Posts Tagged ‘Food and Drug Administration’

Big Pharma executives facing legal threat; including potential fines and prison time

Sunday, October 31st, 2010

The Philadelphia Inquirer, October 31, 2010

by Christopher K. Hepp

Rats that infested a Philadelphia warehouse 40 years ago have found their way into the legal nightmares of the nation’s drug companies.Frustrated that even billion-dollar fines seem to have little effect on pharmaceutical firms, the Food and Drug Administration has increasingly signaled its intent to use a legal doctrine spawned by those long-gone rodents to bring criminal charges against top executives, even those who might have been unaware of company misdeeds.

Earlier this month, Eric Blumberg, FDA litigation chief, told an industry audience that his agency was looking for cases to use what is known as the Park Doctrine as a tool to “change the corporate culture” of firms that have thus far shrugged off other penalties.

In one area the FDA is targeting are companies that have illegally promoted products for unapproved uses, a practice know as off-label marketing.

“I don’t know when, where, or how many cases will be brought,” Blumberg told a gathering of the Food and Drug Law Institute, “but if you are a corporate executive – or counsel advising such a client – I would not wait for the first case to decide now is the time to comply with the law. They won’t get a mulligan on their conduct.”

In an interview Thursday, Blumberg was pointed.

“They need to take this seriously and find out what is going on in the marketing and sales divisions of their companies,” he said of pharmaceutical executives. “In my view, one thing that will get executives’ attention is a few cases in which we have convicted two-legged defendants.”

He singled out firms, including Pfizer Inc. and Eli Lilly & Co., that have paid multiple penalties in recent years.

Eli Lilly, for instance, was hit with a $1.4 billion fine last year for illegally marketing Zyprexa, a antipsychotic drug. The same year, Pfizer was fined $2.3 billion for illegally marketing the pain reliever Bextra. Neither company’s stock price suffered significantly, leading some to conclude that even massive fines are viewed by investors and executives as simply the cost of doing business. Neither firm responded to calls for comment.

“It is clear that fines are not working here,” Blumberg said. “We need to put something else on the scale to make people think twice, three times, before they promote drugs for unapproved uses.”

That something is the threat of prison and industry debarment, which could result from a successful prosecution using the Park Doctrine.

Under the Park Doctrine, a corporate officer is liable for illegal corporate actions the officer should have known about or was responsible for preventing.

It stems from a case involving John Park, president of Acme Markets Inc. in 1970, when the company was cited for rodent infestations at a warehouse here.

The FDA charged Park personally with violating sanitation laws after other rodent infestations were discovered despite a number of agency warnings.

Park argued that as company president he was too far removed from warehouse supervision to be held responsible.

The U.S. Supreme Court ultimately agreed with the FDA that Park, as president, was responsible for ensuring rodent-free warehouses.

Park got off relatively easy: a $250 fine.

Prosecutors now hope to extract stiffer penalties under the doctrine, including up to a year in prison and $100,000 fines.

Those are the possible punishments facing four executives of Synthes Inc., a West Chester firm that pleaded guilty early this month in connection with illegal clinical trials of a bone cement. Charged under the Park Doctrine by the U.S. Attorney’s Office in Philadelphia, the executives have also pleaded guilty.

The Park Doctrine can be “a very powerful tool,” said Assistant U.S. Attorney John Pease, who supervises criminal prosecutions involving pharmaceutical-industry fraud cases in eastern Pennsylvania. But it also presents prosecutors with a number of hurdles, he said.

The crimes under scrutiny have a five-year statute of limitations, for instance. Often, prosecutors are not even alerted to them for several years, he said.

“And with multinational pharmaceutical companies with billions in revenue, you find responsibility is very diffuse,” Pease said. “The real challenge is finding a person who was in a position to know about and prevent the conduct that occurred.”

Scott Gottlieb, a former FDA commissioner who is now a partner with Arcoda Capital in New York, said another challenge would be assuring that an off-label case would hold up in court, particularly if it involved executives several layers above the departments that committed the illegal acts.

“There are clearly cases where the management is so far removed from the activity, they have no direct knowledge of the issue,” he said. “To hold them criminally liable is a significant policy step that needs to be done with great care.”

