Drug industry writers behind some articles purportedly written by doctors
Monday, Aug. 24, 2009 | 2:05 a.m.
A student who hands in a term paper under his own name when in fact it had been written by someone else has committed a serious breach of ethics.
The same is true for doctors who allow their bylines to appear above articles published in medical journals when in fact the articles were largely produced by ghostwriters pushing a product.
According to stories published Wednesday by The New York Times and the Associated Press, many doctors have been persuaded by drug companies to cooperate on such articles.
A “sophisticated ghostwriting program” used by London-based drugmaker GlaxoSmithKline to promote an antidepressant pill called Paxil was an example given by AP. Although the company says it has discontinued the ghostwriting program, the news service obtained court documents showing that it had used this marketing tactic.
The danger here is that doctors are trusted. Readers who see a doctor’s name atop an article about a certain drug are apt to believe what is being stated. They would certainly be more skeptical if they knew the article was actually written by people working for the company that makes the drug.
Ghostwritten articles on Paxil, which highlighted doctors as their authors, appeared in five medical journals from 2000 to 2002. AP reported that today hundreds of people are pressing personal injury and wrongful death suits against GlaxoSmithKline, claiming the company downplayed the risks of Paxil.
The Times disclosed that there is “a growing body of evidence suggesting that doctors at some of the nation’s top medical schools have been attaching their names and lending their reputations to scientific papers that were drafted by ghostwriters working for drug companies — articles that were carefully calibrated to help the manufacturers sell more products.”
There are no laws prohibiting ghostwriting. But there is no question that the widespread practice is unethical and that universities and medical associations should crack down. We agree with a bioethics expert at Duke University who told the Times, “To blow this off is not acceptable.”
The Seroxat scandal was originally brought to mass public consciousness by the BBC with their groundbreaking expose “The Secrets of Seroxat” in October 2002. Since that time a multitude of documentaries , blogs, news articles , forums , comment and opinion on Seroxat and the dangers of other SSRI medications has followed. For the past year, the mainstream media have been fairly quiet on the Seroxat situation, but in the last week, the excellent Sarah Boseley of the Guardian newspaper UK has once again began to investigate the dangers of Seroxat and SSRI drugs.
Here are the links to her new articles :
I came across this interesting article in the LA Times :
SPECIAL ISSUE: DEPRESSION
Stopping antidepressants can cause side effects
Recognizing withdrawal symptoms and working with your doctor are key.
Regina Nuzzo, Los Angeles Times Staff Writer
Ryan Yorke, now 21, started taking Paxil after an out-of-the-blue panic attack his freshman year of high school. At first it worked great. But he gained weight and had other problems — he started acting up in school and failing classes, for example. So after a year, he — along with his mother and his psychologist — decided it was time to stop.
Every time he reduced his dose, things got out of control, says his mother, Laurie Yorke, a registered nurse and now an administrator of paxilprogress.org, an antidepressant-withdrawal support site.
After the first big dose drop, Ryan slashed his wrists in front of his mother in the living room. “It was a six-hour psychotic episode. He was quoting Shakespeare and saying he wanted to die,” she recalls.
A few weeks later, after more gradual dose changes, Ryan was still so sensitive to light and sound that he taped shut the window shades in his bedroom. His memory and concentration were poor. He dropped out of school and got his GED later, after the withdrawal process was over.
Mental health professionals aren’t sure how many people have problems when stopping antidepressant medication. It’s not even clear how to define the cluster of withdrawal symptoms people report, or even what causes the effects. “It’s a difficult corner of the field,” says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness and psychiatry professor at Harvard Medical School. “It’s hard to know whether the person’s depression is worsening or if they’re having a variation on a discontinuation syndrome.”
Knowing what to look out for when you and your doctor start the stopping process (which the medical community ƒè terms “antidepressant discontinuation syndrome”) can help minimize issues.
All approved antidepressant medications either come with documented discontinuation problems or a manufacturer’s warning of the possibility. Typical symptoms can depend on the class of antidepressant.
Drugs that affect serotonin levels — selective serotonin reuptake inhibitors, or SSRIs, such as Prozac, and serotonin-norepinephrine reuptake inhibitors, or SNRIs, such as Effexor — can cause dizziness, upset stomach, headache and flu-like symptoms when stopped. Some people also report electric-shock sensations that zap through the body.
