The Atypical Antipsychotic War

By John M Grohol PsyD

Robert Farley of the St. Petersburg Times had an excellent in-depth piece about the war to increase prescriptions of atypical antipsychotics in America. I say “war,” because it really seems like there was a concerted, although perhaps not coordinated, effort to change the thinking about the best course of treatment for people with disorders like schizophrenia.

Typically, drug companies are happy to publish the studies that show their drugs are superior to others’, and then hand that over to their sales and marketing team to do the hard sell to the doctors and consumers (through office visits, seminars and direct-to-consumer advertising).

But in the case of atypical antipsychotics — drugs that are significantly more expensive than those they are intended to replace, yet no more effective — the drug companies went one creative step further. They organized state by state working groups stacked with experts who were either funded by the same drug companies, or had been in the past. The panels published guidelines that — surprise, surprise! — recommended the newer, more expensive atypical antipsychotics over the older, cheaper medications. Even though they didn’t work any better and had their own potential negative side effects — weight gain and diabetes.

Even after large scale clinical trials done by independent researchers, such as the ground-breaking CATIE trials, showed that newer antipsychotics really weren’t any better than the older ones, these policy-making groups still kept to their recommendations — atypicals first, then consider others. A British study published after CATIE also mirrored the CATIE study’s findings.

But then people started noticing these biased working groups recommending the same drugs from the makers that funded the panels and everyone who sat on the panels:

“They got expert opinion to be the deciding factor,” Jones [a whistle-blower] said in an interview. “Essentially, the drug companies could pay people to say what the drug companies could not claim themselves,” namely that they were superior to the older generation of antipsychotics.

“It was a concentrated, deliberate attempt to substitute illusion for science.”

A company spokesman denied it. “Janssen has always been committed to the highest ethical standards and responsible behavior … and this includes clear, FDA-approved information about the product’s efficacy and safety profile.”

Jones was not a lone wolf. The Texas attorney general joined his lawsuit in 2006 and demanded the return of tens of millions of taxpayer dollars.

The still-pending lawsuit has reverberated around the country. Nine states sued Eli Lilly, four sued Janssen, two sued AstraZeneca. Dozens more states have teamed in a joint investigation, seeking billions of dollars in restitution for money they say they overpaid for atypicals through Medicaid.

It’s a long article, but if you’re interested in the backroom workings of how atypicals suddenly moved up the prescription chart to become one of the top types of psychiatric medications prescribed in just a few years’ time, you’ll enjoy it.

The saddest take-away from the article, for me anyways, was how few policymakers it took to “influence” in order to get the recommendations that were favorable to the same companies funding the groups. And how nobody noticed any of this going on at the time.

Read the full article: Drug research: To test or to tout?

Dr. John Grohol is the CEO and founder of Psych Central. He has been writing about online behavior, mental health and psychology issues, and the intersection of technology and psychology since 1992.