He agreed, however, that bringing criminal charges against executives “would be a significant deterrent.”

read the rest of the article: http://www.philly.com/inquirer/business/20101031_Big_Pharma_executives_facing_legal_threat.html?viewAll=y

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Booming Sales of Antipsychotic Drugs Often Fueled by Illegal Marketing Tactics

Wednesday, October 6th, 2010

FairWarning, October 6, 2010

By Jessica Roberts 

Antipsychotic drugs, once used to treat only the most serious mental illnesses, have emerged as the top-selling class of pharmaceuticals in the U.S., generating annual revenue of about $14.6 billion. Yet much of the sales boom has been achieved with illegal or controversial marketing tactics by major pharmaceutical companies to promote uses of the drugs that have not been approved by the U.S. Food and Drug Administration.

The result, according to an account by The New York Times, is that every major manufacturer of antipsychotic drugs — Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca and Johnson & Johnson  — has recently settled criminal or civil government cases for hundreds of millions of dollars or is under investigation by the Department of Justice for possible health care fraud. The criminal fines paid by Eli Lilly and Pfizer last year set records last year for the largest criminal fines ever imposed on corporations, although in the case of Pfizer, the case was built only partly on the marketing of an antipsychotic drug.

In their defense, the companies say that they follow tight business ethics guidelines and that all possible side effects of their medicines are fully disclosed. Recently, however, the government has warned that some of the drugs may be fatal for older patients and have unknown effects on children. And critics question how drugs approved by the agency for use by 1 percent of the population, to treat illnesses such as schizophrenia and bipolar mania, could have turned into top sellers, prescribed for everyone from preschoolers to octogenarians.

At least part of the answer lies in the companies’ marketing tactics. The Times reports that civil and criminal lawsuits against big pharmaceutical companies have revealed hundreds of documents showing that some company officials knew they were using questionable tactics when they marketed these powerful, expensive drugs.

According to analysts and court documents, these tactics have included payments, gifts, meals and trips for doctors, biased studies, and ghostwritten medical journal articles. These all are meant, federal investigators say, to promote the benefits and downplay the risks of the drugs, while encouraging off-label uses — that is, uses the FDA has not approved but which doctors, if they choose, can pursue with their patients anyway.

Drug companies skirt restrictions on promoting off-label uses by hiring consultants, researchers and educators to handle the job, delivering the marketing message verbally and through company-sponsored studies. “They can give a small hint, and people will take the bait,” Dr. Robert Rosenheck, a professor of psychiatry and public health at the Yale School of Medicine, told the Times. “Psychiatric disorders are vaguely defined enough that you can stretch definitions.”

The Justice Department claims drug companies trained sales representatives to rebut valid medical concerns about unproved uses of antipsychotic drugs. For example, the department says, Eli Lilly produced a video called “The Myth of Diabetes” to sell Zyprexa, which became its all-time best-selling drug, even though evidence showed that Zyprexa could cause diabetes.

Read the rest of this article here: http://www.fairwarning.org/2010/10/booming-sales-of-antipsychotic-drugs-often-fueled-by-illegal-marketing-tactics/

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Antipschotic Drugs—Side Effects May Include Lawsuits

Monday, October 4th, 2010

The New York Times
By Duff Wilson
October 2, 2010

FOR decades, antipsychotic drugs were a niche product. Today, they’re the top-selling class of pharmaceuticals in America, generating annual revenue of about $14.6 billion and surpassing sales of even blockbusters like heart-protective statins.

cover
Department of Justice Statements on the Five Major Companies Selling Anti-Psychotic Drugs:
AstraZeneca
Bristol-Myers Squibb
Eli Lilly
Johnson and Johnson
Pfizer

While the effectiveness of antipsychotic drugs in some patients remains a matter of great debate, how these drugs became so ubiquitous and profitable is not. Big Pharma got behind them in the 1990s, when they were still seen as treatments for the most serious mental illnesses, like hallucinatory schizophrenia, and recast them for much broader uses, according to previously confidential industry documents that have been produced in a variety of court cases.

