Friday, March 20, 2009

Seroquel, Haldol, and The Full Court Media Press

I was very pleased to have been acknowledged in a recent story in the St. Paul Pioneer Press. The reporter, Jeremy Olson, wrote the following in his story:

An Internet psychiatry blog first raised questions March 2 about the research Schulz presented at the APA conference and why it lacked any of the company's findings."It raises troubling questions when an independent academic author presents results that are in direct opposition to the underlying data," wrote the blogger, an anonymous academic.

He didn't cite my blog by name -- the unwieldy long name which I stupidly chose for the site may be responsible for that -- but I'm nonetheless grateful that my site was acknowledged for its work on this story. He is referencing my post in which I noted that a University of Minnesota psychiatry professor (Charles Schulz) had stated in a press release that Seroquel was "more effective" than Haldol. This was based upon his analysis of data comparing Seroquel to the much older antipsychotic drug Haldol in the treatment of schizophrenia. Yet an internal AstraZeneca analysis found that Haldol was actually more effective than Seroquel. Both the Pioneer Press and the Star Tribune, the two big papers in the Minneapolis-St. Paul area ran stories on the controversy.

When asked about his lavishing of praise on Seroquel in the press release, the Pioneer Press said:

In an interview with the Pioneer Press last week, Schulz defended his research and presentation of Seroquel as accurate and ethical. However, he acknowledged the corporate press release from his APA presentation might have exaggerated in calling Seroquel "significantly superior."

"You know," he said, "I can't disagree with that."

Schulz said the following in the Star Tribune:

In an interview this week, Schulz said the pharmaceutical company never shared its doubts about Seroquel, which went on to become a blockbuster, with annual sales of $4.5 billion today. "I don't recall anybody calling up and saying, oh my goodness, we have this problem," he said. At the same time, Schulz acknowledged that his own study did not really show that Seroquel was more effective than the older drug. "That's a bit of a misunderstanding," he said. "I think the overall message is that it works about the same."

Thanks to a helpful reader, I was able to track down what appears to be Schulz's presentation from 2000. It says "...quetiapine was clearly statistically significantly superior to placebo as well as to haloperidol..." This appears to contradict his statement that Haldol and Seroquel "work about the same." Again, the data from Schulz's presentation don't match AstraZeneca's internal analysis. Schulz is obviously backing away from his earlier praise for Seroquel, for which he deserves some credit. The problem was that Schulz, along with a laundry list of researchers in psychiatry were caught in a tidal wave of unbridled enthusiasm for the atypical antipsychotics, first as wonder drugs for schizophrenia, then as the Next Big Thing in bipolar, then moving into the world of depression and anxiety disorders in the absence of decent supportive evidence.

Interesting sidenote: While Schulz was presenting on the wonders of Seroquel, he was likely quite unaware that AstraZeneca has conducted a study (Study 15) which had found that Seroquel compared unfavorably to Haldol in preventing psychotic relapse among patients with schizophrenia who began the study in full or partial symptom remisison. Furious Seasons has some additional reporting on this study. It is a near certainty that Schulz was not informed about this study's results, as this could have changed his lofty opinion of Seroquel. This points to the problem of researchers relying on data collected by drug companies -- how are researchers to know they are receiving all of the data?

Note to key opinion leaders: If you don't realize it by now, you are pawns. You are being used to place an academic veneer on the marketing of drugs. The drugs that you are marketing as major breakthroughs typically offer little to no benefit over existing treatment and may cause a slew of nasty side effects. Decide if you want to be a scientist or a marketer. Don't try to do both at the same time, because the odds are pretty good that your scientific credentials will end up being tarnished. Just ask this guy. Now that the media are paying much closer attention to the conflicted interests and skewed science that sadly underlie much of psychiatry these days, it would be a good idea to maintain appearances.

6 comments:

Anonymous said...

As a person who has had Haldol, some of these sado-masochists masquerading as Doctor's make me sick. The son of a bitch probably never made anything too clear to the poor bastard that was strapped down while he administered the hypodermic to his latest guinea pig. They know absolutely nothing about some of these mental illnesses.

therapyfirst said...

Nice job, CL. And, to your end comment about advising KOLs to pay heed to the risks, you are howling into the wind. Just look at what FS and Carlat have reported about the good ol boy Bierderman and each blog's different conclusion to it. I am very disappointed Dr Carlat seemed to defend this Nazi-type charlatan, and I know that reference annoys some readers, so I am glad I got your attention.

As this crap just escalates, so will I, but I will try to keep it respectable enough to allow the blog authors to print my comments. I apologize for my March 12 comment at an earlier post for the f-word, but the rest I stand by fully. Psychiatrists are lame until proven otherwise, and I can say that as I am one, but I hope not lame.

