Over the Falls Without a Barrel: The Patent Cliff and Prescriber Impartiality

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Imagine calling up your old college friend Science and asking her advice. She speaks softly, hesitantly, and with frequent caveats. You strain to hear what she says, but there’s a problem.
It’s a party line.
While you try to hear Science speak, two boisterous rowdies named Marketing are shouting at you, all but drowning her out. They butt in, answering your questions before she gets a chance, claiming to speak on her behalf. It’s tempting to give up and listen to them instead.
This is the situation for any prescriber. “Science” is out there, murmuring in the distance, while the boys from Marketing giggle, whoop, and exclaim in an attempt to attract attention. They sound like 15-year-old boys, and their understanding of Science is about as deep. There is a light at the end of the tunnel, however. At 16, they get bounced off the line.
Umm, what? A Primer on Drug Development.
When a pharmaceutical company discovers a potential new drug, they undertake a mammoth project designed to assess a) whether it really works, and b) whether the risks and side effects outweigh the benefits. The aim is to amass sufficient evidence that the Food and Drug Administration (in the USA) or other national organizations (such as Health Canada in, you know, Canada) will approve the sale of the drug, and the type of disorders for which it can be openly prescribed – the so-called “on-label” uses.
The process of gaining approval generally takes 5 to 8 years and can cost from several hundred million to more than a billion dollars. The figures vary widely, in part depending on whether one includes the cost of researching drugs that don’t ever make it to market. For every drug eventually approved, there are four to ten that start human trials and don’t wind up on the pharmacy shelf. So the true cost of development is not just the enormous cost of the trials for successful Drug A, but also the costs of failures B, C, D, E, and F. During the development period, the company is bleeding money and can only get it back once the drug is available in the marketplace.
In order to encourage companies to undertake this risk, governments place a pot of gold at the end of the rainbow. This is patent protection. The company that develops the drug has the exclusive right to produce and market it – in effect, achieving a monopoly on that medication. They can set the price to reflect not only the cost of producing the drug, but also to repay the cost of drug development and testing. If they have a “blockbuster drug” – one that becomes a major seller – they can also make huge profits.
The problem with this system is that patients and governments wind up paying enormous prices for the drug. The solution is to impose limits on patent protection – after which rival companies can produce generic versions of the same drug. Generics companies don’t have the same development costs, and so they price their versions much lower, which the original developers are forced to come close to matching. So when a drug goes off patent, the price drops sharply (often by over 80%) and the advantage to the original developer vanishes.
The period of patent protection is typically 20 years from the date of initial filing of the request. Given the delays in the approval process, the actual period during which a company can market the drug exclusively varies, but is usually around 15 years.
The result is that FDA approval essentially fires the starting gun on a race to recoup development costs and turn a profit. The finish line is the end of patent – often called the patent cliff.
The Expensive Elephant in the Room
There’s one bit of accounting that’s often left off these sketched reviews of the process, and that’s the cost of marketing the drug once it has been approved. Most accounts indicate that pharmaceutical companies spend at least as much on marketing as they do on drug development research. One account (below) suggests the figure is almost twice as high for marketing.
Well, fine. What’s the point of developing a new treatment if no one finds out about it and patients go untreated?
The marketing costs do not include the means by which prescribers are alleged to receive their knowledge about practice: reading journal articles. Here’s an estimate of total costs from Gagnon & Lexchin (2008) – all figures in billions of US dollars:
  • Samples (the provision of free packages of medication to prescribers, who can offer them to patients in the office to get them started, after which they will continue on paid prescription): $15.9b.
  • Detailing (essentially, visits by sales representatives to physician offices, plus the provision of pamphlets, swag, and related products): $20.4b
  • Direct to consumer advertising (advertisements in newspapers, magazine, television, and internet that is directed to the general public rather than to healthcare providers, often with the advice to “ask your doctor”): $4b
  • Sponsorships, displays, and the provision of speakers to professional meetings: $2b.
