How Florida Fell In Love With Antipsychotics
9 CommentsBy Ed Silverman // April 14th, 2008 // 7:49 am
Four years ago, Lilly and several other drugmakers proposed the creation of The Florida Behavioral Health Collaborative. And they provided $10 million to the state to get it up and running. Soon, an expert panel was convened and recommended state standards, and national scholars with financial ties to drugmakers that sell atypicals were invited to participate, according to The Tampa Bay Tribune.
To treat schizophrenia, the panel decided docs should first try an atypical - a newer generation of meds that includes Risperdal, Seroquel, Zyprexa, Geodon and Abilify. If that didn’t work, they should try a different atypical. If that still didn’t work, they should try a third atypical or one of the older generation drugs, the paper writes. A Lilly spokeswoman tells the paper the goal was not company profit, but patient care: “Patients always must be the top priority. It can’t always be about the bottom line.”
Last July, the collaborative convened another panel to revisit whether Florida should rely so heavily on atypicals. By then, the CATIE study found atypicals generally were no more effective than older drugs and were linked to weight gain and diabetes. One host was Rajiv Tandon, chief of psychiatry for the state Department of Children and Families and a former University of Michigan professor who was once a consultant and speaker for drugmakers that sell atypicals. The other was Robert Constantine, head of the collaborative and a research associate professor at USF’s mental health institute, who is partly paid through a grant from Bristol-Myers Squibb, which sells Abilify.
Tandon tells the paper the experts he invited as voting members were knowledgeable and respected with a working knowledge of med guidelines. Because most experts have ties to drugmakers, Tandon explains, conflicts of interest are inevitable. “There are clear conflicts of interest,” he says. “Everyone is biased. For someone to say, ‘I’m not biased,’ they are not truthful or they are not introspective.”
Given that there is a divide in the academic world about atypicals, the Tribune asks why not bring in someone from the other camp, maybe somebody from the CATIE study, someone who would challenge the existing medications model? “You could go with extremes,” Tandon says. “I didn’t think that was the way to go,” because the point of the process is to reach a consensus.
“Were the benefits of atypical medications exaggerated? Absolutely. And was it the pharmaceutical companies doing that? Absolutely…By no means are the newer medications astoundingly better, but they are better.
The outside experts were…
• William Glazer, who was brought in as the schizophrenia expert, is president of Glazer Medical Solutions, a national consortium of mental health care consultants. He is a consultant to Eli Lilly and AstraZeneca.
His company Web site makes clear his bias: “Are you interested in building a case for the value of new atypical antipsychotic medications? This section offers a step-wise approach to help providers, family members, consumers and others advocate for access to these agents.”
• Madhukar Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center, is a consultant, serves on speakers bureaus or receives research money from 24 drugmakers, including all the atypical makers.
• Terence Ketter, a professor of psychiatry and behavioral sciences and chief of the bipolar clinic at Stanford University, is a paid consultant or a lecturer for all the drugmakers that make atypicals.
• John Greden, chairman of the psychiatry department at the University of Michigan Medical Center, serves on scientific advisory boards for five drugmakers, including two that make atypicals.
More than a dozen Florida mental health officials sat on the committee, many of them adamant that the newer drugs generally offer a better alternative to the older ones. They said they feared that if they put the older drugs alongside the newer ones as front-line options, HMOs might require them to go with the cheaper option, the Tribune writes.
To treat schizophrenia, the previous expert panel had made atypicals the first and second options. For the third option, doctors were left to decide whether to try a third atypical. This time around, the paper notes, the group kept atypicals the first option. As a small nod to CATIE, the group voted on a recommendation that if that first atypical failed, a doctor should try either a second atypical or an older-class, typical drug. Asked for a show of hands, all were raised in favor.
Source: The Tamba Bay Tribune
Joan
What exactly is an atypical? I could use some definition and context here.
Ed Silverman
Hi Joan,
I’ve added a line that, hopefully, answers your question. Thanks for asking.
ed
Duane Sherry
Great article.
The atypicals are actually WORSE than the older ones.
People with ’schizophrenia’ used to die on average 10 to 15 years earlier than the general population.
Thanks to the newer ‘atypical’ antipsychotics, that has turned into 25 years less. Could it be the ‘new drugs’ that these people have been persuaded, coerced, or sometimes legally forced to take? Maybe we should find out…..
I know one thing for certain - the cozy relationship between the FDA and Big Pharma is criminal.
It’s time for full investigations by the US Attorney General’s office - everyone deserves a fair trial - even the major CEO’s of Big Pharma.
After the fair trial, it’s time for the Big Pharma CEO’s (who will be convicted in my opinion - by any jury with any common sense) to go to jail.
Duane
jackie
Given that the atypicals are more likely to cause diabetes in patients, it is near criminal to require that an atypical be prescribed first. A decision as to whether a patient is at risk for diabetes or could otherwise be harmed by use of an atypical is the first decision that should be made.
HorusCat
Whoa, people. All of the atypicals do not present the same risk. Geodon has little weight gain and has not shown any signal of increased diabetes risk. Abilify is similar. The evidence for diabetes and Risperdal/Seroquel is equivocal.
None of these drugs are without VERY serious risks. Tardive dyskinesia with the typicals is a very real concern–have you ever seen a person moving their mouth like a chewing rabbit constantly?