Other serotonin-stopping symptoms can mimic those of depression: lethargy, sleep problems, sadness, anxiety and thoughts of suicide.
Tricyclic antidepressants, which were introduced in the 1950s and include Sinequan and Tofranil, can trigger withdrawal symptoms similar to those of SSRIs and SNRIs. But since these drugs work on dopamine as well as serotonin and norepinephrine, stopping them can cause balance problems or Parkinson’s-like tremors.
Even more dramatic are problems from quitting the oldest kind of antidepressants: monoamine oxidase inhibitors, or MAO inhibitors. These work on several brain chemicals; withdrawal symptoms include agitation, nightmares, aggression and psychosis.
Many people have no symptoms when they quit taking antidepressants. And any problems are usually mild and short-lived, Duckworth says. But sometimes the effects can be so bad as to require time off work or, rarely, to send people to the emergency room.
Estimates vary as to how often problems will happen. And some of the symptoms that patients report may not in fact be linked to withdrawal from the drug. One clinical trial from 1995 found that 35% of patients taking Paxil had mild to moderate discontinuation symptoms — but so did 14% of patients who had been taking a placebo.
Symptoms usually appear within three days after a change in dose and disappear after two weeks, says Dr. Christopher Kratovchil, an American Psychiatric Assn. spokesman and psychiatry professor at the University of Nebraska Medical Center. A 1993 study of the SSRI Luvox found that the average number of symptoms shot up within the first few days after a missed dose, peaked during the fifth day and then gradually dwindled over the next week or so.
Doctors can’t really predict who will have problems. One study in 2002 found that women were likely to have more severe symptoms, but other studies have found no gender difference. Genetics likely plays a role.
Some drugs get more complaints than others. In a 2006 study of antidepressant-withdrawal calls to a help line in England, about 40% were from people who had problems stopping Paxil, and about 14% were from those quitting Effexor. No other drug accounted for more than 10% of calls.
Drugs with more users would be more likely to garner more complaints, of course. So when researchers took into account the relative usage of each of the drugs, Paxil and Effexor fell to fifth and ninth place on the complaints list. The top three spots all went to MAO inhibitors.
The biology behind symptoms is unclear. Antidepressants boost levels of brain chemicals such as serotonin and dopamine, but they also dampen the system that transports these chemicals, researchers believe. When there’s suddenly less drug in the brain, it takes time for the system to pick itself up again. And since these brain chemicals control more than just mood (they also influence digestion, sleep and motor control, for example) withdrawal reactions can be broad.
Faster-metabolized drugs are generally more likely to cause discontinuation symptoms, Kratovchil says. The shorter a drug’s half-life, the faster it’s cleared from your body, and so the more abrupt the change in your brain’s chemical system when you don’t replenish the medication.
A typical dose of Paxil (which among SSRIs has some of the highest reported rates of discontinuation symptoms) has a half-life of less than a day, for example. The half-life of a typical dose of Prozac is three to six days. For that reason, Prozac has some of the fewest reported problems.
This means that stopping antidepressants cold turkey can be a bad idea, especially for short half-life drugs. A gradual taper gives the brain more time to right itself. “If a plane wants to land in Los Angeles, it’s nice to start going down very, very slowly over Denver,” Duckworth says. “I make changes gently.”
There’s no one right way to taper. A schedule for Paxil, for example, may involve stepping down the daily dose from the full amount by 10 milligrams or less a week.
Another option is to switch to a drug in the same class with a longer half-life — say, from Zoloft to Prozac. That should allow a quicker step-down.
Some patients try exotic regimens to wean themselves even more gradually. They count individual granules from a capsule, use a nail file and a jeweler’s scale to measure tablet shavings, or try the “orange juice” strategy. This last trick might involve dissolving a capsule into a measured glass of orange juice every day and drinking 90% of it for the first week, 80% of it during the second week, and so on.
But a small 2008 study suggests that long step-down schedules might not help that much.
In a group of 28 patients taking SSRI and SNRI antidepressants, about half had significant withdrawal symptoms — no matter whether they had been randomly assigned to three-day or 14-day tapering.
“Every person is unique,” Duckworth says. “This needs to be a collaborative effort between patients and doctors.”
Read more about antidepressant discontinuation at http://www.aafp.org/afp/20060801/499.html.