  • E-promotion & mailings (generally to prescribers), promotion-related post-approval clinical trials: $0.3b
  • Journal advertising (advertisements in publications aimed at professionals): $0.5b
  • Unmonitored promotion (estimated; includes amounts that do not appear in other categories including promotion to unmonitored physicians or in unmonitored journals and miscellaneous other marketing strategies): $14.4b
Of particular note here for the nonprescriber is the contrast between the amount for direct to consumer advertising (the seemingly ubiquitous and presumably expensive “ask your doctor” ads) at $4 billion, and the marketing to physicians, a much smaller group of people, at a cost 5 times as great at $20.4 billion.
One might be tempted to wonder how the firms can possibly spend so much money marketing to prescribers. Imagine that instead of producing television ads they sent the salesperson directly to your home to act out the advert in person – while making you lunch and providing golfing fees.
But All This Ends?
Once a medication “goes off the patent cliff,” profits decline precipitously and the motivation to promote the med to physicians and the public decline as a consequence. The drop can have a major impact on a pharmaceutical firm – just search using the terms “antidepressant patent cliff” to turn up a variety of business analyses like this one.
Let’s take a look at the names and patent expiration dates of some of the most well-known antidepressants.
  • Prozac (fluoxetine), 2001
  • Paxil (paroxetine), 2003
  • Zoloft (sertraline), 2006
  • Remeron (mirtazapine), 2010
  • Effexor XR (venlafaxine), 2011
  • Lexapro, Cipralex (escitalopram), 2012
  • Cymbalta (duloxetine), 2013
  • Wellbutrin (bupropion), 2013
  • Pristiq (desvenlafaxine), 2022 – of note, desvenlafaxine is marginally different from Effexor and is often regarded as little more than a patent extender on Effexor.
  • Viibryd (vilazodone), 2022
Overall dollar sales figures for antidepressants have tended to fall as the medications have gone over the patent cliff. Revenue for antidepressants peaked at about $15 billion per year in 2003, and is projected to decline to $6 billion in 2016. Depression, once a major money-maker for pharmaceutical corporations, is fading as a revenue opportunity.
Why is This Important?
Remember our party line? The marketing rowdies drowning out our friend Science get laid off when their drugs go off patent. The drugs are still around, but the distorting influence of their promotional activities (disguised as science) largely end. The air clears, and our prescriber is left undisturbed to examine the literature once more.
Of course, this doesn’t solve all the problems. Prescribers are likely still to have received most of their psychopharmacology education from the marketing team. And having been subjected to endless lectures about the wonders of various drugs, they may feel that they already understand the scientific backing and neglect to look again. As well, most of the articles in the scientific journals are funded and written by (guess who!) the pharmaceutical companies themselves, and there has been a marked publication bias favoring positive studies over negative ones.
Nevertheless, the end of patent means fewer free samples, fewer visits from pharmaceutical reps, fewer paid lunches, fewer “opinion leaders” making the rounds showing the companies’ own slides, fewer conference symposia lavishly funded by patent owners, and less general noise distorting the environment. Medical decision-making is likely to be based at least somewhat more on science than on enthusiasm and hoopla.
What About Newer Antidepressants?
There are still a few preparations on patent, and in the past there have always been new medications coming online. Once Prozac went off patent, everyone finally shut up about it and more profitable medications picked up the baton and continued the charade. Won’t that continue?
Well, that’s the thing.
The pipeline is just about empty. Some firms have given up on depression, and in the past few years a variety of preparations have bitten the dust before reaching the approval stage. There is a noticeable lack of enthusiasm about upcoming products, though the few that remain on patent will doubtless be promoted to death. So there will still be some rowdies on the line trying to drown out science, but there will be fewer of them and they seem to have become somewhat muted. Not even the pharmaceutical reps seem able to muster much enthusiasm for the newer products, and the usual claims of “revolutionary advances” are not being heard.
So, Science. It’s been a while. At last we’re (almost) alone. Whisper your ambivalence. We can finally hear you.
Resources
Gagnon M-A, Lexchin J (2008) The cost of pushing pills: A new estimate of pharmaceutical promotion expenditures in the United States. PLoS Med 5(1): e1. doi:10.1371/journal.pmed.0050001
York University. “Big Pharma Spends More On Advertising Than Research And Development, Study Finds.” ScienceDaily. ScienceDaily, 7 January 2008.

