NPR – August 22, 2011
by Nancy Shute

Drug firms fear that being "liked" on Facebook could get them in trouble with the FDA. iStock photo

People love how Facebooklets them comment on and share other people’s posts. But the idea of sharing on social media has got drug companies scared. When Facebook told drugmakers that they had to start allowing comments on their Facebook pages, some of those pages started disappearing.

“Take On Depression” suddenly disappeared. “ADHD Moms” vanished, too. So did “Epilepsy Advocate.” In the past, drug companies had been reluctant to create Facebook pages without a guarantee that they’d be closed to public comments — a unique accommodation on Facebook’s part. But that accommodation ended last week.

Diabetes blogger Amy Tenderichthinks it’s high time the drug companies quit walling themselves off. She’s the founder of  Diabetest Mine,  an independent site. She says: “The notion that they would be able to be able to put up these Facebook pages and then close them off to comments is ridiculous.”

On her site, people with diabetes comment a lot. They share information on what drugs they’re taking, give each other advices on dosages, and tell people which drugs are working for them, and which are causing side effects. For Tenderich and others, the whole point of social media like Facebook and Twitter is to comment on other people’s posts.

But drug companies have to play by different rules. The Food and Drug Administration requires that each a drug manufacturer mentions a prescription drug, they also have to list its risks and side effects. That’s called fair balance.

“You see some of those magazine ads that are three and four pages long and you wonder why they are?” asks Tony Jewell, who supervises drugmaker AstraZeneca’s social media efforts. “It’s because we’re communicating the full risks, benefits and appropriate use of the medicine. That’s a little bit harder to do in a social media channel like Facebook and Twitter.”

One big reason companies cite for killing Facebook pages is that they wouldn’t be able to adequately police comments with inaccurate information about prescription drugs.

“So they might say, ‘Lipitor’s great at whitening your teeth,’ which it’s not approved to do,” says Jonathan Richman. That’s his example of a potentially dicey comment. He’s a group director for the Possible Worldwide ad agency in Cincinnati, and he closely follows the drug industry’s social media efforts on his Dose of Digital blog. “The question becomes, What’s Pfizer’s liability? What action could the FDA take, based on somebody else posting that?”

So far, the FDA hasn’t come down on a single drug company for allowing public comments. The only action the agency has taken against use of social media was last year, when it warnedNovartis that a Facebook “share” widget for the leukemia drug Tasignaviolated fair balance.

But the FDA also hasn’t told the companies how to use social media and still follow the “fair balance” rule. In November 2009, the agency held public hearingson how pharma companies should use social media. But the FDA has yet to issue official guidance. Jewell says that because of that, his employer and other companies are erring on the side of caution.

Tenderich says patients would benefit from a rich interaction with drug makers. She sees more and more drug company employees interacting on her site, giving advice on behalf of their employers. That’s a huge benefit for patients, she says.

The pharmaceutical companies could benefit, too, she says, by learning what problems patients are having with drugs, and how to make them better.

“They could get so much fantastic, free, very high-value feedback,” she says.

http://www.npr.org/blogs/health/2011/08/22/139859210/why-drug-companies-are-shy-about-sharing-on-facebook?ps=sh_sthdl

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PsychCentral
By John M Grohol PsyD
Founder & Editor-in-Chief

You know it’s not good when one of the most prestigious pediatric journals, Pediatrics, can’t differentiate between correlation and causation.

And yet this is exactly what the authors of a “clinical report” did in reporting on the impact of social media on children and teens. Especially in their discussion of “Facebook depression,” a term that the authors simply made up to describe the phenomenon observed when depressed people use social media.

Shoddy research? You bet. That’s why Pediatrics calls it a “clinical report” — because it’s at the level of a bad blog post written by people with a clear agenda. In this case, the report was written by Gwenn Schurgin O’Keeffe, Kathleen Clarke-Pearson and the American Academy of Pediatrics Council on Communications and Media (2011).

What makes this bad a report? Let’s just look at the issue of “Facebook depression,” their made-up term for a phenomenon that doesn’t exist.

The authors of the Pediatrics report use six citations to support their claim that social media sites like Facebook actually cause depression in children and teens. Four of the six citations are third-party news reports on research in this area. In other words, the authors couldn’t even bother with reading the actual research to see if the research actually said what the news outlet reported it said.

