given treatment beyond just medication, but I wonder to what extent this is true (especially given the situation described in the blog entry above).

Sunday, November 3, 2002

The Los Angeles Times has an interesting article about rapid detox – a way for opiate addicts to get clean and sober in 48 hours.  Sound too good to be true?  A lot of people think so, and I don't really blame them for being skeptical.

Still, the skeptics are exhibiting a bit of hypocrisy, or at least inconsistency.  The article quotes medical personnel who say that they can't in good faith recommend rapid detox, because the procedure hasn't been shown to be effective.  Well, fine – but what can they recommend, then?  Traditional, 28-day rehabs are largely ineffective – and very expensive to boot – but plenty of doctors recommend rehab to their alcoholic/addicted patients.

I'm moderately enthusiastic about the rapid-detox approach, if only because I think it's important for society to start exploring alternative methods of treating addicts (and alcoholics).  I long for the day when places like the Betty Ford Center become viewed as an anachronistic embarrassment.  I'm not at all surprised that drug addicts don't respond well to a month of quasi-religious indoctrination (Alcoholics Anonymous / Narcotics Anonymous) and group therapy.  Oh, lots of people might think that it's effective, but studies show otherwise.

In short, I'm glad that rapid-detox is attracting some attention, and I hope that other non-12-step-based approaches continue to be developed.

Also about addiction, and also in the Los Angeles Times:  a new study claims that acupuncture is quite effective at helping people quit smoking cigarettes.  Well, maybe.  I remember back a few years ago a preliminary study supposedly showed that acupuncture could help cocaine addicts break their habit.  This spring, though, a much larger, better-designed study showed no effect.  I'm not opposed to the study of acupuncture, but I doubt that – in the final analysis – it will prove to be good for much of anything.

Saturday, November 2, 2002

The Boston Globe reports, “The Food and Drug Administration has ordered Biogen Inc. to stop using certain promotional claims for its top-selling multiple sclerosis drug, Avonex, that the agency deemed either misleading or unsubstantiated.  In a letter dated Oct. 24 and posted on its Web site this week, the regulatory agency cited several examples from marketing materials to patients and physicians that it said violate federal regulations.”  I suspect that the FDA could issue a lot more of these decisions if the agency wasn't so under-staffed.

OK, fair is fair.  In Thursday's blog entry, I chastised the anti-drug-abuse industry for blindly and persistently adhering to ineffective programs – both prevention and treatment.  Now, the Associated Press is reporting on a new study from the University of Akron, showing that a revamped version of D.A.R.E. (Drug Abuse Resistance Education) might work at preventing children from using drugs.  The standard version of D.A.R.E. either does nothing or actually makes matters worse.  Still, this is only one study, and it's not clear that the people who run D.A.R.E. will ever incorporate the results into the actual program as it is used in schools across the country.

Reuters news service reports on an article recently published in the British medical journal The Lancet:  “Drug firms have become the largest sponsors of medical research, generating vast amounts of valuable information through their efforts – but the companies' enormous control over when, where and how that data is reported may not serve patients' best interests...”.  The full text of the original report is available on the Lancet's website.  The title is, “The pharmaceutical industry as an informant”.

A study from the University of Michigan shows that exercise and cognitive-behavioral therapy (either alone or in combination) can help alleviate the symptoms of Gulf War syndrome.  The article doesn't mention this fact, but exercise and cognitive therapy can also be used to treat depression.  Coincidence?  I admit that I don't really know much about Gulf War syndrome, chronic fatigue syndrome, fibromyalgia, or (alleged) chronic Lyme disease, but I've always suspected that these are not real, distinct illnesses.  I bet that they can be explained by some combination of malingering, hypochondriasis, depression, and perhaps other psychiatric conditions.

Drug company Pfizer has agreed to pay $49 million to settle allegations that Parke-Davis (a subsidiary of Pfizer) defrauded the government by overcharging for the cholesterol-lowering drug Lipitor.