44 COMMENTS

    • Two videos on You Tube are worth watching to rule out vitamin B12 Deficency.
      – Diagnosing and Treating Vitamin B12 Deficency -Sally Pacholok and Jeff Stuart.
      Pernicious Anaemia Society Conference 2013 Part 2.
      Professor David Smith B12 as key player in preventing brain atrophy that leads to Alzheimer’s disease.
      In James Davies book – Cracked Why Psychiatry is doing more harm than good , he explains how a drug that is off patent changes colour, packaging and name to treat a different condition.

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  1. Very interesting article Randy and thanks for the info. The dollar amount used to “influence” doctors is mindboggling.

    I though this piece of your article was also interesting…

    “Nevertheless, the end of patent means fewer free samples, fewer visits from pharmaceutical reps, fewer paid lunches, fewer “opinion leaders” making the rounds showing the companies’ own slides, fewer conference symposia lavishly funded by patent owners, and less general noise distorting the environment. Medical decision-making is likely to be based at least somewhat more on science than on enthusiasm and hoopla.”

    I guess my question would be…what science? The biased big Pharma studies fill many of the medical journals and alternative interpretations of the effectiveness (or non-effectiveness) of antidepressants is likely to be downplayed even after the “patent cliff.”

    I would like to think that the medical profession would reexamine the merits of these drugs using more unbiased non-industry studies and “science’ but I fear I have become fairly cynical.

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    • My post this week involves one of the many factors that distort medical decision-making – I hope that I have not implied that it is the only problem!

      You are right – virtually all pharmaceutical research is funded, conducted, analyzed, and written up by pharmaceutical companies (or those whom they fund) – the companies that stand to make or lose millions (or billions) depending on the outcomes of the work. The hope that this work will be carried out dispassionately is a slim one.

      But yes, there is science. Even in some of the most egregious examples, such as Study 329 (the trial of paroxetine for adolescents that has received so much attention (see http://www.psychologysalon.com/2015/01/science-in-court-study-329-paxil-and.html for background), the data are there to be found, beneath the layer of misinterpretation. The question is how to get greater impartiality in study design and reporting than we have today.

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      • “how to get greater impartiality in study design and reporting than we have today”
        Take it out of the hands of people who stand to profit from the results? It’s a clear conflict of interest and it will always lead to corruption.
        All trials should be pre-registered, approved by independent ethics committee and each and every participant should be followed and if he/she is removed from the study the reasons must be stated clearly. All data, save from one which identifies patients, should be open access not only for professionals but for general public. And of course it should not be conducted by pharmaceutical companies or their proxies.

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        • But the second question is how to get those involved in the system to pay attention to the actual science that is known.

          Some examples: 1) the ‘low serotonin’ theory of depression was discredited in the early 80s, before Prozac came to market, yet millions of doctors continue to promote this discredited theory.

          2) Parents by the millions are told that “untreated ADHD” leads to delinquency, drug abuse, school failure, and vocational instability, despite the long-standing and consistent research finding that stimulant treatment does nothing to improve any of the listed outcomes.

          3) SSRIs were known to cause suicidal thinking and attempts as well as aggression as far back as 1987, and Prozac was temporarily not approved in Germany for that very reason, yet it took until 2002 that the “black box warning” made its way onto the label, and there are still many researchers and “thought leaders” who deny this is an issue and disingenuously blame a temporary surge in teen suicides (which started before the warning and did not appear to be correlated, yet alone causal) on reduced AD prescriptions in teens.

          I could go on. This is more than a problem with science vs. pharmaceutical company marketing. There appears to be a high degree of disease and drug marketing occurring WITHIN THE PSYCHIATRIC PROFESSION AT THE HIGHEST LEVELS. And people who raise these scientific issues, even insiders like David Healy, are accused of heresy and blackballed by the profession. And the media continues to trumpet these untruths and helps organize attacks on those who have the courage to demur from the “conventional wisdom.”

