‘New’ diseases an excuse for ‘phony’ drugs, researchers say
Recent changes to the classification of psychiatric disorders
are encouraging pharmaceutical companies to develop new drugs that are of
questionable clinical value, according to researchers in the BMJ
(formerly British Medical Journal).
Since 1980, anxiety and depression have
been split into separate diseases. Drug development has subsequently been
tailored to new “niche” diagnoses such as panic, social anxiety disorder,
and post-traumatic stress disorder.
The proliferation of niche diagnoses is
liked by industry because it creates new licensing opportunities for phony
new drugs, but it has also led to a slow down in production of drugs for the
most common psychiatric disorder of mixed anxiety and depression, the
article noted. The authors are Edward Shorter, who heads the History of
Medicine Program at the University of Toronto, and Peter Tyrer, of the
Department of Psychological Medicine, Imperial College Faculty of Medicine,
St. Mary’s Campus, London. “We believe that the failure to advance the
treatment of anxiety and depression is related to wrong classification,”
they concluded.
The problem comes from the undue
influence the drug companies have over the categorization of diseases.
“Officially, diagnostic decisions are made through scientific consensus by
the World Health Organization and the American Psychiatric Association.
Small committees of experts decide whether, for example, schizophrenia is
one disease or several, and the process of decision making should be
transparent and based on good scientific evidence,” they stated. “But
sometimes the evidence is poor and influenced heavily by the pharmaceutical
industry. The industry exerts a major influence through publication of
sponsored supplements to journals, which are often poorly peer reviewed and
promote unapproved treatments. Such supplements are particularly common for
drugs for anxiety and depression as these are the most common treated
conditions. Worldwide sales of antidepressants dwarf sales of drugs for all
other psychiatric disorders.”
The huge amount of money generated by
these drugs has led to sleazy research procedures. “Sometimes the relation
between academic psychiatrists and industry veers over the line
of acceptability in the form of ghost writing – academics lending their
names to articles drafted by industry hacks,” the researchers revealed.
Although they noted that this unsavory practice has been a problem since the
1950s, they cited the 2002 case in which Vienna psychiatry professor
Siegfried Kasper was identified in the Austrian press as signing
an industry ghostwritten article about an antidepressant.
“Under normal circumstances, the interpenetration of
industry and academe can be fruitful, as talent and ideas wash
back and forth. Yet when drugs start earning the kind of money
usually associated with the oil industry, there is potential for
trouble,” they warned.
Although the researchers said regulatory
agencies like the FDA can do their part by approving only those drugs proven
effective for conditions categorized by the American Psychiatric
Association’s “Diagnostic and Statistical Manual of Mental Disorders,”
individual practitioners can help solve the problem as well. “Doctors could
encourage this change by being more cynical about pitches from
drug representatives claiming to have ‘the latest’ in anxiolytic
medication,” they advised.
SOURCE:
“Separation of anxiety and depressive disorders: blind alley in
psychopharmacology and classification of disease,” by Dr. Edward Shorter,
and Dr. Peter Tyrer. BMJ, 2003;327:158-160 (July 19, 2003)
