Effexor, Marketing, and Dr. Drug Rep

Great job by Dr. Daniel Carlat. Read his piece in the New York Times Magazine regarding his stint as Dr. Drug Rep, when he stumped for Wyeth's antidepressant Effexor for a cool $30k in one year. Not bad work if you can get it. It is a fascinating account of a common industry practice -- train doctors to give speeches to other doctors in which certain treatment is pushed hard. Overplay efficacy and downplay negative effects. Drug companies state, with a straight face, that this is "educating" physicians -- buying them fancy dinners and having one of their colleagues read company-produced marketing slides on their product.

Carlat's blog is also a great source of information.

Is Wyeth's Psychiatric Ship Sinking?

Wyeth's attempt at an antipsychotic (bifeprunox) was rejected by the FDA today. Liz Spikol has a post on the topic that I found immensely entertaining. Daniel Carlat points out why the drug was rejected -- because it does not work very well. Yes, some doses showed a bit of improvement over placebo, yet bifeprunox did not impress when tried head-to-head against risperidone or olanzapine. Adding this drug to an already crowded antipsychotic market would seemingly do little for people with schizophrenia but would help Wyeth, which is looking a little desperate these days considering it has little to replace its flagship antidepressant Effexor.

What about Pristiq, the "son of Effexor," -- well, that ain't looking so promising (1, 2, 3). Good luck, Wyeth. It appears you're going to need it!

Chemical Imbalance Watch

I have ranted before about the alleged chemical imbalance in depression. Any time I've seen a commercial for any of the SSRI's, I've just shaken my head (0r banged it against the wall), as the ads love to tout how "experts" (i.e., their marketing department ?) believe that depression is caused by some sort of chemical imbalance. The evidence, as you can read here, is scant, at best, to support such an assertion.

Well, Wyeth is still on the chemical imbalance train with their knockoff of their current bestselling antidepressant Effexor, which may be gracing your pharmacy before long. The new drug is called Pristiq and Wyeth is offering up the following as part of its early PR campaign for the drug:

In the area of depression, Pristiq is expected to improve the balance of serotonin and norepinephrine as compared with serotonin reuptake inhibitors (SSRI) because of its pharmacologic profile as a dual reuptake inhibitor.

Well, whoopee! Will it work any better than antidepressants that attempt to target either norepinephrine or serotonin? Nope. Why? Because a reliable imbalance of either neurotransmitter has never been found in depression. That's right -- never. But Wyeth continues to run with the chemical imbalance program because a lot of people have been indoctrinated, through advertising or perhaps through teachers who themselves lacked much education on the topic, to buy into this whole chemical imbalance deal.

I'm not saying that biology does not impact depression. I am saying that our current level of understanding in this area is much more speculation than it is fact. I do not believe there is a single serious scientist who would stick his/her name behind the simple "chemical imbalance" theory of depression.

And the name Pristiq? It would appear that Wyeth is aiming for a close resemblance to "Pristine," which is a bit ironic given the side effect profile of Pristiq (which will likely resemble that of Effexor closely).

More on Pristiq in an interesting post at Depression Introspection.