          I only wish the absence of the juvenile marketing agents would solve the problem. I think it’s more akin to the scientist having an abusive partner who hangs up the phone on her every time she tries to make a call to someone who would want to hear what she has to say. It’s more than just marketing – there is bullying going on here by people who stand to lose big bucks if the truth comes out!

          —- Steve

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  2. So interesting to see how all of this plays out between Big Pharma and physicians. It’s the clients I’d be concerned about, as of course, these drugs have absolutely nothing whatsoever to do with healing. The resources used for all of this is sheer waste. Thanks for an interesting read.

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    • “So interesting to see how all of this plays out between Big Pharma and physicians. It’s the clients I’d be concerned about, as of course, these drugs have absolutely nothing whatsoever to do with healing. The resources used for all of this is sheer waste. Thanks for an interesting read.”

      I disagree. I am grateful for some of the meds they produce. Some of their drugs save lives.

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    • I disagree that the drugs have nothing to do with healing. I think they are overused, badly studied, and unethically marketed in many, many instances. And there are some drugs that I wish had never been approved for use in humans or animals.

      But I have also seen remarkable benefits for some people from some meds – benefits we would never have had if the resources had not been devoted to medication development. I suspect that there is a problem in psychopharmacology: If the medications were prescribed only to those who stand a good chance of truly benefiting, based on moderately well-conducted research, and used in quantities that are actually helpful, the sales figures might not justify the development costs.

      So is the money wasted? Perhaps, if the result is financial pressure to overprescribe to the point that a medication winds up doing more harm than good overall. But is good EVER done? Yes, I think so. But not often enough for my taste.

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      • You don’t seem to be accounting for the problem of whackadoodle diagnosis through the DSM. According to your criteria, alcohol is a treatment for an anxiety disorder. It reduces the symptoms, and could be prescribed only to those who benefit by ethical prescribers. I’m not saying alcohol doesn’t address anxiety – it does, and better than the benzos, in my opinion. Dosage control is a bit of a problem, but it is with benzos as well. I have no problem with recommending a snort of brandy before a plane flight for your anxious flyer mentioned below, and I guess no real big problem with a benzo, either, given informed consent. But that’s basically just a substance to reduce the anxiety temporarily, not a treatment for a “disease.”

        Perhaps you are taking a “Moncrieffian” view of these drugs – a drug-based rather than disease-based paradigm? Otherwise, it seems your argument sinks very quickly in the quicksand of DSM diagnostic chicanery.

        — Steve

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      • A newly designed drug often addresses more than the original targeted problem. I expect it is difficult to find better minds than the chemists who are paid very well to develope life saving drugs and life enhancing products. A love of money is a deceitful culprit. He makes his influence known on many levels and in many places. I don’t hear much about his brother, Greedy. These fellas cause much grief, create wars, jealousy, but little happiness or contentment. The question I must keep asking is “am I greedy”

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  3. If you decided to start a drug manufacturing company, what would you do? Where would you get the capital, how would you pay it back, how would you promote your products and what would you try to produce first?

    Anyone can research any drugs’ efficacy. That the drug companies publish most of the literature about their drugs, means what? Who else would we expect to invest huge sums of money to do so? Take the profit motive out of making drugs and what do you think will happen? If corporations are psychopathic monsters who don’t mind killing people, like someone posted the other day, better not get in an airplane or a car or a bus, a ship, a train, don’t eat most food sold in supermarkets, drink coffee, or enter buildings or houses or use elevators, buy t.v.s, radios, R.V.s, and away we go.

    Some drug companies have produced some drugs that have saved lives and enhanced our health. As I constantly rethink my view on the drug industry, I can’t deny some of their achievements.

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    • You’re absolutely correct in this. The pharmaceutical industry has produced drugs which have unquestionably saved thousands of lives. Witness, for example, the almost unbelievable success they have had with HIV. Government agencies do not have the funds to develop drugs, and the profit motive is a great motivator for this work to be done. People who work for the pharmaceutical industry are almost unfailingly pleasant people who believe in what they do.

