Big Pharma and the buying of psychiatry
www.americanprospect.orgVolume
13, Issue 13. July 15, 2002.
The Going Rate on Shrinks
Big Pharma and the buying of psychiatry
E. Fuller Torrey
It was last summer in Berlin when I first encountered pharmaceutical funhouses.
I was one of 4,000 attendees at the 7th World Congress of Biological Psychiatry.
Until about a decade ago, pharmaceutical companies passed out pens or notepads
with their companies' logos at such events, and most speakers presented data and
opinions based upon their true scientific beliefs.
That all changed when Big Pharma took over. At the congress, I counted 15 major
displays on the way to the lunch area, including an artificial garden (Janssen-Cilag),
a brook running over stones (Lundbeck), and a 40-foot rotating tower (Novartis).
Almost all offered free food and drink, T-shirts, or other inducements designed
to get psychiatrists to pause so that an army of smiling sales representatives
could give their sales pitch.
Eli Lilly's display included two large, walk-through tunnels set up like
funhouses. One tunnel, labeled "Zyprexa," included a mirrored room with dozens
of telephones dangling from the ceiling. Was Lilly trying to convince me that
God was calling, telling me to prescribe Zyprexa? The sales representative said
no, the phones were meant to illustrate the communication problems common in
schizophrenia, which Lilly claims Zyprexa improves. The other funhouse, labeled
"Prozac," featured a 10-foot mouselike creature sitting in front of a blank
television screen. I asked whether Lilly was recommending Prozac for mice. The
representatives said no, the creature was really a depressed man who needed
Prozac.
My favorite display, by the Dutch firm Organon, advertised Remeron, an
antidepressant. It featured a small, multihued tent with purple doors and the
painted head of a genie. Inside, a red-robed young woman with sprinkles in her
hair was taking Polaroid pictures, one by one, of psychiatrists who had waited
patiently in line for 20 minutes or more. This was no ordinary picture but
rather a snapshot of one's aura, taken, as the Organon brochure noted, "with
advanced biofeedback equipment." The equipment consisted of two small machines,
on which I placed my hands. The result was a picture of my head peering out of a
red, orange, and yellow cloud.
According to the brochure, "the aura colors give you information about your
appearance, character, talents, and future energy." After taking my picture, the
red-robed young woman escorted me to a yellow-robed young woman with even more
sprinkles in her hair. "Hi! My name is Amber," she said, and proceeded to
interpret the picture of my aura as indicating intelligence and good judgment,
although with some hints of skepticism.
I privately asked the Organon sales staff if they thought it wise to associate
their product with auras, magic, New Age thinking, and anti-science. They said
the decision had been made at "a higher level" but pointed out that the waiting
line was an ideal place for engaging psychiatrists in brief, friendly chats
about the virtues of Remeron.
This is, after all, big business. Antidepressant and antipsychotic drugs are
among America's top-selling pharmaceuticals. Last year Prozac and Zyprexa
accounted for almost half of Eli Lilly's total sales. Sales of antipsychotic
medications have quadrupled in the past four years to more than $4billion. These
drugs are a major reason why the profitability of the 11 pharmaceutical
companies in the Fortune 500 "was almost four times greater" than the median for
all Fortune 500 companies during the 1990s, according to a report by the Public
Citizen Health Research Group.
Not surprisingly, psychiatrists have become a prime target of pharmaceutical
companies' marketing, because prescription drugs can't be sold directly to
consumers. In the United States, pharmaceutical companies spend an estimated
$8,000 to $13,000 per physician per year on marketing.
At professional gatherings, of course, one must offer the attending psychiatrist
more than an opportunity to view one's aura. The Berlin Congress offered 136
symposia plus workshops and lectures. Of these, 23 were clearly labeled as being
sponsored by pharmaceutical companies; all focused on drugs to treat psychiatric
disorders. Several other industry-sponsored talks had no disclosure of the
sponsorship.
Each brought in two to four psychiatric experts, whom the sponsoring
pharmaceutical company usually gave business-class air tickets, four-star hotel
accommodations, and an honorarium, typically $2,000 to $3,000. If the expert
organized the symposium, the payments went as high as $5,000, and higher still
if the expert presented data very favorable to that company's drug (or at least
presented unfavorable data in a very favorable light). One American expert was
paid $10,000 last year to fly to Europe to give a single lecture.