I expect to see this sort of lack of quality and laziness on blogs. Hey, a lot of time we’re busy and we just want to make a point — that I can understand.

When you go to the trouble not only of writing a report but also publishing it in a peer-reviewed journal, you’d think you’d go to the trouble of reading the research — not other people’s reporting on research.

Here’s what the researchers in Pediatrics had to say about “Facebook depression:”

Researchers have proposed a new phenomenon called “Facebook depression,” defined as depression that develops when preteens and teens spend a great deal of time on social media sites, such as Facebook, and then begin to exhibit classic symptoms of depression.

Acceptance by and contact with peers is an important element of adolescent life. The intensity of the online world is thought to be a factor that may trigger depression in some adolescents. As with offline depression, preadolescents and adolescents who suffer from Facebook depression are at risk for social isolation and sometimes turn to risky Internet sites and blogs for “help” that may promote substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors.

Time and time again researchers are finding much more nuanced relationships between social networking sites and depression. In the Selfhout et al. (2009) study they cite, for instance, the researchers only found the correlation between the two factors in people with low quality friendships. Teens with what the researchers characterized as high quality friendships showed no increase in depression with increased social networking time.

The Pediatrics authors also do what a lot of researchers do when promoting a specific bias or point of view — they simply ignore research that disagrees with their bias. Worse, they cite the supposed depression-social networking link as though it were a forgone conclusion — that researchers are all in agreement that this actually exists, and exists in a causative manner.

There are a multitude of studies that disagree with their point of view, however. One longitudinal study (Kraut et al., 1998) found that, over a period of 8–12 months, both loneliness and depression increased with time spent online among adolescent and adult first-time Internet users. In a one-year follow-up study (Kraut et al., 2002), however, the observed negative effects of Internet use had disappeared. In other words, this may not be a robust relationship (if it even exists) and may simply be something related to greater familiarity with the Internet.

Other research has shown that college students’ — who are often older teens — Internet use was directly and indirectly related to less depression (Morgan & Cotten, 2003; LaRose, Eastin, & Gregg, 2001).

Furthermore, studies have revealed that Internet use can lead to online relationship formation, and thereby to more social support ([Nie and Erbring, 2000], [Wellman et al., 2001] and [Wolak et al., 2003]) — which may subsequently lead to less internalizing problems.

In another study cited by the Pediatrics authors, simply reading the news report should’ve raised a red flag for them. Because the news report on the study quoted the study’s author who specifically noted her study could not determine causation:

According to Morrison, pornography, online gaming and social networking site users had a higher incidence of moderate to severe depression than other users. “Our research indicates that excessive Internet use is associated with depression, but what we don’t know is which comes first – are depressed people drawn to the Internet or does the Internet cause depression? What is clear is that for a small subset of people, excessive use of the Internet could be a warning signal for depressive tendencies,” she added.

The other citations in the Pediatrics report are equally problematic (and one citation has nothing to do with social networking and depression [Davila, 2009]). None mention the phrase “Facebook depression” (as far as I could determine), and none could demonstrate a causative relationship between use of Facebook making a teenager or child feel more depressed. Zero.

I’m certain depressed people use Facebook, Twitter and other social networking websites. I’m certain people who are already feeling down or depressed might go online to talk to their friends, and try and be cheered up. This in no way suggests that by using more and more of Facebook, a person is going to get more depressed. That’s just a silly conclusion to draw from the data to date, and we’ve previously discussed how use of the Internet has not been shown to cause depression, only that there’s an association between the two.

If this is the level of “research” done to come to these conclusions about “Facebook depression,” the entire report is suspect and should be questioned. This is not an objective clinical report; this is a piece of propaganda spouting a particular agenda and bias.

The problem now is that news outlets everywhere are picking up on “Facebook depression” and suggesting not only that it exists, but that researchers have found the online world somehow “triggers” depression in teens. Pediatrics and the American Academy of Pediatrics should be ashamed of this shoddy clinical report, and retract the entire section about “Facebook depression.”

Read article here:  http://psychcentral.com/blog/archives/2011/03/28/pediatrics-gets-it-wrong-about-facebook-depression/

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Joseph Kenan was removed from one case and has been challenged in others after posting the photos.

