In the doctor’s office

90 day humility by katyhutch
90 day humility by katyhutch

Anna David shares her personal experience with an all-too-common problem. Doctors who don’t understand addiction and do more harm than good:

I continued to see my pinkie-ring psychiatrist for the next year or so, because he told me I had to if he was to keep prescribing me Paxil and Ambien—drugs I was convinced I needed. I thought he was a terrible psychiatrist and a worse person, and found the $250 half-hour sessions a serious financial strain. But he was a professional, and I was desperate and afraid.

Then one day he calmly explained that he couldn’t continue to see me, and I “must know why.” I theorized it had to do with my constantly telling him I’d gone out of town again and—would you believe it—had left my bottle of Ambien in Houston or Vegas (in reality I was barely leaving my apartment and taking roughly 10 times the amount he’d prescribed me). But I was too ashamed to say anything, so I only nodded.

He told me to find a new shrink, and that he wouldn’t give me any more Paxil; then he handed me a prescription for six months’ worth of Ambien. At no point did he mention AA, rehab, or even the words “addict” or “addiction.” I left his office hysterically crying, scrip in hand, feeling like he hoped I would kill myself.

It’s a big enough problem that we decided to add it to our education series.

GlaxoSmithKline’s corruption

GlaxoSmithKline
(Photo credit: Ian Wilson)

The details are simultaneously exactly what you’d expect and shocking.

And some people wonder why we’re reluctant to embrace the latest and greatest pharmacological fad. Keep all of this in mind next time someone suggests that medicalizing addiction treatment will improve professionalism, ethics and reliance on scientific evidence.

Sham advisory boards:

Glaxo also used sham advisory boards and speakers at lavish resorts to promote depression drug Wellbutrin as an option for weight loss and a remedy for sexual dysfunction and substance addiction, according to the government. Customers were urged to use higher-than-approved dosages, the government said.

Phony continuing education programs:

GSK paid millions to doctors to promote the drug off-label during meetings sometimes held at swanky resorts, the government said. The company relied on pharmaceutical sales reps, “sham advisory boards,” and continuing medical education programs that appeared independent but were not.

Misleading doctors:

The company went to extreme lengths to promote the drugs, such as distributing a misleading medical journal article and providing doctors with meals and spa treatments that amounted to illegal kickbacks, prosecutors said.

Bribing doctors:

“GSK’s sales force bribed physicians to prescribe GSK products using every imaginable form of high priced entertainment, from Hawaiian vacations to paying doctors millions of dollars to go on speaking tours to a European pheasant hunt to tickets to Madonna concerts, and this is just to name a few,” said Carmin M. Ortiz, U.S.attorney in Massachusetts.

Widespread:

Crimes and civil violations like those in the GlaxoSmithKline case have been widespread in the pharmaceutical industry and have produced a series of case with hefty fines. One reason some have said the industry regards the fines as simply a cost of doing business is because aggressively promoting drugs to doctors for uses not officially approved — including inducing other doctors to praise the drugs to colleagues at meetings — has quickly turned numerous drugs from mediocre sellers into blockbusters, with more than $1 billion in annual sales.

Stories have noted that Pfizer agreed to a $2.3 billion settlement in 2009. Also, Johnson & Johnson settled with Arkansas for $1.2 billion for several violations, including:

…for not disclosing the risks of the antipsychotic Risperdal.

Withholding data on Paxil:

GSK allegedly participated in the publishing of medical journal articles that stated paroxetine was effective in patients under 18, when, in fact, the data showed that the opposite was true. At the same time, the company withheld study data in from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18, according to a press release from the Justice Department.

Kept safety issues secret:

…the company kept secret data on raised cardiovascular effects.

Chantix should be a last resort

A new study suggests that Chantix should be a last resort tool for smoking cessation:

The psychiatric side effects of a popular quit-smoking drug make it too dangerous to use as a first attempt to kick the habit, according to a new study. The authors suggest the drug should eventually be taken off the market altogether.

The new study on the safety of varenicline (Chantix), appearing in the journal PLoS One, found that when compared with other smoking-cessation treatments, including nicotine replacement and the antidepressant bupropion (Zyban), varenicline was associated with significantly more cases of suicide, self-injury and depression. Varenicline was linked to 90% of 3,249 reported cases of self-harm or depression in people using quit-smoking drugs between 1998 and 2010, the study found, compared with 3% for nicotine replacement and 7% for bupropion.

…Dr. Curt Furberg, professor of health sciences at Wake Forest Baptist Medical Center and an author of the latest study, notes that his analysis found that varenicline resulted in many more cases of mental disturbances than bupropion. Given its safety profile, he argues that varenicline should be used only as a last resort for smokers who have tried other methods — including behavior modification, nicotine replacement and bupropion — and still can’t quit.

The Veterans Affairs Administration already uses varenicline by these guidelines, and Furberg approves of the policy. “They got it right,” he says. “They have restricted use of Chantix to a last-resort drug. They say when you try to get people to quit, and if you need a drug, start off with nicotine replacement and then Zyban. If they don’t work, then use Chantix. But if you do, you need to monitor mental status to see if people are suicidal in any way.”