Anointed with names like Abilify and Geodon, the drugs were given to a broad swath of patients, from preschoolers to octogenarians. Today, more than a half-million youths take antipsychotic drugs, and fully one-quarter of nursing-home residents have used them. Yet recent government warnings say the drugs may be fatal to some older patients and have unknown effects on children.

The new generation of antipsychotics has also become the single biggest target of the False Claims Act, a federal law once largely aimed at fraud among military contractors. Every major company selling the drugs — Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca and Johnson & Johnson — has either settled recent government cases for hundreds of millions of dollars or is currently under investigation for possible health care fraud.

Two of the settlements, involving charges of illegal marketing, set records last year for the largest criminal fines ever imposed on corporations. One involved Eli Lilly’s antipsychotic, Zyprexa; the other involved a guilty plea for Pfizer’s marketing of a pain pill, Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon; Pfizer settled that part of the claim for $301 million, without admitting any wrongdoing.

The companies all say their antipsychotics are safe and effective in treating the conditions for which the Food and Drug Administration has approved them — mostly, schizophrenia and bipolar mania — and say they adhere to tight ethical guidelines in sales practices. The drug makers also say that there is a large population of patients who still haven’t taken the drugs but could benefit from them.

AstraZeneca, which markets Seroquel, the top-selling antipsychotic since 2005, says it developed such drugs because they have fewer side effects than older versions.

“It’s a drug that’s been studied in multiple clinical trials in various indications,” says Dr. Howard Hutchinson, AstraZeneca’s chief medical officer. “Getting these patients to be functioning members of society has a tremendous benefit in terms of their overall well-being and how they look at themselves, and to get that benefit, the patients are willing to accept some level of side effects.”

The industry continues to market antipsychotics aggressively, leading analysts to question how drugs approved by the Food and Drug Administration for about 1 percent of the population have become the pharmaceutical industry’s biggest sellers — despite recent crackdowns.

Some say the answer to that question isn’t complicated.

“It’s the money,” says Dr. Jerome L. Avorn, a Harvard medical professor and researcher. “When you’re selling $1 billion a year or more of a drug, it’s very tempting for a company to just ignore the traffic ticket and keep speeding.”

NEUROLEPTIC drugs — now known as antipsychotics — were first developed in the 1950s for use in anesthesia and then as powerful sedatives for patients with schizophrenia and other severe psychotic disorders, who previously might have received surgical lobotomies.

But patients often stopped taking those drugs, like Thorazine and Haldol, because they could cause a range of involuntary body movements, tics and restlessness.

A second generation of drugs, called atypical antipsychotics, was introduced in the ’90s and sold to doctors more broadly, on the basis that they were safer than the old ones — an assertion that regulators and researchers are continuing to review because the newer drugs appear to cause a range of other side effects, even if they cause fewer tics.

Contentions that the new drugs are superior have been “greatly exaggerated,” says Dr. Jeffrey A. Lieberman, chairman of the psychiatry department at Columbia University. Such assertions, he says, “may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications.”

“At the same time,” he adds, “the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical evidence.”

Others agree. “They sold the story they’re more safe, when they aren’t,” says Robert Whitaker, a journalist who has written two books about psychiatric medicines. “They had to cover up the problems. Right from the start, we got this false story.”

The drug companies say all the possible side effects are fully disclosed to the F.D.A., doctors and patients. Side effects like drowsiness, nausea, weight gain, involuntary body movements and links to diabetes are listed on the label. The companies say they have a generally safe record in treating a difficult disease and are fighting lawsuits in which some patients claim harm.

The cases, both civil and criminal, against many of the world’s largest drug makers have unveiled hundreds of previously confidential documents showing that some company officials were aware they were using questionable tactics when they marketed these powerful, expensive drugs.

Such marketing, according to analysts and court documents, included payments, gifts, meals and trips for doctors, biased studies, ghostwritten medical journal articles, promotional conference appearances, and payments for postgraduate medical education that encourages a pro-drug outlook among doctors. All of these are tools that federal investigators say companies have used to exaggerate benefits, play down risks and promote off-label uses, meaning those the F.D.A. hasn’t approved.

