Charting ties between drug companies, psychiatrists, lawmakers

Project Proposal: Some recent articles have covered the over-prescription of antipsychotics by both psychiatrists and general practitioners. Abilify and Seroquel, two antispychotics, are the fifth and sixth best selling prescription drugs in the U.S., writes Dr. Richard A. Friedman, professor of psychiatry at Weill Cornell Medical College in Manhattan, in a September article for the New York Times.

Second generation antipsychotics, so-called atypical antipsychotics, including the two mentioned above, came to market in 1993. While they have fewer neurological side effects than the first-generation of drugs, clinical trials have shown them to be no more effective or well-tolerated than the first generation of drugs. Plus they have serious long-term side effects of their own.

Here’s the worst part: they are increasingly being prescribed for illnesses for which they have not been approved by the FDA, including everyday anxiety disorders, insomnia and even mild emotional discomfort. And many of the people who are prescribed these medications are never told of their side effects. Nor have any real efforts been made to discourage this kind of off-label drug-pushing. In fact, the U.S. has been barred, under free-speech laws, from prosecuting drug-marketing reps for marketing their drugs for “lawful” but non-FDA approved off-label purposes.

Back in 2008, a US Senate investigation revealed that a number of academic psychiatrists who study psychiatric medications had failed to disclose millions of dollars they received from the drug companies that make them as required by the National Institutes of Health and their universities. These were not small-time psychiatrists at small-time institutions. Dr. Joseph Biederman, a high-profile child psychiatrist at Harvard who has conducted numerous clinical trials, was one of them. He had failed to declare over a million dollars of income that he received from pharmaceutical companies as consulting fees.

The Physician Payments Sunshine Act—Section 6002 of the Affordable Care Act (ACA)—requires public disclosure of the financial relationships between physicians and applicable manufacturers, including pharmaceutical, medical device and biologics companies. The Centers for Medicare and Medicaid Services (CMS) were tasked with implementing final regulations by October 2011 but missed the deadline, and the final rules still have not been written. But Jan. 1, 2013 is the deadline for companies to begin “collecting” data on the payments made to physicians. Meanwhile, 12 major drug companies have already begun disclosing these payments online, partially as a result of legal settlements, and ProPublica has begun compiling this information into a searchable database of the payments that individual physicians and medical centers receive.

This project would use the data currently available on ProPublica—and collect it from other companies as it becomes available after the Jan. 1 deadline—to begin to chart the specific ties between psychiatrists and the drug companies that market psychiatric drugs. It would also attempt to quantify the dollar value of the prescriptions for psychiatric drugs written by individual doctors, and to create an interactive map of the dollar in-dollar out amounts.

The project would also look at the power drug companies wield in Washington. How much do individual lawmakers get in financial contributions from pharma companies and how have they voted on laws regulating the companies and the drugs they make? The financial contributions information is readily accessible at openscrets.org. Getting the information about voting records would require combing through congressional records.

 

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