Barry Blackwell: Corporate corruption in the psychopharmaceutical industry
Hector Warnes’ comment
Barry Blackwell’s essay reminds me of Emile Zola’s, J’accuse, in its impact and diversity. One cannot dismiss his statements on the basis of biogenic, psychogenic or sociogenic biases, nor on the basis of taking sides with particular schools of psychiatry. Like Barry himself, after 50 years in Psychiatric practice, I have seen enough. I cannot forget a young patient suffering from Hemophilia who was given factor IX from a contaminated sample. At the age of 10 years he contracted HIV and the multinational drug company arranged privately with the Government to compensate him financially which was the end of the story. I have also come to respect the reductionist approach of scientists, which have produced the greatest discoveries in science, and since the 1950s, I have followed the growth of the psychopharmacology industry with its therapeutic successes and draw-backs (e.g., akathisia, tardive dyskinesia, retinitis pigmentosa, aplastic anemia, cardiac complications and now the metabolic syndrome).
In the last 50 years, Professor Blackwell has become a formidable and distinguished psychiatrist with training in neuropsychopharmacology and experience in the Pharmaceutical Industry. Most of his assertions about corporate corruption are based on his personal experience, which were published in peer reviewed journals but also supported by 7 books written by other researchers which were deemed causes célébres. If we were to read all of the books like Blackwell did we are likely to have our confidence and complacency shaken about the politics of Big Pharma and in the thousands of doctors who have fallen under their spell. Professor Blackwell’s early introduction to theinfluence of this politics was the dismissal by SKF of his publication in the Lancet of the ‘cheese effect’ of the MAO inhibitors. Several others’ observations including the cardiovascular effect of the COX 2 inhibitors were also initially rejected by Big Pharma.
There is no question that we are coming to an era of medical overprescribing and poly-pharmacy, which allows Big Pharma an unprecedented boom with questionable ethical practices to promote to the utmost its products for profitable ends. The questionable practices of the industry include lobbying, controlling or manipulating research data, concealing potential risks of products, failing to report negative outcomes, setting up aggressive marketing policies and achieving massive earnings, which facilitate paying doctors, institutions, politicians very outrageous sums of money. In a way, we are being caught in a collusive relation with the powerful pharmaceutical industry without paying attention to the potential harm or the risk versus benefit equation of its products.
There were also a few scandals such as the fact that Big Pharma tested their products in Third World Countries or emerging economies before testing them in the advanced economies. We have accumulated plenty of data on the adverse, if not lethal, side effects after a drug was approved by the FDA. Something must have gone wrong in the early Phase 2 and 3 of the testing process or insufficient time was given to testing the drug on selected patients under strict controls, as was the case of thalidomide (phocomelia), iproniazid (liver necrosis) or clozapine (aplastic anemia which can occur just over 24 hours after the last normal hemogram).
There is no doubt that industry is very successful in marketing its products, e.g., the US has just 5% of the world population and consumes 80% of the world’s supply of painkillers and most doctors and patients are eager to use the latest product to alleviate or cure a state of ill-health. Hagopian (2015) reported that about 440.000 patients died yearly in USA hospitals from preventable mistakes related to drug use. We are also aware that drug-interactions are on the rise. The dismal picture of our drug culture promoted by Big-Pharma and widely accepted by most doctors raises the question: if this is true, why has life-expectancy risen to almost 80 years in the developed countries.
Alfred Pletscher, who was research director of Roche in the late 1950s pointed out that he had some doubts regarding the marketing practices of the pharmaceutical industry. In his autobiographical account, he wrote disparagingly about the choices he had to make: “Did I have to orient my research to the expected profitability of products”, and further, “was the pharmaceutical industry sufficiently aware of its responsibility towards society?” (Pletscher 2004).. Pletscher was well aware of the conflict of interest between marketing and education. He was pleased when Roche created two purely research oriented Institutes totally independent from Roche’s industrial research.
Personally, I am inclined to blame our medical profession for the unchecked and widespread medical practice that yields to the pressures of the greedy Pharmaceutical Industry. But, then, I must add that I have also seen hundreds of patients who leave their doctor when he does not prescribe one or two drugs.
We cannot deny that the pharmaceutical industry encourages overprescribing and polypharmacy. I agree with Professor Blackwell that there is a sort of conspiracy of silence regarding risks versus benefits of drugs.
Most pharmaceutical representatives who visit doctors would rarely mention potential risks. Often a drug is taken off the market without explanation. It is usually not brought to the attention of patients that SSRI antidepressants, in addition to decreasing bone density, may result in bleeding because of a decreased platelet aggregation and this has to be considered before a surgical intervention.
One out of 4 women in their 40th and 50th are taking anti-depressants, the majority of them SSRI antidepressants (Hagopian 2015). Generally, over the age of 50, polypharmacy increases to the point that bona fide illnesses cannot be distinguished from untoward drug interactions. They act synergistically, potentiate each other and are cumulative.
The only shortcoming of Barry Blackwell’s essay is his overgeneralization, perhaps over-inclusiveness, of his war on Big Pharma. He started with specificity of a patient’s reaction to a particular drug and as his paper unfolds, he gets involved in a battle with Corporate Big Pharma.
We doctors are also guilty of believing that the reported results of research papers, which often are subsidized, are not free of biases. Over the years, hundreds of drugs were produced and fell by the wayside. I understand that developing a drug is expensive and testing for potential adverse effects and drug-drug interactions, increases this expense, but the price paid by the patient’s health is jeopardized by poorly tested drugs by Big Pharma.
References:
Hagopian J. The Evils of Big Pharma Exposed. Global Research. January 18, 2015
Pletscher A. From Inside the Pharmaceutical Industry (Roche). In: Ban TA, Healy D, Shorter E, editors. Reflections on Twentieth-Century Psychopharmacology. Budapest: Animula; 2004, p. 19 - 27.
Hector Warnes
September 15, 2016