Lawyers suing AstraZeneca say documents they have unearthed show that the company tried to hide the risks of diabetes and weight gain associated with the new drugs. Positive studies were hyped, the documents show; negative ones were filed away.

According to company e-mails unsealed in civil lawsuits, AstraZeneca “buried” — a manager’s term — a 1997 study showing that users of Seroquel, then a new antipsychotic, gained 11 pounds a year, while the company publicized a study that asserted they lost weight. Company e-mail messages also refer to doing a “great smoke-and-mirrors job” on an unfavorable study.

“The larger issue is how do we face the outside world when they begin to criticize us for suppressing data,” John Tumas, then AstraZeneca’s publications manager, wrote in a 1999 e-mail. “We must find a way to diminish the negative findings,” he added. “But, in my opinion, we cannot hide them.”

Tony Jewell, an AstraZeneca spokesman, said last week that the company had turned over all that material to the F.D.A. as part of the approval process and updated its label over the years to show the latest safety information.

Dr. Stefan P. Kruszewski, a Harvard-educated psychiatrist who once worked as a paid speaker for several drug makers, became a government informant and now consults for plaintiffs suing drug companies. Earlier in his career, he spoke at events for Pfizer, GlaxoSmithKline and Johnson & Johnson as an advocate of antipsychotics. He said one company offered him incentives of $1,000 or more every time he talked to an individual doctor about one of its drugs.

“When I started speaking for companies in the late 1980s and early ’90s, I was allowed to say what I thought I should say consistent with the science,” he recalls. “Then it got to the point where I was no longer allowed to do that. I was given slides and told, ‘We’ll give you a thousand dollars if you say this for a half-hour.’ And I said: ‘I can’t say that. It isn’t true.’ ”

Slides for one new antipsychotic drug contended that it had no neurological side effects. “They made it all up,” Dr. Kruszewski said. “It was never true.”

Read entire article:  http://www.nytimes.com/2010/10/03/business/03psych.html?_r=2

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Sex, Lies and Pharmaceuticals—How Female Sexual Dysfunction (a “mental disorder”) was invented by the drug industry

Friday, October 1st, 2010

The Independent
By Jeremy Laurance
October 1, 2010

Female sexual dysfunction – which is claimed to affect up to two thirds of women – is a disorder invented by the pharmaceutical industry to build global markets for drugs to treat it, it is claimed today.

Drug companies have invested millions in the search for a female equivalent of Viagra, so far without success. But while doing so they have stoked demand by creating a buzz around the disorder they have created, according to Ray Moynihan, a lecturer at the University of Newcastle in Australia.

Corporate employees worked with medical opinion leaders, ran surveys aimed at portraying the problem as widespread and helped create the diagnostic instruments to persuade women that their sexual difficulties deserved a medical label. But sex problems in women are far more complex than they are in men, encompassing lack of desire, lack of arousal and lack of orgasm and the drug industry’s narrow focus is failing them.

Mr Moynihan, who first investigated the drug industry’s role in female sexual dysfunction a decade ago, says it illustrates a wider problem about the creation of new diseases, and the widening of existing boundaries for treatment with designations such as pre-diabetes, pre-hypertension and pre-osteoporosis, for which the latest treatments are aggressively promoted.

In his new book, Sex, Lies and Pharmaceuticals, which is previewed in the British Medical Journal, he says: “Drug marketing is merging with medical science in a fascinating and frightening way. Perhaps it is time to reassess the way in which the medical establishment defines common conditions and recommends how to treat them.”

In 2005, Pfizer, makers of Viagra, funded a survey which showed 63 per cent of women had sexual dysfunction and that testosterone and Viagra might be helpful. In 2006, Procter and Gamble, makers of a testosterone patch for women, sponsored a survey showing one in 10 postmenopausal women had hypoactive [low] sexual desire disorder (the company sold its drug business in 2009). In 2008, Boehringer Ingelheim, makers of flibanserin which is claimed to boost the female libido, sponsored a survey which also showed one in 10 women was in need of help.

