Marketing of Psychiatry, Mental Illness, Drugs and More
"Corporate Disguises in Medical Science: Dodging the Interest Repertoire" by Sergio Sismondo, Bulletin of Science, Technology & Society, December 2011
Roughly 40% of the sizeable medical research and literature on recently approved drugs is “ghost managed” by the pharmaceutical industry and its agents. Research is performed and articles are written by companies and their agents, though apparently independent academics serve as authors on the publications. Similarly, the industry hires academic scientists, termed key opinion leaders, to serve as its speakers and to deliver its continuing medical education courses. In the ghost management of knowledge, and its dissemination through key opinion leaders, we see the pharmaceutical industry attempting to hide or disguise the interests behind its research and education.
"The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States" by Marc-André Gagnon, Joel Lexchin, PLoS 2008. "it appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry's claim. While the amount spent on promotion is not in itself a confirmation of Kefauver's depiction of the pharmaceutical industry, it confirms the public image of a marketing-driven industry and provides an important argument to petition in favor of transforming the workings of the industry in the direction of more research and less promotion."
"`Consumers are Patients!' Shared Decision-making and Treatment Non-compliance as Business Opportunity" Kalman Applbaum, Transcultural Psychiatry March 2009. Abstract: This article describes an aspect of the progressive insertion of commercial interests into the relationship between patients and their clinicians, with particular reference to psychiatry. Treatment noncompliance, a long-standing problem for healthcare professionals, has lately drawn the attention of the pharmaceutical and allied industries as a site at which to improve return on investment (ROI). Newly founded corporate `compliance departments' and specialized consultancies that regard noncompliance as a form of marketing failure are seeking to rectify it with reinvigorated models and strategies. This intervention stands to impact patients' experience of illness as well as the participation of those formally (physicians, case managers, etc.) and informally (family, friends, etc.) involved in treatment. My analysis draws upon observation at compliance conferences to demonstrate the contrasting models of patient empowerment underlying the marketing vs. medical approaches. I propose a research agenda for measuring the effects of industry compliance programs.
"Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey" by Joseph S. Wislar, et al; BMJ 2011. There is "evidence of honorary and ghost authorship in 21% of articles published in major medical journals in 2008"
"Public Relations -- Why Advocacy Beats Direct to Consumer--The battle for market share..." by Josh Weinstein, CEO of jwEinstein Strategic Messaging, a PR and marketing firm. Reprinted from Pharmaceutical Executive, October 2004
A revealing marketing strategy article for pharmaceutical companies discussing how to use patient advocacy groups that will represent the pharma company's best interests.
"A Decade of Direct-to-Consumer Advertising of Prescription Drugs" by Julie M. Donohue, Ph.D., Marisa Cevasco, B.A., and Meredith B. Rosenthal, Ph.D., N Engl J Med 2007; 357:673-681August 16, 2007
"It has been 10 years since a change in a policy of the Food and Drug Administration (FDA) allowed direct-to-consumer advertising of prescription drugs on television. Such advertising has been criticized for encouraging inappropriate use of medications and driving up drug spending. Concern that such advertising may lead to increased use of expensive medications was amplified by the introduction of a prescription-drug benefit in Medicare in 2006 (Part D). Studies of the effect of advertising on prescribing practices have shown that such advertising increases classwide sales, helps to avert underuse of medicines to treat chronic conditions, and leads to some overuse of prescription drugs...." Read more here.
"FDA study casts doubt on danger of "distracting visuals"" Matthew Arnold, January 31, 2012, Medical Marketing & Media MM&M
An FDA study looking at the power of background visuals to distract viewers from the often-ominous risk info read in the “major statement” section of TV drug ads found no evidence that consumer understanding of risk info is affected by the “emotional (affective) tone of images.
"Pharma Marketing Stuck in Web 1.5: Still Playing It Safe After All These Years!" By Richard Meyer, Senior eMarketing Manager, Medtronic, Pharma Marketing News, Sept. 2007.
This pharma marketing newsletter includes an analysis of Pharmaceutical advertising spending, by media type for 2006. Chart shows 55% spent on television, 36% in magazines (total ad spending was $5.3 billion. Read more here.
"Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants: A Randomized Controlled Trial" by Richard L. Kravitz, MD, MSPH; et al, JAMA, April 27, 2005
Patients’ requests have a profound effect on physician prescribing in major depression and adjustment disorder.
"Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature" by Jeffrey R. Lacasse, Jonathan Leo, PLoS, November 2005. "The impact of the widespread promotion of the serotonin hypothesis should not be underestimated. Antidepressant advertisements are ubiquitous in American media, and there is emerging evidence that these advertisements have the potential to confound the doctor–patient relationship."