      One of my reservations about this site is that people perceive it as anti-psychiatry, and in some posts and articles it genuinely is. I believe this is wrong-headed. Psychiatry, like the pharmaceutical industry, is a field intended to improve mental health. To this extent I am whole-heartedly PRO-PSYCHIATRY.

      The problem is that the reward systems we have in place are often imperfect. It is to a company’s very significant advantage, for example, to market a drug beyond the narrow confines of its approved uses, and we have seen much prescribing that should not have happened. As well, there are virtually no brakes on the amount companies can do to promote their products, including funding heavily biased “Continuing Education” talks that should more properly be considered advertisements.

      Nor, and I think this is a more significant concern, are there sufficient ethical brakes on the medical profession. If a politician accepted a cruise, meals, golf fees, free samples, and more from a representative of industry hoping for an advantage, that politician would be rightly accused of gross corruption. For a physician to do it is not regarded as problematic. “Ah,” goes the reply, “because physicians have their patients’ interests at heart (true) and could not be swayed by a bottle of wine.” I’d like to agree. But that would imply that the corporations are simply wasting billions on such efforts unnecessarily and getting no benefit. The research strongly suggests otherwise, and surely no one can believe that the companies are so misguided.

      We do need psychiatry, and pharmacology, and a profit motive to drive parts of the industry. But like all industries, medicine and pharmacy need carefully-thought-through guidelines and regulation, without which their noble aims can fall victim to shorter-term considerations.

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      • “We do need psychiatry, and pharmacology, and a profit motive to drive parts of the industry. But like all industries, medicine and pharmacy need carefully-thought-through guidelines and regulation, without which their noble aims can fall victim to shorter-term considerations.”

        Oh wow, this statement concerns me a great deal, in that I feel it completely undermines the goal, purpose, and nature of healing. No way should it be an ‘industry,’ and no way that “profit” and “noble aims” belong in the same sentence. Imo, that’s an oxymoron.

        I sincerely believe that, in no way, do we need psychiatry and psychiatric pharmacology. The illusion of needing this is based on control and corruption, I thought that was a given by this point. We need a complete restructuring of how we perceive reality. This is cultural programming, in my eyes. I appreciate your perspective, here, but I feel it is limited in many respects, and merits further investigation of antithetical perspectives.

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        • A lot of people feel similarly – that healthcare should not be an industry. It is, however. It costs a great deal of money to provide, and somehow it has to be funded. If privately, then by consumers or insurers. If publicly, then by a single customer – the government.

          We can dance around the term, but I think this makes it a business – one that can be run ethically, with standards, and under appropriate regulation, or one that exists in an unregulated free-for-all situation. My own view is that if the bridge-building industry was as badly monitored as mental health there would be few bridges standing – but that’s just my opinion.

          Do we need it? My own city has a good model of what can happen with no functioning mental health system, and it is not a pretty sight. So yes, I think a society can benefit from mental health services – provided they are adequately researched and based on what hard evidence we can muster.

          I think you are right that much of the problem we have currently is cultural in nature. We (the culture generally, and mental health practitioners like me as well) have created a culture in which normal difficulties in life are often pathologized, unhappiness is a disease, and the experience of reality (which is that life is often difficult, tragic, and disappointing) is viewed as a disorder.

          If we were to acknowledge that distress and periods of dysfunction are normal, would there be a role for mental health? Yes, I think there still would be. Many of my own clients have no diagnosable “illness” – or, if it might be possible to find them in the DSM, I choose not to do so. Yet they report benefiting from having a trained listener (and sometimes a good-natured confronter) helping them work out the challenges of life in the 21st century.

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      • Physicians make little from writing drug prescriptions. They probably deserve to be wined and dined occasionally, too. All they do is work with people who are sick.

        Just kidding. Lawyers hold the industry accountable, some. If we don’t have personal ethics that guiding us, we are always going to be in trouble. And we are and always will be.

