Tuesday, October 5, 2010

Same old crap, different day

Over the week end, the New York Times published an article called "Side Effects May Include Lawsuits". It discusses the government's ongoing fines and lawsuits brought under the federal False Claims Act against pharmaceutical companies and their peddling of antipsychotics for off label uses.

As the article points out, the False Claims Act has largely been used in the past by the government to defend against fraud in the defense industry. If you look through this list, you'll see defense contractors like General Electric, Boeing, Northrup Grumman, and Lockheed Martin on the perp walk. Their historic and ongoing fines pale, however, in comparison to the recent fines and criminal penalties levied against the pharmaceutical industry.

Certain people in the c/s/x community feel that this new prosecution by the government will rein in the over-prescription and off-label uses for a class of very dangerous drugs with debilitating, if not deadly, side effects. Sadly, I don't think this will be the case for at least three reasons.

One, as you can see from this list of defense contractors, prosecution and conviction under this law has never stopped them from showing up to bid on the next round of contracts. It's just the simply the cost of doing business with a very lucrative customer, a customer who know he gets cheated every time but who is always willing to come back for more.

Secondly, you need to look at the attitudes of the drug companies. In the article, they claim that they're going to change their ways, but in the next breath they are reported as claiming, "The drug makers also say that there is a large population of patients who still haven’t taken the drugs but could benefit from them."

And third, the scientific discipline behind the promotion of the drugs, psychiatry, is so inexact, so fuzzy. These two quotes from two separate mainstream psychiatry professors at prestigious universities are quite instructive:

“If you have a lot of money on the table and you have clinical uncertainty over mental health conditions, where you don’t have a blood test or objective test for it, you see it’s kind of a combustible mixture,” says Dr. Mark Olfson, a Columbia University psychiatry professor and researcher.


...Dr. Robert Rosenheck, a professor of psychiatry and public health at the Yale School of Medicine, who has received research support from drug makers and federal agencies. “Psychiatric disorders are vaguely defined enough that you can stretch definitions,” he says. “So many treatments are completely ineffective, people are willing to try anything.”

In other words, psychiatrists can prescribe these drugs for whatever they want to prescribe them for and their medical decisions are beyond reproach.

It's a very sad situation. To me, there's a sort of parallel here with another long and ugly incident involving psychiatry.

To me, there's sort of a parallel here. When lobotomies were practiced heavily in the 1940s and 1950s, psychiatrists gushed about how wonderful they were and a lot of people jumped on the bandwagon. It took a while for the general public to determine what the people who'd had them already knew--that they weren't that great. And of course the people harmed by them received very little, if any, compensation.

Flash forward to this day and age. These second generation atypical antipsychotics were heralded as being such an improvement over the old ones. Lots of people jumped on the bandwagon thanks to the marketing by the pharmaceutical industry and the happytalk of the shrinks. A great many of the patients have discovered that they aren't that great and the general public is only beginning to catch up with what the patients already know.

I think it's very unfair that it's only the government who will be collecting money under these suits and not the patients for having their health so seriously harmed. It is also very alarming to see what the government has done in the past under the False Claims Act. Although the contractor does a bit of marginal window dressing, he's still peddling the same old crap and the government shows up again only to ask, "Please, sir, may I have some more?" Very sad.

h/t Stan.

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