"Useless Studies, Real Harm" by Carl Elliott, The New York Times, Published: July 28, 2011
LAST month, the Archives of Internal Medicine published a scathing reassessment of a 12-year-old research study of Neurontin, a seizure drug made by Pfizer. The study, which had included more than 2,700 subjects and was carried out by Parke-Davis (now part of Pfizer), was notable for how poorly it was conducted. The investigators were inexperienced and untrained, and the design of the study was so flawed it generated few if any useful conclusions. Even more alarming, 11 patients in the study died and 73 more experienced “serious adverse events.” Yet there have been few headlines, no demands for sanctions or apologies, no national bioethics commissions pledging to investigate. Why not?
One reason is that the study was not quite what it seemed. It looked like a clinical trial, but as litigation documents have shown, it was actually a marketing device known as a “seeding trial.” The purpose of seeding trials is not to advance research but to make doctors familiar with a new drug.
In a typical seeding trial, a pharmaceutical company will identify several hundred doctors and invite them to take part in a research study. Often the doctors are paid for each subject they recruit. As the trial proceeds, the doctors gradually get to know the drug, making them more likely to prescribe it later.
"Study of Neurontin: Titrate to Effect, Profile of Safety (STEPS) Trial--A Narrative Account of a Gabapentin Seeding Trial" by Samuel D. Krumholz, BA; David S. Egilman, MD, MPH; Joseph S. Ross, MD, MHS. Arch Intern Med. 2011;171(12):1100-1107
"Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?" by Sergio Sismondo, PLoS Med 4(9): e286. 2007
There are no straightforward solutions, short of large changes to the nature of medical publishing and/or research, changes that would effectively sequester pharmaceutical company funding from research and publishing or from marketing. Until such changes come about, at least we can hope for more awareness of and responsiveness to the issue.
Peer review has not been proven to be an effective tool for quality control, so we cannot rely on journals' peer review systems to guard against biases created by ghost managing. Indeed, MECCs are effective at creating publishable articles and getting them published in peer-reviewed journals. Nor are current disclosure measures effective. Major journals have put in place strong disclosure procedures, but while these might disallow extreme forms of ghost management, many forms of it do not run afoul of any rules other than failure to acknowledge some contributors and facilitators. With awareness of the issue, however, perhaps journal editors can recognize signs of behind-the-scenes work.
Pharmaceutical Marketing and Influence - "Getting to Yes: Corporate Power and the Creation of a Psychopharmaceutical Blockbuster" by Kalman Applbaum, _ Cult Med Psych 2009. An analysis and examination of the development and marketing of the antipsychotic, Zyprexa.
"Children Labeled 'Bipolar' May Get A New Diagnosis" by Alix Spiegel, NPR, Feb. 10, 2010
Bipolar may not be the right diagnosis for some kids, according a panel of experts with the American Psychiatric Association.
New diagnostic labels can bring new sales....
"Fabrication, Falsification of Medical Research Data" By: Gary Schwitzer January 25, 2012, Medpage Today.com blog
The BMJ reports:
“More than one in ten (13%) UK-based scientists or doctors have witnessed colleagues intentionally altering or fabricating data during their research or for the purposes of publication, while 6% say they are aware of possible research misconduct at their institution that has not been properly investigated, reveals a BMJ survey published today which attracted over 2,700 responses.
…Dr Fiona Godlee, BMJ Editor in Chief, said: “While our survey can’t provide a true estimate of how much research misconduct there is in the UK, it does show that there is a substantial number of cases and that UK institutions are failing to investigate adequately, if at all. The BMJ has been told of junior academics being advised to keep concerns to themselves to protect their careers, being bullied into not publishing their findings, or having their contracts terminated when they spoke out.”
"The Times Hears a WHO--An accidentally broken embargo causes the World Health Organization to engage in sanction overkill." by Jack Shafer, Thursday, Dec. 6, 2007, Slate
Open access issue of media embargoes by health organizations, scientific publications and others releasing news of studies.
Integrating Evidence-Bsed Practices and the Recovery Model by F. Frese III, et al The authors suggest that the degree of support for evidence based practices by consumer advocates depends largely on the degree of disability of the persons for whom they are advocating. Advocates such as members of the National Alliance for the Mentally Ill, who focus on the needs of the most seriously disabled consumers, are most likely to be highly supportive of research that is grounded in evidence based practices.
Marketing 'Evidence Based' Psychiatry: i.e. biopsychiatry