Los Angeles Times
By Kim Christensen and Victoria Kim
February 27, 2011

Dr. Joseph Kenan, a Beverly Hills psychiatrist and child custody evaluator, said the pictures of him on the Web were not intended for public viewing. (Los Angeles Times / February 15, 2011)

A prominent Beverly Hills psychiatrist who has helped decide hundreds of child-custody disputes was thrown off one recent case and has been challenged in at least two others after posting lewd photos of himself on Facebook and allegedly promoting illegal drug use, unprotected sex and male prostitution.

Dr. Joseph Kenan, president of the American Society for Adolescent Psychiatry, is also being investigated by the Medical Board of California on at least four complaints by parents who hired him to do custody evaluations, according to records and correspondence reviewed by The Times.

Among the postings on Facebook and other websites under the slightly different names of “Joe Kegan” and “Joe Keegan” were photos showing Kenan baring his buttocks to the camera in public and another of him posing with a friend holding a cake that explicitly depicted a sexual act, court records state.

The litigation over Kenan’s fitness sheds light on a highly influential, but lightly regulated, group of experts — the evaluators who advise family courts in contested custody cases. Evaluators can earn fees of tens of thousands of dollars for assessing parents’ fitness.

Critics of the system say the courts do a poor job of overseeing the work of people who often play pivotal roles in the lives of vulnerable children. A recent state auditor’s report faulted two courts in Northern California for how they vet custody evaluators’ qualifications and training.

Kenan’s detractors have been particularly vehement.

“This man should not be allowed to determine whether any father or mother is a good parent,” said Deborah Singer, who persuaded a court commissioner to remove Kenan from her child-custody case last year after she discovered explicit postings on Facebook and elsewhere on the Internet.

Singer and another parent who sought to disqualify Kenan, Deborah Zolla, say their concerns were sparked, in part, by his demands for tens of thousands of dollars, which they considered excessive fees, to develop custody plans for their children.

Kenan declined to be interviewed for this article. In a written statement submitted in Singer’s case, he said the Facebook page was never meant for public viewing. He closed it and asked other websites to remove photos of him, Kenan wrote.

“Ms. Singer misunderstands the bawdy humor I occasionally present to my friends, as evidenced by some of those pictures. I do NOT promote what she is concerned I promote. My comments are entirely in jest. In fact, my comments serve to educate the community’s problems through satire.”

Kenan’s lawyer, Donald S. Eisenberg, said the doctor’s private life had no bearing on his professional performance. He said Kenan’s detractors were unhappy with his evaluations or trying to avoid paying his fees. In court papers, he called the allegations inadmissible hearsay, conjecture and innuendo.

“His entire livelihood is being crushed by information … that is quite irrelevant to the work he does,” Eisenberg said. “These allegations show what lengths, in some litigation, that people will go to try to unwind unfavorable opinions expressed by qualified experts in their child custody cases.”

Singer and Zolla, who also cited the Internet postings, made their objections to Kenan before he completed evaluations in their cases.

At a hearing last Aug. 3, Family Law Commissioner Steff Padilla dismissed Kenan from Singer’s case after reading descriptions of Facebook photographs in her disqualification motion.

In at least one other case, however, a court commissioner in Pasadena ruled the other way, denying a mother’s request to remove Kenan from a case involving the custody of her 11-year-old daughter.

“You’re saying Dr. Kenan should be disqualified because of a goofy Facebook page. What on earth does it have anything to do with this court?” Commissioner Mary Lou Katz asked in denying the removal motion.

State law sets requirements for evaluators, but county courts oversee their appointments and handle any complaints. The Los Angeles County Superior Court requires private evaluators like Kenan to submit sworn declarations detailing their training and experience, including at least three years of working with families in custody disputes, but does not vet the information or conduct background checks.

Court records show that Kenan, 41, has been involved in at least 250 custody cases in the last 10 years. Kenan began working with the court’s custody evaluations office as a medical intern in 2002 and was a part-time employee there from 2004 to 2009, said Margaret Little, Superior Court family law and probate administrator.

When he became a private contractor, his name was added to a directory posted on the court’s website, Little said. The list is for the convenience of parents seeking a private evaluation and is not meant to be an endorsement, she said.

Court officials told The Times they had received no complaints about Kenan.

Unlike evaluators on the court’s staff, who work at a fixed rate, private evaluators set their own fees, which can be more than 10 times as much, sometimes leading to clashes with clients.

Singer paid Kenan a $7,500 retainer last May, court records state, and she and her lawyer said they were taken aback when he later asked for tens of thousands of dollars more to finish his report.