What trials like CATIE don’t measure are patient satisfaction with their meds. Adherence to a med regimen is a poor surrogate for patient satisfaction. Many patients feel better on the atypicals, and physicians DO consider the patients’ desires when prescribing.
I sold against Zyprexa for years. The most persuasive argument physicians made for prescribing it is that is works and the patients feel good on it. That is not Lilly telling the doc that the patient feels good; it is the patient saying they like the way they feel on the med.
The CATIE trial was informative, but hardly shocking to anyone who works with these meds and patients every day. We all knew the typicals and atypicals have the same efficacy. We also all know that compliance with oral meds is terrible. (Compliance is an issue with all patients, not just the mentally ill.) CATIE, as I said, did not measure patient satisfaction.
Perhaps the proof of this will be forthcoming soon: Risperdal goes off patent imminently, and Zyprexa and Seroquel are soon to follow. Will docs shun them once there is no one marketing them and return to the typicals? I doubt it.
Duane Sherry
Geodon is not a safe medication - None of them are.
A strong statement?
Perhaps, but I almost lost my son on Geodon.
The problem with each of these meds is how short the clinical trials are - some are only for weeks, or perhaps a couple or few months.
But, we are talking about giving people medication with addictive properties that are surreal.
How many people ever get off of them? Very few, and it’s life-threatening to do so any faster than 10% at a time - most doctors don’t know this.
The other problem is that people are routinely given one drug, only to have it replaced with another. According to Wolfgange Saddee with Ohio State Medical - by the time we know about the efficacy of a drug - ‘irreparable harm’ is done.
And so, we are doing nothing more (and nothing less) than subjective guess-work based upon symptomology - hardly scientific….
Read ‘Your Drug May Be Your Problem - How and Why to Stop Taking Psychiatric Medication’ by Peter Breggin, MD - Psychiatrist, Harvard Medical School Grad - called “the conscience of American Psychiatry”.
People get ‘better’ on these psychotropics?
The doctors and families see things like tardive dystonia as a symptom of the ‘illness’ - when it’s a side-effect of the medication - these side effects show up somewhat rarely in short-term clinical trials, but go out the roof after long-term use - and doctors, psychiatric nurses, social workers and counselors do not even know that these are side-effects.
Start with the book - and see if you ever see ‘medical compliance’ in quite the same way as it pertains to psychotropics…..
We keep talking about weight gain, and diabetes. These drugs damage the brain itself - they interrupt messaging from the basal ganglia to the frontal cortex - they actually cause parts of the brain to shrivel away…..
Hard to wrap your head around at first (pardon the semantics), but true……
The days of Thorazine were much more comfortable for the psychiatric patient - the new ones are a lot worse - they are literally killing people…..
‘Woahh, back off’??? - Not this kid - not until there are criminal investigations by the US Attorneys Office - not until justice is served.
I almost lost my son to Geodon - he turned into a ‘zombie’ and it took months to get him back…..and I know similar stories around the country…..and people are being forced to take these meds…..and some families are not as fortunate as we were - some of their sons and daughters die.
Duane Sherry, M.S. CRC
http://discoverandrecover.wordpress.com
Sam
Lets face facts - there is no cure for schizophrenia! All these drugs are nothing but chemical straight-jackets. According to an NIH study performed without any financial aid from PHARMA, it was shown that the older, generically available psychotropic drugs were as good if not better than the new very expensive, overpriced new drugs. All of these drugs have side effects and the new drugs cost this country $10 billion a year. What happened in Florida is a copy of what happened in Texas about 8 years ago and it cost Texas hundreds of million of dollars.
Nothing changes - over a hundred years ago, charlatan salesmen drove their
horse driven wagons to small towns and sold bottles of snake oil. If you rubbed it on your head, it grew hair.; on body joints, it took care of arthritis
and sore muscles. If you applied to your skin, it cured the heart-break of
psoriasis.
The FDA should be sued for approving PHARMA chemically developed drugs
whose therapeutic effectiveness is suspect and cannot show vast improvement over older drugs.
Sam R.Ph.
Duane Sherry
Sam,
Thanks for being bold enough to use the term ‘chemical straightjackets’ - that’s exactly what these meds are.
Constantly amazed at the denial involved - can parents not see their own children turn into ‘zombies’ - or are they so convinced that medical doctors know best, they are unwilling to believe what they see with their own two eyes.
Regarding ’schizophrenia’ - a collection of symtpoms does not a disease make - in spite of what our conventional medical model insists. Individuals recover from these symptoms all the time - in various ways - depending on the source of the symptoms. There can be trauma behind these symtpoms, along with an inability to properly absorb various amino acids, and/or specific vitamins. Many times, when the trauma is dealt with, and/or the underlying physical condition, recovery is possible.
We are afterall, talking in large part about the human ‘pscyhe’ - Conventional medicine may have cornered the market and created a monoopoly on a large part of our medicine, but not on the The Pennsylvania Gazette’spirit’ of an individual, nor that person’s ability to rise to the challenge of even such horrific symptoms as ’schizophrenia’.
Duane
Duane Sherry
not sure why ‘Pennsylvania Gazette’ got before the word ’spirit’ - must have been a ‘copy and paste’ gliche -
Duane