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        • “Physicians make little from writing drug prescriptions.”
          https://www.youtube.com/watch?v=YQZ2UeOTO3I
          This comedy segment does a very good job of explaining how this works.

          “They probably deserve to be wined and dined occasionally, too. All they do is work with people who are sick.”
          Emmeline tells us we should not treat you as a troll so I’ll just go along with it I guess…

          “Lawyers hold the industry accountable,”
          If you have money for a good one, that’s first. If you rely on the public advocates – good riddance and I hope you enjoy the abuse because it’s not going anywhere. And even if you have money and find a lawyer – the laws are written in such a way that you have no rights to begin with. You have to prove you’re not a danger to self and others (basically defend yourself against a pre-crime accusation – unless you can get a psychic to testify you’re screwed) or you have to prove beyond reasonable doubt that your problems were caused by drug and not “underlying mental illness” (since the “symptoms” are the same and there are no objective measures to assess what’s causing them – you’re screwed) or that the good doctor has not made a medical error (which is that he acted according to the prevailing medical practice which is in general so abysmal that the bar is pretty low plus you would have to find another doctor to actually testify against him which almost does not happen).

          “If we don’t have personal ethics that guiding us, we are always going to be in trouble.”
          We don’t rely on personal ethics in many things since history has shown over and over that even good folks care much more about protecting their own rear and reputation than the few (hundred) people that get harmed or die. There are of course notable exceptions but that is what they are – exceptions. the whole point is to set up a system in such a way that abuse is not possible or if it is possible it will get discovered and severely punished. Not the system we have today.

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      • One of my reservations about this site is that people perceive it as anti-psychiatry, and in some posts and articles it genuinely is. I believe this is wrong-headed. Psychiatry, like the pharmaceutical industry, is a field intended to improve mental health. To this extent I am whole-heartedly PRO-PSYCHIATRY.

        Rest assured, I think your chilling all-caps declaration of faith has suitably distanced you from the handful of MIA authors with an anti-psychiatry viewpoint.

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        • Thank you. It gets worse: I am even pro-medication! Provided they are used in limited quantities, with a clear eye on the hard data, taking into account side effects and long-term disadvantages.

          Why just the other day I had a client contemplating their first flight after a few sessions of treatment for flight phobia, and I agreed that using a benzo for that first flight wasn’t a bad idea (provided that the goal was to go benzo-free for the 2nd or 3rd flight – and that the flight should not be the first time they try the med). I suspect that the pharmaceutical companies would go bankrupt if I was prescribing on their behalf, but if I had a prescription pad would it ever get used? Yes, now and then. Not many refills, though.

          When we feel strongly about an issue there is always the temptation to gravitate to the poles and look for all-or-nothing, good-or-bad solutions. The complicated truth usually lies somewhere between the extremes. Most psychiatrists I know are dedicated people who genuinely want to help their patients – and in many instances actually do so.

          Are there problems in the field? Absolutely. Just as there are problems in psychology and psychotherapy. Will we solve those problems through polarization? Probably not.

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          • Well, I hope that you warned the guy that he can experience complete anterograde amnesia so that when he gets off the plane he won’t know how he got there or where he is. Or that he can become suicidal or aggressive (paradoxical reaction). Or that he may have cardiovascular problems and lowered blood pressure (not a good idea on a plane). Or that he will simply feel totally high (that one may not be so bad). These are only some of the side effects, three of them I’ve experienced personally on supposedly small doses, the remaining one I know another person who did. They are not infrequent, they happen to a significant percentage of people on a single small dose and are potentially life threatening.
            I’d recommend a glass of whiskey or two – it’s safer, more predictable (I guess the guy knows how alcohol works on him), and frequently used by people who are afraid of flying.

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          • I’m afraid I don’t regard my private life as someone else’s “field” though this group seems to have no difficulty in doing so. Moreover, it’s a “field” already polarized with a truly insane amount of power granted to psychiatrists and none to the ever-patient patients. I think you’re optimistic in expecting a solution that will leave psychiatry’s or psychology’s economic preserve intact.

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          • Congratulations on being pro-medication! How awesome for you! Does that mean you’ll be taking it, too?