Her attorney, Dennis E. Braun, said in court papers that Singer already had custody of her daughter, now 5, and supported her financially. Singer’s estranged husband had barely seen the child in two years, was serving a one-year jail sentence for a probation violation and faced additional felony charges upon release, the records state.

When Kenan asked for an additional $35,000 and offered to send a “runner” to her house for a $20,000 check, she became alarmed and researched him on the Internet, leading her to the explicit photos, her court papers say. After he was removed from the case, Kenan voluntarily returned the $7,500 retainer to Singer, who later won full legal and physical custody of her daughter.

Some of Kenan’s Facebook postings — all since taken down — appeared to promote illicit drug use, including a picture of a woman holding a large straw while kneeling on a mirror with lines of white powder. Another was a photo of Kenan with a party banner that read “It’s snowing,” a phrase alleged in court papers to refer to crystal meth or cocaine.

Sheriff’s deputies have been called to Kenan’s home at least twice, records show, once in late 2007 to quell a raucous party and again last Oct. 23 on a report of a possible drug overdose death. The death proved to be from natural causes and no drugs were found in the dead man’s body. But coroner’s investigators found a burnt meth pipe in the room where he died.

“Dr. Kenan has no idea what that is, or where it came from,” his lawyer, Eisenberg, said of the pipe. “He is not a drug user, has never been a drug user and denies any drug use. Period.”

Many of Kenan’s Facebook postings were explicitly sexual and included ads for parties he co-hosted at nightclubs, including some that appeared to promote unprotected sex. One ad promoted a gay porn site and Rentboy.com, which features male escorts for hire.

“If any of my clients were doing what he’s doing, trust me, they would lose custody of their kids,” Braun said. “Yet, he is the one making recommendations to the courts — and which the courts have been following.”

Hours after he was disqualified from Singer’s case, Kenan took himself off the court’s directory of evaluators, although he continued to work on some custody cases and accepted at least one new one — Deborah Zolla’s — last October. Days before a March 2 disqualification hearing in that case, Zolla and her estranged husband settled their custody dispute, rendering Kenan’s involvement moot.

As word of his removal from Singer’s case has spread, however, other clients have complained to the medical board or sought to boot him from their cases.

Some lawyers who have worked with Kenan said he was well regarded.

Anja Reinke, a veteran family law attorney, said that although she hasn’t always agreed with Kenan’s recommendations, she’s had no major problems working with him on a half dozen or so cases. Kenan “quickly got a very good reputation” and was particularly knowledgeable in cases involving complex mental illnesses, she said, adding: “I think he’s competent.”

A volunteer assistant clinical professor at UCLA, Kenan is nearing the end of his term as president of the American Society for Adolescent Psychiatry, which has about 250 members.

Dr. Dean De Crisce, the president-elect, said that Singer complained about Kenan to the association but that it lacks the “legal, financial, and investigative power” to act on complaints and relies on investigations by other bodies, including state medical boards.

Kenan “is respected for the work he does” and his fees are in line for someone with his background, De Crisce said. As for Singer’s reaction to the photos, he said: “It’s understandable that those were not pictures of the kind of person she would want to determine the fate of her family.”

Read the article here:  http://www.latimes.com/news/local/la-me-kenan-20110227,0,7724924.story?page=1

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November 16, 2009

On November 13th, 2009, Pharmaceutical companies flocked to a two-day FDA hearing into online drug advertising, which could influence their use of social media on the net. ¹ Already, the explosive growth in online advertising has intensified public concerns: the pharmaceutical industry spent more than $1 billion on Internet ads last year and is projected to spend $1.7 billion on such marketing efforts in 2012, according to the Direct Marketing Association.²

Both Eli Lilly and Merck have received warning letters this year from the FDA accusing them of misleading online advertisements.³ But while the FDA scrambles to monitor online ads, who monitors the psychiatric-pharmaceutical industry’s use of front groups to indirectly market their products?

