08 January 2011

Fraud and science, part II

There are reports all over (they're actually just disguised pressers since that's all the journalists read) about a new study in a journal no one reads (Pharmacoepidemiology and Drug Safety; it's the fourth google result when searching its title...). That antipsychotics are being prescribed off label in ever increasing amounts with scant data to support doing so. The actual study (gated, natch) is not linked to by a single one of those articles.

It does not reflect well on the PR acumen of Science (capital S) or scientists that the article was first "published" and the presser released on a Friday. It's as though they're undermining their own cause by ensuring that no one will read this article. (What possible incentive could they have for that? See III.)

Because I'm not actually a journalist, I'm just going to tell you that the presser gives you the highlights fairly accurately and reading the article is (probably) a waste of your time (unlike real journalists, I did link you to the article itself). Here were those highlights:

  • Antipsychotic treatment prescribed during the surveyed doctors' visits nearly tripled from 6.2 million in 1995 to 16.7 million in 2008, the most recent year for which they had data. During this period, prescriptions for first-generation antipsychotics decreased from 5.2 million to 1 million.
  • Antipsychotic use for indications that lacked FDA approval by the end of 2008 increased from 4.4 million prescriptions during surveyed doctors' visits in 1995 to 9 million in 2008.
  • In 2008, more than half — 54 percent — of the surveyed prescriptions for the new-generation antipsychotics had uncertain evidence.
  • An estimated $6 billion was spent in 2008 on off-label use of antipsychotic medication nationwide, of which $5.4 billion was for uses with uncertain evidence.
  • Prescriptions for antipsychotics began dropping slightly in 2006, shortly after the FDA issued a warning about their safety.
I'm not a psychiatrist (nor, God willing, will I ever be) but this is Bezwoda all over again. An entire industry built upon some questionable assumptions and a few unproven theories has exploded into a multibillion dollar industry for pharmaceutical companies and a publication factory for grant/tenure hungry faculty members.

The difference here is that there are too many genies for us to stuff back into the bottle if and when the whole house of cards falls down. This isn't someone falsifying data and then exhorting their colleagues to follow their invented protocols. This is a bunch of psychiatrists writing prescriptions that may work with no real basis for doing so beyond "everyone else is doing it and it might work." (If this sounds a lot like homeopathy to you, you're not far off... this is Homeopathy 2.0 where we use real drugs because they cost more and require med checks.)

Incidentally, if everyone else is doing it and you aren't, have fun trying to pay your mortgage. When word gets out that you won't exhaust every option for your patients not only will the malpractice suits come raining down, the waiting room will empty out. Patients don't care how well considered your refusal to participate in this charade is, they just want to get better and it's your job to make that happen.

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