On this page, ISTC considers the evidence regarding the impact of drug company marketing and money on the practice of therapy and client care . . .
The Latest Research on the Effect of the Industry on Clinical Practice . . .

He who pays the piper calls the tune...
More bad news...at least for anyone trying to figure out what the truth is about medication. Researchers Kjaergard and Als-Nielsen (2002) studied the association between published reports regarding the effectiveness of medication and who was paying for the research. Surprise! They found that the researcher's conclusions were significantly more positive toward an "experimental intervention" (e.g., a drug) in studies funded by for profit organizations–a difference of .48 SD! The difference could not be explained, by the way, by methodological quality, statistical power, type of intervention, type of control, or medical specialty. In contrast, competing personal, academic, and political competing interests were not significantly correlated with study findings. In another study:

Trials of anti-psychotic drugs funded by drug companies are more likely to show a benefit of treatment.

It does seem that he who pays the piper calls the tune...

Kjaergard, L., & Als-Nielsen, B. (2002). Association between competing interests and author's conclusions. British Medical Journal, 325, 249.

Can you trust the FDA? or is the Fox truly in Charge of the Hen House?
Just when you thought it was safe to trust the government again, reports in the USA Today show that advisors to the organization established in 1906 to ensure the "safety, efficacy, and labelling of pharmaceutical products" have financial links to pharmaceutical companies with products under FDA review!! While Federal Law prohibits such relationships without special permission, the report shows that FDA-approved waivers are granted with "alarming frequency." Consider, for example, that in 159 advisory meetings between 1998 and 2000, 40 conflict-of- interest waivers were refused while 830 of 1620 attending members were granted waivers. Think about that the next time you take your medication!

Psychology Today, 34(1), 10-11.

The Pharmaceutical-Friendly Media . . .
Unless you're Rip Van Winkle, you've seen the glitzy and slick pharmaceutical ads that now run constantly on American television. Americans pride themselves in being a skeptical lot even though the data clearly show that such advertisements increase the appetite for the chemicals in the ads. Rarely discussed but more troubling is the unusually positive press that pharmaceutical products get from non-paid media sources (e.g., the news)! A recent study in the prestigious New England Journal of Medicine indicates that the positive bias is overwhelming. Media sources typically omit discussion of risks, overstate the benefits, and neglect to tell the public how drug testing is funded. So much for unbiased journalism . . .

McCarthy, K. (2000). Misleading media. Psychology Today, 33(6), 10.

"Say No to Drugs (but yes to Prozac)! America's Schizophrenic relationship with Chemicals . . .
On the surface, America appears to have a strong anti-drug culture. Almost every day, the evening news touts a major drug bust or spotlights professionals working to address the scourge of drugs. And yet, Americans expanding consumption of antidepressants shows an appetite for chemicals that belies a different agenda: legalized alteration of mind and mood. Since Prozac was introduced in 1988, prescriptions for antidepressants have tripled to more than 120 million. Sales of antidepressants, the most costly and fastest growing of the top four therapeutic drug categories, topped $7 billion in 1998, up from $2 billion in 1993, the report notes. "I don't think it's bankrupting us, but it is a pretty astounding number that the cost went up by $5 billion," Sandra M. Foote, director of the Health Insurance Reform Project at George Washington University in Washington, DC, and author of a recent study.

Drug makers "have no legal obligation and few incentives" to conduct cost-effectiveness studies said the author. Their job is to sell drugs. From the looks of it, they're doing a good job.

Health Affairs 2000;19(4):165-170.

Recent Research

Drug Company Influence on Treatment Research
After an embarrassing incident in which the New York Times and later the editors of the prestigious New England Journal of Medicine found a large number of articles which failed to disclose ties to drug companies, a decision was made to require disclosure for all articles to be published. How little the editors knew . . . In the May 18, 2000 issue of the journal the authors of an article on the treatment of depression had so many ties that there wasn't enough room to print them all! The lead author alone served as a consultant to 9 companies, had received grants from nine, and served on thirteen separate advisory boards. The effect of such funding on the objectivity of the results is clear? As the old saying goes, "He who pays the piper calls the tune." The editor of the journal lambasted the conflict of interest cocktail arguing that in order to restore integrity medical schools should immediately ban faculty from receiving lucrative speaking fees (an indirect reward), stock offerings (a direct reinforcement), and gifts from drug companies. Next time you or your family is offered a drug by your doctor, you should ask yourself, "Who is benefiting most from this product."