A Washington Post article of June 16, 2009 reported that an increasing number of pharmaceutical firms are turning to social media tools, such as Facebook, YouTube, Twitter and MySpace, to market their products.  It cites how a community site sponsored by drugmaker McNeil called “ADHD Allies”—aimed at adults with ADHD—was established and offered an online podcast on financial advice and an “ADHD self-assessment tool.”⁴

British psychiatrist Joanne Moncrieff explains how this ultimately increases drug sales because only a biomedical approach is promoted: “Drug companies…provide funds for pro drug patient and carer groups and address advertising or disease promotion campaigns to the general public…This influence has helped to create and reinforce a narrow biological approach to the explanation and treatment of mental disorders and has led to the exclusion of alternative” treatments.⁵

Such websites do not mention company’s product but rather market the “disease.” In advertising, it can be accomplished through a strategy known as “condition branding,” where “mental illness” can be pitched just like cars, beer or laundry detergent.  Witness the brand name “bipolar” and “social anxiety disorder” that drug companies marketed at a fever pitch.

John Read, PhD, Psychology Department, University of Auckland did an analysis of 54 random “advocacy” groups for Post Traumatic Stress Disorder (PTSD) through the Internet. The results, published in the Journal of Trauma & Dissociation this year, found 42% of the websites received drug company funding. The researchers found:

• “Patients tend to trust these organizations to act in an unbiased manner” but as earlier researchers argued in some cases “patient organizations have become a mouthpiece for the pharmaceutical industry in influencing regulatory authorities.”
• “Drug company influence within the area of mental health is prevalent and now extends to the Internet. This influence is not always transparent. This study suggests that drug company sponsorship of websites leads to a greater emphasis on pharmacology in the treatment of PTSD,” Dr. Read’s report concludes.⁶

ADHD Allies/ADHD Moms

In June 2008 Concerta was given an expanded indication by FDA and is now indicated for patients aged 6 to 65.⁷ In July 2008, McNeill Pediatrics—a subsidiary of Ortho-McNeill Pharmaceuticals—launched what they called an “unbranded group” called “ADHD Moms.” ADHD Moms markets the trademarked name “Mom-bassadors” to get mothers into the Facebook page. ⁸

• McNeill spuriously claims “the group is not product-specific, nor are there any advertisements for the company’s ADHD drug Concerta (methylphenidate).” Well not directly, but providing material for the site is a Dr. Quinn, a paid consultant and speaker for McNeil Pediatrics. ⁹ April White, who also provides content is a paid spokesperson for McNeil Pediatrics.¹⁰
• On April 22 2009, McNeill launched a second ADHD-focused Facebook page called “ADHD Allies,” this time targeting adults.  The “Allies” are board members of another front group Attention Deficit Disorder Association (ADDA), funded by McNeill.¹¹
• The pharmaceutical company has trademarked “ADHD Allies” and “ADHD Moms.”  ADHD Allies was responsible for a “2008 Harris Interactive survey of 1,000 adults with ADHD.” Not surprisingly, the survey found the condition significantly affects them. ¹²

Log onto The Bipolar Journey: Living With Bipolar Depression website and while it does show AstraZeneca on the home page, there’s no mention of its blockbuster antipsychotic drug Seroquel, approved by the FDA in 2006 for “bipolar.”  The site looks like a patient information site providing facts about the “disease” and misleadingly saying that it may be caused by a chemical imbalance—for which there is no evidence.

It refers people to the National Alliance for the Mentally Ill (NAMI) that has received $23 million recently from at least 18 drug companies. The site shows that of 17 cites for the exhibit’s showing in 2009, 12 are conferences or events put on by NAMI.

It also links to The Depression and Bipolar Support Alliance, a group that received close to $1 million in pharmaceutical company funding in 2007.

According to an August 27 2009 press announcement, AstraZeneca launched its interactive exhibit, endorsed by New York psychiatrist Janet Taylor. The press release does not mention that Dr. Taylor has financial ties to the company.¹³

In 2005, global sales for Seroquel reached $2.8 billion.  October 20, 2006, company announced Seroquel was FDA approved for bipolar.¹⁴ Within a year, sales reached $3 billion and then soared again in 2008 to $4.66 billion.¹⁵

By funding social media front groups that talk only about the “disorder,” drug companies can overcome fears of running afoul of FDA regulations that govern drug advertising and “are embracing social networks to help brand and position their companies in a positive light with consumers and practitioners.”  The top 10 drug companies using social media are: Pfizer, Johnson and Johnson, Novartis, Boehringer Ingelheim, AstraZeneca US, Bayer, GlaxoSmithKline, Sanofi-Aventis, Roche, and Merck.¹⁶

This post was written by CCHR International.
Coming next from CCHR Int: Psycho Pharma Front Groups

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