            I wonder why your client would need benzos at all after having had flight phobia counseling sessions.

            Re: the oft trotted out and patently offensive charge of black/white thinking on the part of anti-psychiatry: Sure, it’s possible that people arrive at an anti-psychiatry position that way, but it’s also possible that they got to that position by following logic and/or morals and/or the scientific evidence about psychiatric “treatments.” And the middle of the road is not always the best place best to be. (Take the issue of slavery, for example. One wouldn’t want to be a “moderate” on that issue.) The intentions of individual psychiatrists are not at issue.

            What is at issue is that the field of psychiatry is inherently flawed in a way that other “mh” professions are not. It is flawed because it is a medical specialty that seeks to treat metaphorical diseases with dangerous physical interventions.

            That said, anti-psychiatry makes no judgements about how individuals choose to cope, so please don’t make assumptions as to who will be “anti-meds.”

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          • Randy I don’t know if I would classify you as Pro-medication…but how about “pro-selective use without bias from pharmaceutical companies and a hell of a lot less than what we have been doing medication? “. That might not fit on a bumper sticker though.

            I think there a re a number of people who are fine with a model of using psych drugs much more cautiously as long as people are informed of their long term complications and are not given false information such as Meds are necessary for “mental illness” just as insulin is necessary for diabetes.

            There are people who take meds intermittently, or only during a crisis, or at a low dose.

            I think the main ire I have is against the excessive over prescription of the drugs, the corruption in the industry, massive unnecessary polypharmacy, irresponsible use of drugs for youth and the elderly, and on and on. But I am not against the idea of using psych drugs so I would agree with you. I don’t think I would characterize that as “pro-meds” though. :).

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      • I disagree. This is a typical example of capitalism: externalize the costs, privatize the gains and take all the credit. Pharma does not fund basic research for the most part – government does. And without this you can forget about drug discovery – that is only a small last step. Plus many drugs were developed on government funds and then taken over by pharma who made money on them (and then used all the tricks in the book to avoid paying taxes as all corporations do). Here you have some relevant steps (from Wikipedia):
        – Françoise Barré-Sinoussi, at the Pasteur Institute in Paris, isolates a retrovirus that kills T-cells from the lymph system of a gay AIDS patient.
        – American scientist, Robert Gallo, has discovered the probable cause of AIDS: the retrovirus is subsequently named human immunodeficiency virus or HIV in 1986.
        Both were funded by public institutions.
        “Jerome Horwitz of the Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine first synthesized AZT in 1964 under a US National Institutes of Health (NIH) grant.”
        First drug for AIDS – guess who funded the discovery?
        I could go on and give examples from other branches of medicine (like the famous polio vaccine) but you get the picture.
        Government funds basic research, sometimes develops drugs, then the private entities come in and make money. The moment government starts relying on private entities for drug discovery we end up where we are – all drugs are essentially generics with a little tweak of side group here and there to make it patentable and instead of developing useful stuff we end up with disease mongering to sell the same old crap for new “disorders”.

        Secondly, most scientists are not driven by money. I happen to know a lot of them (one could call me one) and there may be a lot of drivers for doing research, some of them selfless, some of them not so much but money does not make it high on the list. I’m of course talking about basic science here, applied science is more corrupted but then clinical trials often don’t require scientists to conduct them so any doctor with a little standing in the field and significant money behind him can do it. That may be a reason why some of the studies are so abysmal. Not that professional scientists are always geniuses but it’s a completely different way of thinking and skills required.
        Clinical trials don’t require esteemed professors and researchers – a team of good doctors, a good statistician and some skilled bureaucrats could do. There’s no rocket science behind it, just gather the data, analyse the statistics and move on. Trial design is a different story and it should be even more protected from financial conflicts of interest.