Efforts by the companies to meet the need have subsequently foundered. Pfizer pulled Viagra from the market for women after trials showed it had no greater effect than placebo. Procter and Gamble’s testosterone patch was rejected in 2004 in the US, over fears it raised the risk of cancer and heart disease and Beohringer Ingelheim’s drug, flibanserin, was rejected by the US Food and Drug Administration in June on the grounds it had failed to deliver the agreed benefits while carrying the risk of serious side effects.

Mr Moynihan warns that although the drugs have so far failed, more are in the pipeline and claims that “the drug industry shows no signs of abandoning plans to meet the unmet need it has helped to manufacture”. A spokesman for Pfizer said: “We currently have no plans to develop medicines for FSD.”

Read entire article here:  http://www.independent.co.uk/life-style/health-and-families/health-news/female-sexual-dysfunction-was-invented-by-drugs-industry-2094578.html

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Paxil Birth Defects Lawyers Site Offers News And Information About Antidepressant Heart Defects

Monday, September 27th, 2010
Quote startDespite evidence suggesting that Paxil could cause birth defects, Glaxo deliberately chose not to conduct studies that would have uncovered the true dangers of the drug.Quote end

The law firm of Hissey Kientz, LLP is pleased to announce the launch of its new website, Paxil Birth Defects Lawyers (http://www.paxilbirthdefectslawyers.com/). The site will serve as an information resource for the parents and families of children born with birth defects linked to their mothers’ use of Paxil during pregnancy. Multiple studies have found that the children of mothers who take Paxil while pregnant are at an increased risk of severe birth defects.

PR WEB

September 27, 2010

The law firm of Hissey Kientz, LLP is pleased to announce the launch of its new website, Paxil Birth Defects Lawyers (http://www.paxilbirthdefectslawyers.com/). The site will serve as an information resource for the parents and families of children born with birth defects linked to their mothers’ use of Paxil during pregnancy.

Paxil is part of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). After it first went on the market in December 1992, Paxil has gone on to become one of the most widely prescribed drugs in the United States, with annual sales of $3.2 billion by 2002.

Multiple studies have found that the children of mothers who take Paxil while pregnant are at an increased risk of severe birth defects. In December 2005, the Food and Drug Administration called for stronger birth defects warnings on the drug’s labeling after two studies found that Paxil doubles the risk of birth defects when taken by women during the first trimester of pregnancy. Most of these birth defects involved cases of atrial and ventricular septal defects (holes in the walls of the chambers of the heart).

Paxil has also been linked to an increased risk of birth defects when taken later in pregnancy. A 2006 study published in the New England Journal of Medicine found that women who take Paxil or similar antidepressants after the 20th week of pregnancy are six times more likely to give birth to a child with persistent pulmonary hypertension of the newborn (PPHN), a condition which causes breathing and circulation problems that may lead to hospitalization or death.

Taking Paxil during pregnancy may also be linked to a number of other serious heart defects in newborns, including cardiomyopathy, tricuspid stenosis, cleft mitral valves, hypoplastic left heart syndrome (HLHS), hypoplastic right heart syndrome (HRHS), bicuspid aortic valves or patent ductus arteriosus (PDA).

Documents uncovered in the ongoing litigation against GSK [Paxil] products liability litigation (MDL-1574)] have revealed that GlaxoSmithKline, the drug’s manufacturer, was aware of the potential link between the antidepressant and birth defects as early as 1980, but failed to recall the drug or properly warn about its dangers until these risks were made public by researchers.

“Despite evidence suggesting that Paxil could cause birth defects, GlaxoSmithKline deliberately chose not to conduct studies that would have uncovered the true dangers of the drug,” says David Friend of Hissey Kientz, LLP. “It is impossible to say how many lives were drastically altered because of the company’s failure to heed the advice of experts and investigate the link between Paxil and birth defects.”

Read the rest of the article here: http://www.prweb.com/releases/2010/09/prweb4565144.htm

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Drug Industry’s Boast of Ethics Rings Hollow

Thursday, September 16th, 2010

The Star Phoenix, September 16, 2010

by Mark Lemstra

Russell Williams, president of Canada’s Pharmaceutical Companies, recently wrote an opinion piece criticizing a series of articles that I wrote on antidepressants. His article was headlined: “Drug industry ethical standards high.”

