Thursday, January 04, 2007

NASW and Janssen: Strange Bedfellows

The National Association of Social Workers is coming under some serious heat from a group of its members. Why? Here’s the letter from the opposition group.

“On October 6, 2006, the National Association of Social Workers (NASW) sent to its Specialty Practice Sections on mental health and private practice an emailed “Invitation to Join The National Adherence Initiative for Schizophrenia.” An article in the November issue of NASW News also announces and describes the initiative.

The brief text in the email asked social workers to consider enrolling “in a nationwide data collection effort.” It stated: “Partial adherence is a significant problem in the treatment of schizophrenia … and can affect up to 75% of patients.” It invited participants to “identify up to 10 clients with schizophrenia that you feel are at risk for partial adherence.”

The last line of the text informed that this initiative “is sponsored by Janssen, L.P. in partnership with NASW.” The pharmaceutical company Janssen, a subsidiary of Johnson & Johnson, markets Risperdal (risperidone), an antipsychotic drug that grossed $2.3 billion in US sales in 2005. Social workers who enrolled received a packet from Janssen, with the “study instrument,” that spoke of nothing but the importance of drug treatment adherence for schizophrenia.”

Say what? Oh, it gets even more juicy.

“Treatment compliance is an old issue in schizophrenia care. Everyone in this field knows that antipsychotic drugs’ unpleasant effects make them extremely undesirable to patients. The Janssen initiative closely follows the government-sponsored CATIE studies’ findings that three quarters of patients on atypical antipsychotics such as Janssen’s Risperdal—falsely touted for a decade as vast improvements over older drugs—stop taking their prescribed medication because of “inefficacy, intolerable adverse effects, or other reasons.”

The study instrument mailed to social workers consists of eight “yes/no” questions, each describing a “deficit” in patients that would put them “at risk” of “partial adherence.” In our view, no information not already well known from dozens of previous studies on adherence to neuroleptic treatment, including the $45 million CATIE studies on nearly 1,500 patients, is likely to come from this Janssen-NASW study. The adherence initiative repeats that “partial adherence” is a significant problem in the treatment of schizophrenia—but the more significant problem lies rather with the drugs’ now well established ineffectiveness and adverse effects.

Why would Janssen be doing this? Pay close attention…

“Janssen’s exclusive patent to market oral risperidone will expire in 2007, and the company stands to lose significant revenue as cheaper generic versions come to market. Janssen is therefore now emphasizing the long-acting injectable version of risperidone, which it markets as Risperdal Consta—on which it still holds patent for several more years (and which sells for more than the oral version). The history of antipsychotic drug use shows that one notion, and one notion only, has ever justified using long acting injectable antipsychotics: adherence (compliance). In this light must Janssen’s “adherence initiative” be more fully appreciated.”

It appears that Janssen initiated contact with NASW on this matter and they allegedly made a contribution to the NASW foundation in return for this collaboration.

What was Janssen going to do with this information? I don’t know, but I’ll speculate they wanted to get patients to try out a Janssen product like Risperdal Consta or Invega (their “new” antipsychotic that is essentially a clone of Risperdal). I don’t know what the next steps will be – hopefully the social workers will respect patient confidentiality and not just start handing out names and contact information to “researchers.”

To summarize: Janssen gets a wild hair and contacts NASW, which agrees to participate in this “research” campaign to “help” patients, possibly in exchange for a donation from Janssen. There is little scientific knowledge to be gained from such a study, but Janssen gets to push its Risperdal Consta and/or Invega on what could be a large group of patients. Unfortunately, I’ve not been able to track down the full text of the email, but I’ll work on it and I’ll follow up the story as it develops.

Thanks to Writhe Safely for covering the story. Note that her site is not for those who are offended notably by profanity.

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