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    • “If corporations are psychopathic monsters who don’t mind killing people, like someone posted the other day, better not get in an airplane or a car or a bus, a ship, a train, don’t eat most food sold in supermarkets, drink coffee, or enter buildings or houses or use elevators, buy t.v.s, radios, R.V.s, and away we go.”
      As for the foods it’s probably a good idea to avoid a great deal of it and yes the sh*t that companies sell as consumable products is killing people. As for the cars – there has been an ignition switch scandal recently and that killed quite a few people and it’s not the first and not the last either. Yeah, the whole society is corrupt so the regulations are lacking and/or not enforced. But it does not even reach the level of corruption in pharmaceutical industry, simply before it’s easier to spot and prove an error in a car than it is to prove medical error.
      Government funding has brought us many modern advances including the wonders of internet. It has also brought us the research which led to many drugs that actually help people. The mistake is then take the last step – commercialization – and give it away to private drug companies. It’s even a worse idea to give them power to develop new drugs and “self-regulate”. It’s a disaster.

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  4. If I focused on the information Ralph Nader published in books about the poor design and construction of cars, I would never own, rent, borrow or ride in one, ever. I love Ralph Nader. He provided an important service. We were awakened as a nation by his single-handed efforts to alert us to the grave dangers we didn’t see. At the same time, percentage wise, most drivers avoided most of the perils he described.

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  5. Randy ! Read Edwin Black’s most throughly documented book on the planet ” War Against The Weak ” then tell me how “PRO PSYCHIATRY” you are . Of course making some bucks within the field is all some need , to become true believers irregardless of anything else including mass harm to humanity.

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  6. Right now, the drug class that is getting huge attention is the stimulants. While these are far from new, there are a number of patented formulations that are heavily marketed. What the companies – along with the psychiatrists KOLs – are doing is to expand the potential market. So ADHD now extends into adulthood. Doing the math, it is easy to see how this quickly broadens the market for drugs that were once promoted for use only in childhood. But Vyvanse just got approval for the new Binge Eating Disorder. So inattention and overeating – two ubiquitous traits of modern life – are now the potential target/market for these drugs.

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  7. Profit margins and bottom lines have replaced any actual concern about improving the human condition. That is not only apparent in regard to psychiatric medications but society as a whole.
    The power imbalance in the field of mental “health” makes it abusive but no one talks about that sad reality. It would be criminal in most other facets of a democracy but it isn’t in this one. The mental health system has placed itself on a pedestal with the help of the drug industry despite the fact that it operates on sheer theory, wishful thinking and measures which, by and far, have been proven to benefit few asides from those making money in some form. It is a high stakes stock market that gambles with the lives of those who are most easily victimized (economically disadvantages, native and African Americans, the young, the elderly, those involved in the criminal justice system, etc) and there is no way to institute balance of power because it is a system which has never had such a thing. The sad fact that mental “health” has weaseled it’s way into every aspect of society (from schools to nursing homes) should give a reason to be alarmed as there are more numerous ways with which to lead one to the gates of the all mighty medication gods.
    Over prescribing, uninformed consent, off label marketing, prescribing drugs never intended for certain populations, the growing rift between the “us” (prescriber) and “them” (the non prescribing clinicians), the harm to millions of people from side effects and long-term use (including withdrawal and lack of support in tapering) among other issues keep the pathetic history of psychiatry intact. Medications are as effective as the other form of witchcraft that psychiatry has performed in it’s history (blood letting, psychosurgery, asylums, etc). It has never been about science but always about a select few being given free run to use the whole of humanity as a collection of lab rats with which to test theory. Even in the light of failure, the same beat goes on all in the name of “helping”. I cringe when I look at the future plans to use MDMA, Nitrous Oxide and other hallucinogens as “treatment” knowing that drug companies would abuse their power through medicine to profit at the expense of a few million more people and psychiatry would hold their hand while they do it.
    Abuse, no matter how subtle, is still abuse.

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  8. Profit margins……have replaced concern for improving the human condition? When did that happen? No one cares any more?

    We live longer
    We live healthier
    We have better nutrition
    We have the finest doctors
    We have the best hospitals
    We have the best technology
    We have more self-help groups
    We have more information/access to information
    We have more choices
    We even have more brilliant, aggressive lawyers than one can possibly imagine who might pursue malpractice for us

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