Curiously, Williams did not address my concern that a review from the United States Food and Drug Administration found that antidepressants not only have no benefit in children, but are associated with a 50 per cent increase in suicidal behaviour.

Regrettably, these negative results were buried by the drug companies. In an editorial in the Canadian Medical Association Journal, titled Drug Company Experts Advised Staff to Withhold Data about SSRI Use in Children, and a separate editorial in The Lancet, titled Depressing Research, the authors express regret that drug companies put profits ahead of preventing suicides among children.

I fail to see the high ethical standards in these actions. In fact, it would be easy to list all of the unethical activity by pharmaceutical companies, but this would take a whole book. Instead, let’s discuss one specific example in detail.

Read more: http://www.thestarphoenix.com/health/Drug+industry+boast+ethics+rings+hollow/3532133/story.html#ixzz0zi3tRIIc

http://www.thestarphoenix.com/health/Drug+industry+boast+ethics+rings+hollow/3532133/story.html

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MomLogic.com “Babies on Antipsychotics?…Why would anyone put a BABY on antipsychotic meds?!”

Thursday, September 9th, 2010

MomLogic.com
By Vivian Manning Schaffel
September 9, 2010

Last week, the New York Times ran a sad yet compelling story about a boy named Kyle, who at 18 months was put on antipsychotic drugs to quell severe temper tantrums.

By the time he was 3, the poor kid had been diagnosed with autism, bipolar disorder, hyperactivity, insomnia and “oppositional defiant disorder” (um, isn’t that a fancy phrase for “normal toddler behavior”?). He was on the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and a pill for attention-deficit disorder.

Did you read that?! Prozac! Sleeping pills!

The side effects had Kyle “drooling” and “overweight,” but his mom likened the worst side effect to a coma. “I didn’t have my son,” she said. “It’s like, you’d look into his eyes and you would just see blankness.”

Fast-forward to the present, and you meet a very different kid. Kyle is 6, in first grade and doing very well in school. He’s off the drugs (except for Vyvanese for ADD), and as it turns out, never should have been on all those drugs in the first place.

In fact, the article pointed out that more and more doctors are writing stronger scripts for younger and younger children, citing a 2009 Food and Drug Administration report which stated that over half a million children and adolescents in America are now taking antipsychotic drugs. Yet some doctors warn of the considerable developmental and physical risks these strong drugs pose to younger children, and say that research has not deemed these meds safe for this age group.

Another disturbing nugget of info: A Rutgers University study found that children from low-income families, like Kyle, are four times more likely to receive antipsychotic medicines than children whose parents are privately insured. Why? Because medicating these children is cheaper than asking them to participate in family therapy.

Read entire article here:  http://www.momlogic.com/2010/09/babies_on_antipsychotics.php

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New study finds Anti-seizure drugs, increasingly prescribed for people labeled “bipolar,” induce suicide & death

Tuesday, August 31st, 2010

Natural News
By David Gutierrez
August 31, 2010

Popular anti-seizure drugs may seriously increase a patient’s risk of suicide and violent death, according to a study conducted by researchers from Brigham and Women’s Hospital and Harvard Medical School, and published in the Journal of the American Medical Association.

The drugs, known as anticonvulsants, were initially designed for the treatment of epilepsy but are now widely prescribed “off-label” for conditions such as bipolar disorder, migraine headaches and pain.

“We all know the range of uses of these medications is very, very wide,” researcher Elisabetta Patorno said.

The researchers examined the prescription and medical records of more than 300,000 people above the age of 14 who had been prescribed an anticonvulsant for the first time between July 2001 and December 2006.

All of the drugs, they found, significantly increased a patient’s risk of attempted or successful suicide, as well as violent death by other causes. During the course of the study, there were 801 attempted suicides, 26 successful suicides and 41 violent deaths.

“We found increased risk for suicidal acts beginning within the first 14 days after treatment initiation, opening the possibility that anticonvulsant medications could induce behavioral effects prior to the achievement of their full therapeutic effectiveness,” the researchers wrote.

