http://www.motherjones.com/news/feature ... rders.html This lengthy and indepth look at the industry will make it painfully obvious what's behind Bushs' initiative to screen the entire population for mental illness. These are but a few of the highlights:
Disorders Made to Order
Pharmaceutical companies have come up with a new strategy to market their drugs: First go out and find a new mental illness, then push the pills to cure it.
By Brendan I. Koerner
July/August 2002 Issue
Word of the hidden epidemic began spreading in the spring of 2001. Local newscasts around the country reported that as many as 10 million Americans suffered from an unrecognized disease. Viewers were urged to watch for the symptoms: restlessness, fatigue, irritability, muscle tension, nausea, diarrhea, and sweating, among others. The disease was generalized anxiety disorder (GAD), a condition that, according to the reports, left sufferers paralyzed with irrational fears. Mental-health advocates called it "the forgotten illness." Print periodicals were awash in stories of young women plagued by worries over money and men. "Everything took 10 times more effort for me than it did for anyone else," one woman told the Chicago Tribune. "The thing about GAD is that worry can be a full-time job. So if you add that up with what I was doing, which was being a full-time achiever, I was exhausted, constantly exhausted."
GlaxoSmithKline's modus operandi-marketing a disease rather than selling a drug-is typical of the post-Prozac era. "The strategy [companies] use-it's almost mechanized by now," says Dr. Loren Mosher, a San Diego psychiatrist and former official at the National Institute of Mental Health. Typically, a corporate-sponsored "disease awareness" campaign focuses on a mild psychiatric condition with a large pool of potential sufferers. Companies fund studies that prove the drug's efficacy in treating the affliction, a necessary step in obtaining FDA approval for a new use, or "indication." Prominent doctors are enlisted to publicly affirm the malady's ubiquity. Public-relations firms launch campaigns to promote the new disease, using dramatic statistics from corporate-sponsored studies. Finally, patient groups are recruited to serve as the "public face" for the condition, supplying quotes and compelling human stories for the media; many of the groups are heavily subsidized by drugmakers, and some operate directly out of the offices of drug companies' P.R. firms.
The strategy has enabled the pharmaceutical industry to squeeze millions in additional revenue from the blockbuster drugs known as selective serotonin reuptake inhibitors (SSRIs), a family of pharmaceuticals that includes Paxil, Prozac, Zoloft, Celexa, and Luvox. Originally approved solely as antidepressants, the SSRIs are now prescribed for a wide array of heretofore obscure afflictions-GAD, social anxiety disorder, premenstrual dysphoric disorder. The proliferation of diagnoses has contributed to a dramatic rise in antidepressant sales, which increased eightfold between 1990 and 2000. Prozac alone has been used by more than 22 million Americans since it first came to market in 1988.
"You often hear: 'There are 10 million Americans with this, 3 million Americans with that,'" says Barbara Mintzes, an epidemiologist at the University of British Columbia's Centre for Health Services and Policy Research. "If you start adding up all those millions, eventually you'll be hard put to find some Americans who don't have such diagnoses."
SmithKline's first forays into the anxiety market involved two fairly well-known illnesses-panic disorder and obsessive-compulsive disorder. Then, in 1998, the company applied for FDA approval to market Paxil for something called social phobia or "social anxiety disorder" (SAD), a debilitating form of shyness the DSM characterized as "extremely rare."
With FDA approval for Paxil's new use virtually guaranteed, SmithKline turned to the task of promoting the disease itself. To "position social anxiety disorder as a severe condition," as the trade journal PR News put it, the company retained the New York-based public-relations firm Cohn & Wolfe. (Representatives of GlaxoSmithKline and Cohn & Wolfe did not return phone calls.)
By early 1999 the firm had created a slogan, "Imagine Being Allergic to People," and wallpapered bus shelters nationwide with pictures of a dejected-looking man vacantly playing with a "If you are carrying out a disease-awareness campaign, legally the company doesn't have to list the product risks," notes Mintzes, the University of British Columbia researcher. Because the "Imagine Being Allergic to People" posters did not name a product, they didn't have to mention Paxil's side effects, which can include nausea, decreased appetite, decreased libido, and tremors.
