I guess any story about historical events is like this one. We already know something about how it comes out, so we want more than a rehashing of the events that were on the front page – the "what" of the story. We’re interested in something more in the range of the "why?" In this story, we know what everyone hoped for [from what had come before]:
• Antipsychotic: As potent as the best of the first generation drugs or Clozapine
• EPS or TD: As low as Clozapine [or lower]
• Weight Gain or Diabetes: No effect on weight, no increased incidence of Diabetes
• Bone Marrow: No Agranulocytosis
• Negative Symptoms: Some therapeutic effect in decreasing negative symptoms
• Relapse: Tolerability and relapse prevention
The thing of it is that we are well past the stage of being excited that antipsychotics even exist, and are now mostly plagued by the negative aspects of the existing drugs instead of being awed by their prowess, thus the laundry list of wished-for improvements. Truth is that we would settle for much less than the whole package so long as fatal side effects [agranulocytosis] was off the list. Remove Tardive Dyskinesia, possible Diabetes, and Agranulocytosis and we’d make plenty of compromises. This is from an AstraZeneca Stock Perspectus in 2001 [hat tip to PharmGossip]:
They wanted their drug to have it all and decimate the competition. And more than that, they wanted to expand the market. This is from another Stock Perspectus for AstraZeneca in 2002:
I don’t know if the "why?" gets any deeper than that – selling a product. AstraZeneca was new to the psychotropic drug market. They were used to the competitive market with drugs like Crestor® and Nexium® – designer drugs fighting over small differences in their profiles. That’s what these slides look like to me – sort of like the "features" list on a computer program for social networking rather than something to do with the major mental illnesses of all time and the actual fate of the afflicted. So they just kept pretending they had it all when they didn’t. It doesn’t really matter in cholesterol-lowers, or acid turner-offers, or even social networking. They all work and the differences approach the trivial. In Schizophrenia or the other conditions on that second slide, these things matter a whole lot. The "why?" is that AstraZeneca was acting like Seroquel was a new whitening toothpaste.
So I’m off to the beach for a week for a mid-winter break in an hour or so. If the Internet connection is good there and we have some cloudy days, I’ll probably continue my Seroquel obsession. If not, tune in in March…
UPDATE: So I’m sitting looking out over Pensecola Bay and I’m thinking about AstraZeneca and my comment that this was their first shot at a psychomarmacologic drug, like that matters. GlaxoSmithKline has been in this market forever, and acted no better – and others. So what happened in the Pharmaceutical Industry in the 1990s and 2000s that produced such widespread misbehavior? Asked another way, how did it happen that so many Psychiatrists were willing to become a part of all of this? Speaker’s Bureaus? C.M.E. programs? Scientific Consultants? Did they actually believe the things they said? The more of it I read, the odder it seems…
Have a great Winter Break….thank you once again for your efforts and insight
here’s one to keep you entertained re study 0041
http://dida.library.ucsf.edu/pdf/hpv09b10
Enjoy your break Mickey.
Face it, psychiatry is based on a non-tangible ‘disease’, unproven, a mystery as to how and why mental illness occurs, no one has answers and never has…& the drugs have never been a ‘cure’, it was an untapped market, w multiple targets…adults & kids, even entire families could be ‘drugged’. What a great market to tap into! psychiatrists & consumers chomping at the bit w HOPE being their only answer…trot in the KOLs, the ‘illness’ & doctors who play with the mind, not always MDs and the marketing teams saw $$$$$. Get KOLs on board such as Biederman, Chang, Nemeroff, Koplewitz et al and there is a BIG market where greed took the highway and ethics, integrity were kicked to the curb.
There IS a reason for the 4000% increase in child bipolar dx the last decade, it is NOT a mystery, and NO America does not have an epidemic of untreated mental illness, America is suffering from a marketing blitz, creating and selling DISEASE, paid off for in order as they were popular and rx’d: Zyprexa, Seroquel, Geodon, Abilify, Saphris…. AND NO DRUG HAS BEEN SUCCESSFUL YET FOR THE TREATMENT OF PSYCHOSIS OR SCHIZOPHRENIA.
BUT the profits were!!