Based on prior studies, the FDA ruled in 2008 that all anticonvulsants must carry labels warning that they double the risk of suicidal thoughts and actions. These older studies had not been able to determine if any drugs posed higher risks than others, however.

Read entire article here:  http://www.naturalnews.com/029614_suicide_anti-seizure_drugs.html

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New Review of FDA antidepressant drug trials suggests antidepressants only “marginally better” than placebo – Ineffectiveness of antidepressants called “jaw-dropping”

Tuesday, August 24th, 2010

Medscape
By Deborah Brauser
August 24, 2010

A new review of 4 meta-analyses of efficacy trials submitted to the US Food and Drug Administration (FDA) suggests that antidepressants are only “marginally efficacious” compared with placebo and “document profound publication bias that inflates their apparent efficacy.”

In addition, when the researchers also analyzed the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, “the largest antidepressant effectiveness trial ever conducted,” they found that “the effectiveness of antidepressant therapies was probably even lower than the modest one reported…with an apparent progressively increasing dropout rate across each study phase.

“We found that out of the 4041 patients initially started on the SSRI [selective serotonin reuptake inhibitor] citalopram in the STAR*D study, and after 4 trials, only 108 patients had a remission and did not either have a relapse and/or dropped out by the end of 12 months of continuing care,” lead study author Ed Pigott, PhD, a psychologist with NeuroAdvantage LLC in Clarksville, Maryland, told Medscape Medical News.

Sustained Benefit “Jaw Dropping”

“In other words, if you’re trying to look at sustained benefit, you’re only looking at 2.7%, which is a pretty jaw-dropping number,” added Dr. Pigott.

Overall, “the reviewed findings argue for a reappraisal of the current recommended standard of care of depression,” write the study authors.

“I believe there are likely some people where [antidepressants] are truly beneficial beyond placebo. The problem right now is that we simply have no way of knowing who those people are,” noted Dr. Pigott. “My hope is that this kind of analysis creates ‘more oxygen’ for looking at other kinds of approaches to treatment.”

The study was published in the August issue of Psychotherapy and Psychosomatics.

When registering new drug application trials with the FDA, drug companies must prespecify the primary and secondary outcome measures, the investigators report. “Prespecification is essential to ensure the integrity of a trial and enables the discovery of when investigators selectively publish the measures that show the outcome the sponsors prefer following data collection and analysis, a form of researcher bias known as HARKing or ‘hypothesizing after the results are known’,” they write.

For this article, Dr. Pigott and his team reviewed the following meta-analyses:

  • 1. Rising and colleagues (reviewed all efficacy trials for new drugs between 2001 and 2002)
  • 2. Turner and colleagues (reviewed 74 past trials of 12 antidepressants)
  • 3. Kirsch and colleagues, 2002 (reviewed 47 trials of 6 FDA-approved antidepressants)
  • 4. Kirsch and colleagues, 2008 (reviewed depression severity and efficacy in 35 trials)

The researchers also sought to reevaluate the methods and findings of STAR*D, a randomized, controlled trial of patients with depression. Its prespecified primary outcome measure was the Hamilton Rating Scale for Depression (HRSD), whereas the Inventory of Depressive Symptomatology–Clinician-Rated (IDS-C30) was secondary for identifying remitted and responder patients.

“STAR*D was designed to identify the best next-step treatment for the many patients who fail to get adequate relief from their initial SSRI trial,” the study authors write.

“When I first read about STAR*D’s step 1 phase, it just seemed biased to me,” explained Dr. Pigott. “I thought of it as the ‘tag, you’re healed’ research design. Patients who were scored as having a remission during the first 4 to 6 weeks of up to 14 weeks of acute care treatment were counted as remitted, taken out of the subject pool, and put into the follow-up care phase. In other words, they didn’t have the ability to have a relapse. But as most people know, depression ebbs and flows.

“So what made me want to continue to follow this study was that it became clear that the only way that people were really going to be able to evaluate the antidepressants’ effectiveness was to wait for the publication of the follow-up findings,” he added. “After their major final summary study was published, I felt as though the results weren’t really being portrayed in a manner that was consistent with the study’s prespecified criteria.”