Science (May 26, 2000). The burden of baring all.

Monmaney, T. (May 18, 2000). Medical journal urges curbs on researcher ties to drug firms. A31.

Does Direct-to-Consumer Advertising by Pharmaceutical Companies Work?
The data say . . . YUP! In this study, researchers asked respondents whether they had seen ads for 10 drugs widely advertised on television. The average respondent was aware of ads for 4/10 of the drugs with Prozac being the most well known of the psychiatric drugs. In spite of the recent explosion of ads on television, however, having read magazine ads was a better predictor of awareness of drug products. What kind of return are the drug companies getting on their advertising dollars? Nearly 20% of those exposed to an ad (1/5) had led them to request a prescription for the drug from their physician. Not bad, eh?

Bell, R.A. et al. (1999). Direct-to-consumer prescription drug advertising and the public. Journal of General Internal Medicine, 14, 651-657.

Can You trust your Doctor?
Well, consider the following study and then decide for yourself. Everyday 45,000 drug representatives fan out all over the United States to make visits to prescribers. Those described as having "busy practices" were more likely to receive visits from drug representatives. Prescribers who are trained in programs that restrict access by drug representatives were just as likely to meet with a rep and receive free samples as those with less restrictive policies. In the end, the drug companies spent an estimated 5.3 billion on marketing, that is one rep and $100,000 for every 11 practicing physicians. You say it has no effect? Well, the chances of a prescriber associating a particular drug with a particular disorder increase from around 50 to 75% following a visit from the friendly representative bearing drug samples.

Ferguson, R.P. et al. (1999). Encounters with pharmaceutical sales representatives among practicing internists. American Journal of Medicine, 107, 149-52.

Some little-known facts the Benevolent Drug Companies . . .

	On average, pharmaceutical companies spend between 10,000 to 15,000 per physician per year on marketing.
	Between 20-30% of the American Psychiatric Association's operating budget comes from Pharmaceutical Companies.
	96% studies which are sponsored by the pharmaceutical industry find the drug under investigation helpful while only 37% of government funded studies do.
	Pharmaceutical companies are the major supporters of the National (Name your Mental Health Problem Here) Days.
	Pharmaceutical companies spend more on marketing their products than on research and development.
	The new and supposedly improved SSRI's are no more effective than the old tricyclic anti-depressants but cost between 10 and 20 times more.

Duncan, B.L., Miller, S.D., and Sparks, J. (March, 2000). The myth of the magic pill. Family Therapy Networker.

Women and the Psychiatric Drug Establishment
Given the women's movement, you would think that the field of psychiatry would have come a long way in their understanding and treatment of female patients. The following article, reprinted with permission from the author suggests otherwise:

THE POLITICAL IS PERSONAL – OR, WHY HAVE A REVOLUTION (from within or without) WHEN YOU CAN HAVE PROZAC?
2000 Sasha Claire McInnes

