Low Dose Antidepressants
How are things going? Everything okay at home?
When a friend of mine (we’ll call her Linda) was asked those two simple questions during a routine physical, she felt at ease enough in the privacy of her doctor’s examining room to unburden herself a little. Things weren’t okay at home. She wasn’t communicating well with her husband. The pressures of child rearing were weighing heavily. Her job was stressful but unfulfilling. And a cousin who she was very fond of
had recently passed away.
Then came the follow up question: Have you been feeling depressed?
We all have those times when life piles on an excess of demands. A sense of being constantly overwhelmed can make anyone feel blue. So when Linda’s doctor also asked if she’d ever considered taking an antidepressant she admitted that she was open to the idea. Suddenly it felt like someone was in her corner.
Later that day Linda filled a prescription for a low dose of a best
selling antidepressant drug. Without knowing it, at that moment she became an unwitting participant in a drug company sales plan.
Numbers racket
I just read a disturbing article in the online magazine, Slate, that
reveals a network of partnerships that combine to encourage doctors to ask leading questions like, “Have you ever considered taking an antidepressant?”
What’s most amazing is that many doctors are unaware of how information about their prescribing habits may be used to manipulate their treatment decisions.
Here’s how it works: About 10 years ago some pharmacy chains began processing insurance claims by computer. As the saying goes, information is power, and of course power can be easily converted into cash. Some chains began to sell prescription sales data to marketing information clearinghouses, which in turn sell the data to drug companies.
Don’t worry, at this point your name isn’t attached to the data. But
what IS attached is your doctor’s physician ID number that’s issued by the Drug Enforcement Administration. Now if drug company executives have already purchased very specific data on the sales of one of their drugs and they want to find out which doctors are prescribing that drug and in what amounts, all they need is a list that reveals physician ID numbers.
No problem!
According to the Slate report, the American Medical Association makes about $20 million per year selling information from a database known as the “physician master file,” which contains both personal and professional information about every doctor in the U.S., including ID numbers.
Nice, huh? And what’s worse, many doctors are completely unaware of this practice.
Then comes the number crunching. Just put together the clearinghouse information on drug sales with the AMA information about doctors, and a drug company sales force can monitor the prescribing habits of virtually any doctor “right down to the pill,” according to Slate. Imagine the huge advantage this gives a drug company salesperson who treats a doctor
to a “friendly” golf game or an expensive dinner.
No they didn’t
The techniques that drug companies use to sell their products never ceases to amaze me. But then what do you expect from an industry that devotes about $15 billion dollars to sales every year? You would expect just about anything. Including unmitigated gall.
Here’s a perfect example.
About the same time I found the Slate article I came across a report in the New York Times about a heartburn medication called Propulsid manufactured by Johnson & Johnson. Porpulsid was approved by the FDA in 1993. Within two years there were obvious problems. Patients were developing irregular heartbeats. The FDA warned J&J that the drug might trigger deaths. The Times reports that by 1998 more than 100 people had
suffered severe heart problems, with children at particularly high risk.
The FDA and J&J negotiated a new warning label and Propulsid continued to be promoted for children. By the end of the 90’s the drug was posting sales of more than $1 billion per year. But by 2000 the wheels were coming off; deaths (including children) and adverse reaction reports were mounting. When a government hearing was scheduled, J&J dodged the bullet by pulling Propulsid from the market.
Nowhere’s the good part.
Times reporters were denied several requests to interview J&J executives for their report. Instead, the company provided written responses defending Propulsid. And here’s the kicker: The drug was removed from the market, according to J&J, because doctors were prescribing it inappropriately.
Unbelievable! Drug salespeople hound doctors to prescribe certain drugs – going so far as to purchase databases with details about doctors’ prescribing habits – and then when a dangerous drug has made billions of dollars, they pull it from the market and blame the doctors.
THAT, my friends, is what put the unmitigated in gall.
Sources:
“Spin Doctored – How Drug Companies Keep Tabs on Physicians” Shannin Brownlee and Jeanne Lenzer, Slate, 5/31/05, slate.msn.com
“Lucrative Drug, Danger Signals and the F.D.A.” Gardiner Harris and EricKoli, The New York Times, 6/10/05, nytimes.com
“Raisins Fight Oral Bacteria” Dominique Patton, NutraIngredients.com 6/8/05, nutraingredients.com