Symposia and workshops on subjects not directly concerned with drug
prescriptions had little, if any, industry support. The speaker at one such
symposium, which was lightly attended, said he "felt like the legitimate act at
a burlesque show, included only to keep the cops out."
Honoraria and future invitations are directly dependent on how experts present
their data. Emphasizing adverse effects of a drug, for example, may well cost
the expert a trip to future congresses. Some of the psychiatric experts
sponsored by a pharmaceutical company are also on the company's speakers bureau;
many own stock and thus have a direct financial interest in the success of the
company's products.
The ultimate targets for this pharmaceutical extravaganza, of course, are the
practicing psychiatrists who constitute the vast majority of attendees. Although
meeting officials won't provide precise numbers, they acknowledge that
pharmaceutical companies had sponsored more than half of the attendees.
Sponsorship normally includes coach-class airfare, hotel accommodations, and
registration fees as well as special receptions and parties, some literally with
dancing girls.
Pharmaceutical companies in many countries can now use computerized pharmacy
databases (which delete the names of the patients) to track how many
prescriptions any given physician writes for any given drug. So Eli Lilly could
sponsor Dr. Smith from Detroit or Manchester, send him to Berlin, and then
monitor his prescribing pattern following the congress. If Dr. Smith's
prescriptions for Zyprexa and Prozac do not increase sufficiently, a company
representative can remind him how well he was treated in Berlin. And besides,
isn't he interested in going to Copenhagen next summer?
There is clear evidence that attending conferences such as the Berlin meeting
does affect the prescribing practices of physicians. In one U.S. study, 10
physicians were invited by a pharmaceutical company to attend "all-expenses
paid" symposia at "popular Sunbelt vacation sites." The company tracked the
physicians' prescribing patterns for two drugs, for 22 months before and 17
months after the symposia. Though the physicians had predicted that their
attendance would not affect their prescribing practices, their prescriptions for
one drug increased 87 percent and for the other, 272 percent. Other studies have
shown that attending drug-sponsored education courses affects drug-prescribing
practices, even though the physicians deny it. Indeed, if it were otherwise, why
would pharmaceutical companies sponsor such activities?
Does any of this really matter? It does, for two reasons. First, patient care
suffers when physicians are misled. Psychiatrists trying to evaluate
schizophrenia drugs are not told that the expert who minimizes the side effects
of Zyprexa receives a $10,000 retainer from Eli Lilly and also owns substantial
company stock. Or that the psychiatric expert claiming that Remeron reverses
depression more rapidly in suicidal patients receives $75,000 per year from
Organon to support his laboratory.
Second, the hoopla adds to the cost of drugs. Payments to aura interpreters and
dancing girls are simply passed on to patients. The pharmaceutical company costs
for the Berlin congress were at least $10 million. According to a recent report,
in 2000 the 11 pharmaceutical firms in the Fortune 500 "devoted nearly three
times as much of their revenue to marketing and administrative costs (30 percent
of revenue) as to research and development (12 percent of revenue)."
Plainly some changes are in order. Reform should start with medical students. As
one observer summarized it in The New England Journal of Medicine: "Medical
training should not include acquiring a sense of entitlement to the largesse of
drug companies." Pharmaceutical companies should be banned from giving gifts to
medical students and residents; the free pizza from the drug representative may
seem trivial, but it sets a pattern that rationalizes accepting a free trip to
Berlin later on. Practicing psychiatrists should get their continuing education
from objective sources, not from drug "detail" (marketing) persons and
industry-sponsored talks. Vermont has just made a modest beginning with a law
requiring disclosure of all drug-company gifts to doctors valued at more than
$25. The profession's ethical standards should prohibit experts who are involved
in drug trials or giving talks at symposia from owning stock in pharmaceutical
companies. Unfortunately, most of the profession's organizations, such as the
American Psychiatric Association, are themselves so indebted to drug companies
that they are unlikely to lead reform.
For speakers at symposia such as the Berlin meeting, the solution is simple.
Prominently displayed next to the speaker's lectern should be a sign reading:
"For this talk, Dr. Smith is being paid $3,500, business-class airfare, and
four-star hotel accommodations by Eli Lilly and Company."
E. Fuller Torrey
Copyright © 2002 by The American Prospect, Inc. Preferred Citation: E. Fuller
Torrey, "The Going Rate on Shrinks," The American Prospect vol. 13 no. 13, July
15, 2002. This article may not be resold, reprinted, or redistributed for
compensation of any kind without prior written permission from the author.
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