Glad you posted finally! Thought you cashed in or something in that vein!!!

insider said...

Great job!

Have you noticed the subtle Seroquel branding on the poster!?

I think we know who did all the work preparing this!!

CL Psych said...

I was unsure whether laughter or tears was a more appropriate reaction to the Seroquel branding on the poster...

Stephany said...

Hey CP, Great article esp your "note to key opinion leaders".

Stephany

Stan said...

TF wrote:

"Psychiatrists are lame until proven otherwise, and I can say that as I am one, but I hope not lame."

Though I can understand on some level the frustration and emotion involved in the scope of TF's views. I also must admit I am pleasantly surprised/impressed with the way TF has changed in his opinions and outlook as far as psychiatry goes.

TF you are on the inside looking out. I believe a little less bravado and just a little bit more staying on message will get you a lot more ears listening and agreeing with you from the professional end anywise.

You are in a good position to be a voice of professional reasoning and change. I would only ask you walk a little softer, as well as carrying that big stick with some prudence.

I sure wish you would have been this candid and honest with your awakening when you were at FS posting.

I entered Carlat’s comment section after reading his apologetic stance on Biederman to find out if he was really for substantial change in psychiatry or just walking the fence in the usual patronizing fashion psychiatry tends to do.

His answers and avoidance of them was quite alarming; since without coming out openly and bluntly saying he is agreeing with Biederman's use of preschool age children and the use of dangerous anti-psychotics in that population.

He ardently agrees with Biederman's methods and science as being sound in spite of the fact that Biederman had protocol lapses that were not reported six times in his renowned preschool age study; as well as stating what the results would be before even doing the study surely at J&J’s beckoning.

That leaves open a whole lot of wiggle room and openings for the old Harvard hanky panky and big unreported bucks in his pocket game. I don’t believe children are games or lab rats to be tempered with for greed or status at any level; but especially in what is supposed to be a respected and ethical medical profession.

Carlat also implies he is bought into the Child Bipolar paradigm with the assumed use of anti-psychotics in preschool age children.

That pretty much sealed the deal as far as knowing what side of the fence he is really walking on. I guess once your an indoctrinated MGH Harvard Doctor; your always part of the clan/family so to speak.

Personally, I would more often than not stay away from Nazi death camp doctor references in general in relating to the current events in Pharma and Psychiatry. Carlat has brought this one up himself, and left the door wide open for rebuke.

Quoting Carlat from the comment section of his Blog:

"Hi fans and ex-fans,

The point of the post was to say that there are some things Biederman is guilty of, and some things he isn't. Narcissism, egotism, greed? Yep. Fraud, perpetrator of evil, creator of pediatric bipolar disorder, impetus for all psychiatrists who have ever prescribed too many antipsychotics? Of course not. This is not Dr. Mengele. And anyone who wants to go to pubmed and read his clinical trials will actually find that they are, for the most part very well done and written up fairly without exaggerating positive findings or downplaying side effects. Bipolar disorder does, in fact, occur in children, whether you call in bipolar or conduct disorder or juvenile delinquency. And it is clear that antipsychotics moderate the behavior, though at the cost of significant side effects. Welcome to medicine, a world where there are no perfect solutions to many challenging problems.

It's time to stop blaming Biederman for all of psychiatry's failings and for all of the evils of the pharmaceutical industry. Let's put our energies into something more productive--like coming up with solutions for how to appropriately work with industry without doing their marketing for them."

Dr. Carlat is right! This is not Dr. Mengele since he is dead, a remembered dark chapter in history, and long past thankfully.

Biederman is in fact very much alive, still practicing medicine, collecting a fat pay check, still feeling like he's on top of the world and second in line to God almighty.

Biederman has set a professional standard in the industry, is the dark voice of child psychiatry, its most adamant spokesperson, and is still personally feeding preschool age kids powerful anti-psychotic drugs to this day.

Not just for child bipolar mind you: but also for ADHD and other behavioral disorders. A whopping 4000% increase over the past decade in children including preschool age.

The difference is quite clear; we stopped the Nazi's and declared we would never let atrocities like that happen again. Yet today we are allowing the same type of crimes to happen for greed and omnipotent professor status. Only this time around in the name of science and medicine; yet the vastness of the victimization has not changed really all that much if you see and imagine the decades of damage to come.

I have been reading this site, am impressed with the quality of content, and integrity of information posted here.

I am sad to say there seems to be no end to this corruption and madness anytime soon.

Thank You,

Stan