Big Pharma and their Cuckoo’s Egg in the Nest of Science

Our fellow WordPress.com blogger, James Ridgeway, has been looking into the fuzzy boundaries that exist between pharmaceutical companies and psychiatry. See his reporting here.

The reporting by James prompted me to look into this matter more extensively. In the spirit of full disclosure, I have been to trainings put on by pharmaceutical companies in backwater places like Orlando, Florida [where one could presumably bring along the family to do the Disney Experience while you, the participant, toiled away]. These trainings were held in hotels where they asked $30 for a glass of wine and I couldn’t detect that they felt any shame in doing so. Though wine wasn’t supplied, many a not too cheap meal, and lavish hotel rooms were provided by the international pharmaceutical giant whom I won’t name.

In his section of a debate in the aptly titled article, “Is academic psychiatry for sale?”, David Healy covers the history of how pharmaceutical companies came to have such major influence over the activities of psychiatrists in academic settings ( Healy & Thase, 2003). Three trends beginning in the 1970’s led to the fuzzy boundaries that exist between academic psychiatry and Big Pharma. The first was a restructuring within pharmaceutical companies whereby marketing and sales departments were separated. This in turn led to the emerging of contract research organizations which replaced universities as the organizers of clinical trials. Also appearing at about this same time were medical writing agencies, who now write the first and often subsequent drafts of research reports. Senior academics make superficial instead of meaningful contributions to these research reports that bear their names and formerly good reputations.

Standing in the way of empiricism and “real science” is the fact that Big Pharma companies consider the data they collect as proprietary. Clinicians are only given small subsets of data. This “research” has the appearance of “real” research, and it gets published into prestigious journals. But as Healy states: “It certainly has the appearance of science, but it is a cuckoo’s egg in the nest of science” (Healy & Thase, 2003, p. 389).

Healy summarizes the sorry state of affairs by concluding:

At present, journal editors seem to be the fall guys who, equipped with the shovels of conflict of interest statements and the brooms of authorship declarations, are expected to clean out the Augean stables of an increasingly compromised academic literature, when what is need is a breach in the dam of academic silence and a flood of refusals to accept that publications that involve data that are not publicly available should be called scientific. A failure to take a stand will leave us repeatedly cuckolded by every issue of our major journals (Healy & Thase, 2003, p. 389).

Reference:

Healy, D., & Thase, M.E. (2003). Is academic psychiatry for sale? British Journal of Psychiatry, 182, 388 – 390.

Just as an ending note, meta-analytic reviews have consistently shown that those studies sponsored by pharmaceutical companies  report a larger effect size (greater effectiveness) for the drugs they produce than those studies which are not sponsored by pharmaceutical companies that made the drug under investigation.  This finding holds even when double blind conditions are in effect (which are supposed to limit the apparent bias that looks to be creeping into these results).  Makes ya go, “Hmmmmm???”

7 Comments

Filed under Healthcare, Other blogs, Psychology Ramblings..., The Economy, Universal Healthcre

7 responses to “Big Pharma and their Cuckoo’s Egg in the Nest of Science

  1. lilacluvr

    I work for a closed-door pharmacy that services nursing homes, home health, hospice, assisted living, etc. We have pharmaceutical reps bringing lunches in constantly. Then on top of that, they bring in Sonic cold drinks or Ben & Jerry’s ice cream pints during the summertime for our snacks.

    And I always ask why are they marketing to a pharmacy? We are only filling what the doctor’s prescribe. And the answer I get back is, why not and just enjoy the free food.

    It has become such a common practice that nobody even thinks about it anymore.

    I remember when my husband and I first started working in healthcare, there was no television advertising of any doctors or pharmaceutical drugs. Now they are everywhere. We’ve all seen the commercials asking people if they have this symptom or that symptom and then proudly exclaims how their particular drug will help. They even encourage people to have them ask their doctor for the drug by name.

    It’s all about money.

  2. Sounds just like the local bank that handled our 401k’s for Mass Mutual.
    While watching our supposed retirements dissapear they treated the office workers to stuff weekly. In the same respect, anything left will be spent on meds as we age.
    Psychiatric drugs, not cheap.
    List price for one month’ cymbalta? $180.

  3. iggydonnelly

    With psychotropic meds I think big Pharma is counting on two things given that community samples suggest that the incidence of cases (new cases each year – a public health construct) are few, e.g. the number of pediatric bipolar cases is supposed to be 1% of children and adolescents:
    1) those with the given disorder will be life-long customers; and
    2) the disorder is going to be over-diagnosed.

    The latter is a lot more likely to happen if there are reasonably effective drugs for the condition and given that there are not any known risks for prescribing. The only problem with the foregoing is that we have no idea about the long term effects of using mood stabilizing medications (for example) with children might be.

    I think managed care with their emphasis on quick fixes are also partly responsible for the above problems.

  4. jammer5

    One out of 150 kids is diagnosed with Autism today. I have a serious problem with that number, but the big Pharma sure doesn’t. In fact, it is in their, and their shareholders, interest to make sure that number goes even higher. But try telling the truth to parents. It’s the never-ending story all over again.

  5. lilacluvr

    jammer. I also have to wonder about the true number of autism cases.

    But a majority of the ‘special needs’ kids I’ve been told (and my son-in-law works with them for USD 259) are labeled as such because of behavior problems.

    Are their behavior problems because of some medical problem or simply lacking in parental control and a healthy home environment? Is it caused by drug use by the mother during her pregnancy?

    My son-in-law sees alot of cases where there has been physical and sexual abuse, which is bound to affect the child’s mind.

    One thing I do know, once they are labeled – they carry that with them for life. And the bigger the label – the more funds USD 259 receives to school that child. Perhaps this is the reason for an increase in the number of cases?

    More cases = more money for the doctors, pharmaceutical companies, school districts?

    And what is sad, to me, if what if a child is mislabeled? That child will eventually adapt to their environment and never have the chance to climb out of their mislabeled diagnosis. And that would be sad – don’t you think?

  6. iggydonnelly

    That is an excellent observation jammer. Big pharma is not just in the business of selling solutions to problems, they are also in the business of selling problems, for which they claim to have a solution.

    In the article I cite above, the guy I quote says in 2002 Big Pharma spent 10,000 pounds (English money) per physician in the United Kingdom to educate them on the diseases for which they claim to have answers.

    Cue up… Pink Floyd’s “Money….”

  7. iggydonnelly

    Big Pharma marketing gets involved in the early phases of compound development. They remain involved throughout development, testing, and eventual marketing.

    Profit, huge profits in fact, guide this important “healing” industry. If one is a free-market drone, you see this as dynamic, creative, and ultimately good for service. I think, instead, we end up with a lot more crap than we need.

    I propose that until we have socialized medicine in place, we will be swimming in this cesspool free market health care. Just my humble opinion.