High Dropout, Low Remission Rates

In addition to reporting on low efficacy of antidepressants compared with placebo, the 4 meta-analyses “also document a second form of bias in which researchers fail to report the negative results for the prespecified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure, as though it was their primary measure of interest,” the investigators write.

For example, they note, the meta-analysis from Rising and colleagues found that studies with favorable outcomes were almost 5 times more likely to be published and that over 26% of primary outcome measures were left out of journal articles. Turner and colleagues found that antidepressant studies were 16 times more likely to be published if favorable compared with those with unfavorable outcomes.

In reanalyzing the STAR*D methods, the researchers found that the high dropout rate resulted in frequently missed exit HRSD and IDS-C30 interviews. So the revised statistical analytical plan dropped the IDS-30 for the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR), which was given at each visit.

“Even with the extraordinary care of STAR*D, only about one fourth of patients achieved remission in step 1 [and] the dropout rate was slightly larger than the success rate,” the study authors write. Steps 2 through 4 also each showed increasingly fewer success rates and larger dropout rates.

Of the 4041 patients at the study’s initiation, 370 (9.2%) dropped out within 2 weeks, and only 1854 patients (45.9%) obtained remission “using the lenient QIDS-SR criteria.” Of these, 670 dropped out within a month of their remission, and only 108 “survived continuing care” and underwent the final assessment.

Dr. Pigott described reanalyzing STAR*D as being “a bit like an onion. Each time we thought we understood the results, we found another layer. It wasn’t until about a year and a half ago that we discovered that the secondary outcome measure, the QIDS-SR, was not originally supposed to be used as a research measure. What was particularly disconcerting to me was that in their summary article, they basically used the QIDS-SR to report all of the results, which clearly had an inflationary effect on the outcome.”

He also noted that STAR*D did not have a placebo design. “Because the patients knew they were receiving the active medication, I would have expected a higher remission rate than what you’d find normally in a placebo-controlled study.

“The inescapable conclusion from the STAR*D results is that we need to explore more seriously other forms of treatment (and combination thereof) that may be more effective. This effort will require developing new service delivery models to ensure that as treatments are identified, they are widely implemented,” the investigators conclude.

Read entire article here:  http://www.medscape.com/viewarticle/727323
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Following 7-year-old’s psychiatric drug-induced suicide—Florida bans foster children from clinical drug trials

Wednesday, August 11th, 2010

Education News
By Pareesha Narang
August 9, 2010

Sixteen months after 7-year-old Gabriel Myers committed suicide while taking psychotropic drugs, the state of Florida has banned allowing any children in the state’s custody from participating in clinical drug trials.

It is unclear if Gabriel was involved in any clinical trials. The doctor who prescribed the medicines to him was conducting clinical trials involving psychotropic drops and the Food and Drug Administration sent him a warning letter earlier this year about overdosing children who were involved in those trials.

The Florida ban was imposed  after the state tried to find out from the FDA if Gabriel or any other foster care child in Florida was a participant in such trials, and the FDA said it could not disclose such information and that mostly they know participants by only coded identifiers.

Though Florida officials had suggested that, under such circumstances, the Federal Food and Drug Administration ban all foster care children from participating in such trials, the agency refused, saying the children might benefit from the drugs.

In a letter last month,  George Sheldon, secretary of the state’s Department of Children and Families (DCF), announced that regardless of the FDA’s stance the state, using “administrative procedures,” was precluding children in state care from participating in such trials.

“Children who come into our care are often the victims of abuse, neglect, and abandonment,” Sheldon said in the letter. “It is therefore imperative that the state do all in its power to stabilize their environment, to protect them from further trauma, and to foster their successful growth into adulthood.”…

Before he hanged himself in his foster home, Gabriel had been taking different drugs for a variety of psychological problems – and some of the drugs were not approved for use in children.  Some of these drugs, including Lexapro, Vyvanse and Symbyax, had “black box” warnings cautioning dangerous side effects such as suicidal thoughts.

Read entire article here:  http://www.educationnews.org/educationnewstoday/97911.html

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