NEW ORLEANS -- It was 95 degrees with 99 percent humidity.
The Gulf had the biggest oil spill in US history. And attendees to last week's
American Psychiatric Convention (APA) annual meeting in New Orleans had to
brave 200 protestors chanting, "No drugging kids for money" and
"No conflicts of interest" to get into the convention hall.
Since 2008 when
Congress investigated some APA psychiatrists for alleged pharma conflicts of
interest, more light has shone between the two groups, historically almost
Participants at this
year's meeting, estimated at 14,000, saw conflict of interest slides before
presentations and, in their 240-page program book, fewer pharma-funded classes
and entertainment and no gifts or free meals at the five-day event.
"They used to
wine us and dine us," said one participant, a veteran of decades of annual
"An SSRI maker
flew my entire group to a Caribbean island," remembered a doctor from the
East coast who did not want to be identified. Anymore.
But polarizing figures
were still present. Sitting next to outgoing APA president Alan F. Schatzberg, MD, even as protestors
chanted outside, was Charles Nemeroff, MD, former psychiatry chairman at
Emory University who was investigated by Congress for unreported
GlaxoSmithKline income and left his post in disgrace. Nemeroff was signing the Textbook of Psychopharmacology which he co-edited with Schatzberg, also investigated by Congress.
Schatzberg, psychiatry chairman at Stanford, consults to seven drug companies, owns stock and patents with others
and is on Sanofi-Aventis' Speakers Bureau, according to the meeting's Daily
Heading a symposium about schizophrenia was S. Charles Schulz, MD, psychiatry chairman at the
University of Minnesota who was investigated for financial links to AstraZeneca
believed to alter his scientific conclusions.
Presenting a poster
about the benefits of long acting risperidone
was Wayne MacFadden, MD, AstraZeneca's US medical director for Seroquel until
questions about his alleged sexual affairs with women doing research on the
And a paper presented about attention deficit hyperactivity disorder
(ADHD) was co-written by Harvard's Joseph Biederman, MD, also investigated by
Congress for pharma financial links and considered the father of the pediatric bipolar disorder craze.
Despite the pharma
thaw, exhibition displays were still pretty gee-whiz with Cymbalta, Seroquel
XR, Abilify, Lunesta and Pristiq the most prominent. (A rep struggled to
explain to a group from Columbia that Pristiq was not, repeat not, just a more
expensive Effexor.) ADHD drugs was also big. "Let's be as brave as the
people we serve" said a Shire display, showing a patient's giant, valiant
face; another of its displays reconstructed a children's bedroom to sell
But where take-one
signs once existed, signs now warned health care providers they may be governed
by no gift policies. And whereas glad-handing reps were still eager to answer
questions -- once they scanned badges for marketing data -- pharmacodynamic and patient care
questions were referred to an information booth with a line to, well, see the
Nor was there a star
of the show. The Next Big Thing was not a new drug at all but adjunctive therapy also known as adding existing drugs to existing drugs because they don't work right. Throwing good drugs
after bad, popularized with the antipsychotic Abilify, has only been enhanced
by a study in the January JAMA that found antidepressants don't work for mild
depression at all. Antipsychotics are also being "enhanced" by adding
drugs to offset weight gain and lethargic side effects.
No wonder panelists at
a forum called "Is a Game Changing Psychotropic Too Much to Expect?"
assailed pharma for issuing "me too" drugs and "seat of the
pants" drug combinations, calling the industry nothing but a
No wonder a Canadian
physician castigated the FDA's Jing Zhang for approving drugs for
"competitive reasons" not patient health in a symposium about
comparative drug effectiveness. "In a recent transcript on your web site,
Dr. Laughren [FDA director of psychiatry products] clutches at studies to try
to approve a new drug on behalf of industry," he charged. "FDA's
non-inferiority studies in which a drug can be less effective than an existing
one and only beat placebo, present the 'patient risk' of a drug not
working," he said.
But elsewhere drugs
were given a better spin.
Ann Childress, MD,
gave a veritable commercial for the ADHD drug Vyvanse, manufactured by Shire on
whose Speaker's Bureau she serves. And the Wyeth funded C. Neill Epperson, MD,
appearing with Wyeth Speakers Bureau member Claudio Soares, MD, actually told a
clinician not to trust a pharmacist
for a hormone preparation but to use pharma's drugs in a symposium called
"Mood, Memory and Myths: What Really Happens at Menopause."
Biodentical hormones, compounded by pharmacists, have been a revenue threat for
Wyeth's menopause drugs. (The seminar devolved when breast cancer patients in
the audience discussed their health status.)
If there were a take
home message at the APA meeting about the blizzard of ADHD, bipolar and
personality disorders threatening adults and children, it was don't wait. These dangerous conditions,
likened to cancer and diabetes, won't go away.
Thanks to genetic advancements,
psychiatric disease risks can now be detected and treated before symptoms
surface, said presenters, fostering early treatment paradigms that are pretty
Brave New World: People being told they have a disease they can't feel that needs immediate and lifelong treatment
at hundreds of dollars a month or
their health will suffer. Run that past me again. The National Institute on Drug Abuse is even working on vaccines to treat the
specific genetic risks in opioid addicts. Good luck with that.
Not everyone agreed about early treatment. The very fact that bipolar
disorder is a lifelong disease is reason to wait until you are sure, said Mark
Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital whose
research, published in the June Journal
of Nervous and Mental Disease, finds a link between unconfirmed,
overdiagnosed cases of bipolar disorder and . . . the receipt of disability
Not everyone agreed about multidrug
combinations commonly called polypharmacy either. In between industry
"research" in poster sessions extolling Seroquel, Vyvanse, Saphris,
Geodon, Risperdal and Zyprexa was a study at Maimonides Medical Center in
Brooklyn, NY, "Evaluating Antipsychotic Polypharmacy Regimens for Patients
with Chronic Mental Illness."
When 24 patients on
polypharmacy combinations of Seroquel, Zyprexa and other antipsychotics were
reduced to only one drug -- monotherapy -- there was no worsening of symptoms
or increased hospitalizations in 23. Not only did patients not deteriorate, their
waist circumferences and triglycerides improved, say the researchers, as drug
interactions, side effects and cost of treatment declined.
interesting data," said a young female psychiatrist viewing the poster.
"Normally clinicians are afraid to take such patients off
So is pharma.
Martha Rosenberg is a Chicago
columnist/cartoonist who writes about public health. She may be reached at firstname.lastname@example.org.