Journalists were given a press packet stating that SAD "affects up to 13.3 percent of the population," or 1 in 8 Americans, and is "the third most common psychiatric disorder in the United States, after depression and alcoholism."
Jack Gorman, the Columbia University professor who would later make the rounds on Paxil's behalf during the GAD media campaign. Gorman appeared on numerous television shows, including ABC's Good Morning America. "It is our hope that patients will now know that they are not alone, that their disease has a name, and it is treatable," he said in a Social Anxiety Disorder Coalition press release.
Dr. Gorman was not a disinterested party in Paxil's promotion. He has served as a paid consultant to at least 13 pharmaceutical firms, including SmithKline Beecham, Eli Lilly, and Pfizer
The lessons of "Imagine Being Allergic to People" were also not lost on Zoloft's manufacturer, Pfizer. In 1999, Pfizer gained FDA approval to market Zoloft as a treatment for post-traumatic stress disorder (PTSD). Until then, the condition had been associated almost exclusively with combat veterans and victims of violent crime; now, Pfizer set out to convince Americans that PTSD could, in fact, afflict almost anyone.
In the months following the launch of Pfizer's campaign, media mentions of PTSD skyrocketed. Just weeks after the Alliance's founding in 2000, for example, the New York Times ran a story citing Pfizer-supplied statistics on childhood PTSD, according to which 1 in 6 minors who experience the "sudden death of a close friend or relative" will develop the disorder. Other stories highlighted studies promoted by the alliance according to which 1 in 13 Americans will suffer from PTSD at some point in their lives.
Many of the statistics used to promote new disorders are taken from studies published in second-tier journals, which frequently depend on direct corporate support. One publication that has drawn fire is the Journal of Clinical Psychiatry, whose major funders include GlaxoSmithKline and Eli Lilly. In 1993, the journal published a study claiming that anxiety disorders cost the United States $46.6 billion per year, primarily due to lost productivity. That figure was repeated in countless press releases and made its way into articles in the Washington Post and USA Today.
The study was produced by the Institute for Behavior and Health, a research firm headed by Dr. Robert DuPont, who served as President Ford's drug czar.
Drug companies are understandably eager to help physicians identify conditions that can be treated with their products. One widely distributed diagnostic checklist, a 15-minute test that promises to screen for 17 different disorders using special software, was developed by GlaxoSmithKline. Pfizer has funded a test designed to help obstetricians and gynecologists identify women with mental-health problems. According to a 2000 study, sponsored by Pfizer and published in the American Journal of Obstetrics, a full 20 percent of all ob-gyn patients may need psychiatric treatment for anything from depression and anxiety to eating disorders.
In 2000, the company gained FDA approval to market Prozac as a treatment for the condition; Eli Lilly promptly re-packaged Prozac as a pink-coated pill called Sarafem and launched a P.R. campaign warning that "millions of menstruating women" suffer from PMDD. "Does juggling work, family and personal commitments leave you feeling frazzled and stressed out?" the Sarafem Web site asks. "We have some tools to help."
No such malady is yet listed in the DSM. But the quest for new uses for the SSRIs is continuing. At last year's annual convention of the American Psychiatric Association, researchers presented a major study on a new "hidden epidemic"-compulsive shop- ping. Jack Gorman, the Columbia psychiatrist who had earlier helped publicize anxiety disorders, made another appearance on Good Morning America to discuss the new condition, which host Charles Gibson told viewers could affect as many as 20 million Americans, 90 percent of them women. In the wake of the new study, Gorman said, scientists would "almost certainly" look into treating the disease with SSRIs.
The study in question was funded by Forest Laboratories, for which Gorman has served as a consultant. A laggard in the SSRI business, the company hopes to carve out the compulsive-shopping niche for its pill, Celexa. Expect the publicity machine for something akin to "persistent purchasing disorder" to rev up soon. What do you think?