1999 was a very good year for the legal drug pushers and others who profit from women’s reality.
Are you shy? Having trouble feeling comfortable with people? Don’t despair. While you may have long considered shyness to be just another element of your personality, medical "science" has decided that this trait is the expression of a chronic mental disorder. The American Psychiatric Association asserts that there are 35 million people adrift on a sea of morbid shyness (Social Phobia) and the FDA, in May, gave approval to SmithKlineBeecham to market Paxil as the fix.
Do you experience PMS? On November 3^rd, an FDA advisory committee unanimously voted to recommend approving Eli Lilly’s Prozac for PMS – despite a large percentage of the participants dropping out due to the effects of the drug and a placebo effect accounting for half of the benefits. This recommendation followed clinical trials supervised by Hamilton, Ontario psychiatrist, Meir Steiner, who tittered to the press that "this is the first time the clinic got flowers from husbands" of women participating in the trials. Shades of "The Stepford Wives", "science" assures us that a psychotropic, taken every day, will fix the irritability and frustration we may feel for 4 or 5 days every month. Eli Lilly, savvy big business promoters that they are, have asked the FDA to approve a new name for Prozac because the patent has recently run out.
Shop too much? On December 6^th, as Christmas advertising reached a frenzy, Stanford University psychiatrist, Lorrin Koran, launched trials of ‘an SSRI similar to Prozac and Zoloft for individuals ‘who can’t stop shopping’. While Koran asserts that 90% of these shoppers are women, the focus of the study will not include a critique of big business flooding our mailboxes, television screens, radios and computers with adverts.
Have you been raped, battered, incested and experience Post Traumatic Stress Response* to being violated? The FDA approved Pfizer’s Zoloft on December 7^th to get you through your anguish, torment and rage, asserting that Zoloft works best for women. How long before psychiatrists, with their prescription pads, will be a common site in rape crisis centres and battered women’s shelters? Will these resources for women survive at all in the brave new world of psychopharmacology?
Ever feel anxious? Also in 1999, Pfizer received approval to market Effexor for ‘generalized anxiety’, that garden-variety, free-floating anxiety that has plagued women since the beginning of time. And for those of you who thought Valium was history, a ‘kinder, friendlier’ version will be on the market shortly, according to a group of Swiss scientists.
Lonely? Sad? Worried? In grief? Too happy? Do you FEEL? "Take this," Says the Doctor, "you’ll soon feel better." They do ‘feel’ better, because little by little, they cease to feel at all notes (Jeanette Winterston, Art and Lies). Women’s responses to men’s violence and the stresses we face living under Patriarchy, are being characterized by self-interested others as debilitating ‘mental illnesses’ in order to receive FDA approval for chemical "treatment". This move to pathologize and medicalize every human emotion and behavior is succeeding if one believes IMS America, which tracks the pharmaceutical companies. It reports that in 1997, doctors in the US wrote 51 million prescriptions for serotonin reuptake inhibitors (SSRI’s), the most common antidepressant family, which includes Paxil, Zoloft and Prozac, among others. Sales of the top six SSRI’s topped $3.6 billion. Prozac, Eli Lilly’s best-selling drug and the world’s top selling antidepressant, had sales of $690.2 million in one quarter alone. Big business. Insidious big business: two Eli Lilly staff are sitting on the 5 member organizing committee of the "women and psychosis" conference being developed for March of this year, by the Centre for Addiction and Mental Health. The MOOD FAIR, travelling to major Canadian centres, sponsored by the Canadian Network for Mood and Anxiety Treatments and funded in large part by the legal drug pushers, includes in it’s Symposiums a workshop called "Assessing and treating depression: making the most of 15 minutes."

Welcome to the Brave New Millennium. "And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there’s always soma to give you a holiday from the facts. And there’s always soma to calm your anger, to reconcile you to your enemies, to make you patient and long suffering….[S]wallow two or three half-gram tablets and there you are." Aldous Huxley, Brave New World

You've read the political, now read the personal. By clicking on the authors name above, you'll be able to read her own story at the hands of the medical establishment.

Medical Researchers found "Under the Influence" of Money (Redux)
You can't miss them because they're all over: ads on television and in magazines, booths at professional conferences, and on everything from free pens, note pads, to discussions at free lunches and dinners. THE DRUG COMPANIES. Once solely focused on physicians, the major drug companies have taken to directly marketing to consumers. And, according to recent news reports, they're also marketing to researchers at the National Institute of Health! Case in point, the NIH top diabetes researcher, recently praised a certain diabetes drug used in a government sponsored $150,000,000 study. Lo and behold, it turns out that the good doctor was on the payroll of the drug manufacturer during the time the researcher was conducted! Harmless you say? The report notes that the drug has been linked to 33 deaths and additional liver injuries. And the pill rolls on . . .

William D. (December 7, 1998). Drug maker hired NIH researcher. LA Times, 1, 14.

In order to discover the illegal behaviors of President Richard Nixon, the informant known as Deep Throat advised reporters Woodward and Bernstein to, "Follow the Money!" Well, a study has found solid evidence that money leads researchers to skew their results in favor of those who provide financial support for their research! In this particular study, for example, 96% of studies by researchers who received financial support from the makers of a particular drug found in favor of the drug while only 37% of researchers who did not receive support found in favor of the drug. In other words, as far as money is concerned, the return on the drug companies' investment is a near 100% guarantee of the outcome they hope (paid?) for. Psychotherapy outcome researchers cannot compete with the literally billion dollar drug industry when it comes to promoting their products even though the data are clear: psychotherapy is hands down as good or better when head-to-head comparisons of medication versus psychological intervention are made.

Tanouye, E. (January 8, 1998). Does corporate funding influence research. Wall Street Journal, B1, B6.