Monday, May 11, 2009

It's Official: Pharma is Dead to Us

And on the pedestal these words appear:
`My name is Ozymandias, King of Kings:
Look on my works, ye mighty, and despair!'
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare,
The lone and level sands stretch far away.
-Percy Bysshe Shelley

In My Top Ten Mental Health Stories that I posted here last week, I listed "The beginning of the end of drug companies." As I stated in my entry:

Everything seemed to happen at once: Patients and doctors seeing through the Pharma hype, blockbuster meds losing their patent protection, and no new meds coming out of the pipeline. No longer with any financial interest in influencing psychiatry, Pharma virtually backed out of the game. And with mega lost revenues from loss of patent protection, Pharma may lack the resources to ever get back in it.

Bottom line: Due to their arrogance and stupidity, Pharma fully deserves what's coming, but do we?

In short, how the mighty have fallen. Until just a short time ago, it seemed that Pharma would remain forever at the top of the mental health food chain. Technically, they still are, but we are clearly witnessing the beginning of the end.

I started to see the signs two or three years ago at the American Psychiatric Association's annual meetings. Certain manufacturers were not exhibiting, nor were they sponsoring symposia. The reason was clear: Their current stock of meds had gone off-patent, with no new ones on offer.

The handwriting turned up on the wall even earlier at DBSA conferences I attended. Gone were the frills, such as the canvas conference bags with the GSK logo and the ice cream breaks. A quick comparison of DBSA annual reports two years apart reveals an obvious stampede to the exits.

The DBSA 2005 report lists one $500,000-plus donor - Wyeth. The 2007 report lists none. Fortunately, over the same period, DBSA has been weaning itself off Pharma. What I'm seeing is a far more focused organization in a much better position to serve its constituents.

Psychiatry's make-over may prove far more dramatic and beneficial. Not too long ago, you couldn't throw a stone in the direction of a psychiatrist without it bouncing off at least 10 Pharma hacks. Their tentacles were everywhere: In research, in publishing, in professional education and continuing education, in universities, in hospitals, right into the very sanctity of the psychiatrist's office.

Now, on all fronts, they are disengaging. We are already beginning to see signs of reform in the profession. It's going to take time, but one hopes the final outcome translates into patients being able to take the word of their doctors at face value.

I know what you're thinking: With Pharma gone, where are all the new meds going to come from? Let's define "new," namely something that is not an updated version of an old technology. By this criteria, Pharma has not come up with a new psychiatric med in the last 50 years. To give you one example: J&J's Invega is Son of Risperdal which in turn is based on the ancient Haldol.

It's as if the people running Detroit have been moonlighting as Pharma CEOs.

So, where are the new meds going to come from? Don't bank on Pharma. They got out of drug development - assuming they were ever in it - at least a decade ago. Hopefully, new players looking to make profits based on innovation will fill the vacuum.

In the meantime, it's as if Pharma doesn't exist. Those meds you are taking right now? Probably generic from generic suppliers. Get used to them - these will be your only choices for quite some time.


cretin said...

I believe that where Pharma has failed is holding to some old science that has not stood up to further inquiry (e.g. the whole chemical imbalance arguments). Also, there haven't been discoveries of a single gene for the various mental illnesses that everyone expected to find. If that were the case, Pharma could target that one gene and truly develop new treatments. But as brain science and systems biology have found, dozens to hundreds of genes may be the source of a particular mental illness. Well, you just can't target a hundred genes at once. (This is the same problem encountered in cancer research. Unfortunately because of that, there won't be a single cure for cancer.) For now we have to be content with medicines that target symptoms and not the cause which will vary from person to person. But systems biology may point out which pathways have gone haywire in an illness pointing to new ways to treat symptoms. A lot of researchers are working to understand biological systems on a by-gene level. Maybe in the years to come, that understanding may lead to new treatments for a host of diseases, mental illness included.

John McManamy said...

Hi, Cretin. Bingo. To respond briefly to your points:

Chemical imbalance: A myth. The brain is not chemical soup. It's more like the most sophisticated computer in the universe. Think integrated circuits, operating systems, applications, etc ...

Many genes: The perfect med will be a niche med aimed at small populations (such as for low-energy depressions). Pharm makes its money on very imperfect meds for mass populations (such as for all depressions, whether high or low energy). There is no financial incentive for companies to design a med based on scientific and clinical reality.

Right now I'm thinking we need to wipe the slate clean and start over. Ideas, anyone?

Michelle said...

That article is so true and yet makes me sad. What IS the future of psych Pharma and who truly cares?

John McManamy said...

Hi, Michelle. Fully concur. I can't predict the future, but the good news is that crisis shakes people out of their "business is usual" mindsets and sets the stage for reform and innovation.

But we have to be part of that equation. The mental health advocacy of old is simply not going to cut it. We have to be in your face about agitating for more government research dollars and for government resources towards companies dedicating to getting new drugs to market.

Gina Pera said...

Generic meds are typically such a bad idea for ADHD (my subject area). I imagine they are for bi-polar disorder, too.

The broad leeway allowed by the FDA for the active ingredient far exceeds the narrow window many people find is the optimum dosage.

Moreover, pharmacies will often change suppliers frequently, adding more bumps on the roller coaster. Many people also react to the inactive substances (corn fillers, colors, and the like), but their docs don't see it as such and often attach psychological terms to it.

What a mess!

A good psychiatrist who also takes into account nutritional factors, etc. can do a lot with existing medications. There are too few of those, however.

Gina Pera said...

"We have to be in your face about agitating for more government research dollars and for government resources towards companies dedicating to getting new drugs to market."

Amen Brother John!

Maybe modeled on AIDS' "Act up," we can call it "Act Out." ;-)

John McManamy said...

Hey, Gina. Fully agree. Generics represent yet one more set of out-of-control variables in our uncertain treatment environment. I've been privy to a lot of patient conversations on this.

John McManamy said...

Hey, Gina. Yes, modeled on AIDS activism. Look how successful they were. And look at the results. They get funding. They get results. We get Pat Risser.

Gina Pera said...

Exactly, John. And then un-savvy reporters, in the dog-bites-man school of journalism, fall for the "contrarian" angle of disorders being gifts. ("It must be true, because the person saying it has the gift/disorder!")

Black white black white. Let's hear it for gray!

Oh boy, am I wound up today. Sometimes the inanity of all hits me. Then I go to our local Adult ADHD group meeting and find they're moving ahead with their lives and simply aren't paying attention to the online nonsense. :-)

Still, to dismiss it's impact entirely is to fail to head off a dangerous trend, IMHO.

John McManamy said...

Hey, Gina. That's what I've found at the bipolar end. You go to a meeting and find people moving ahead with their lives. Yes, I've found plenty at those meetings to support the notion that our meds need to be better and that there are a lot of bad psychiatrists, but no one - and I mean no one - talks about the tedious nonsense those blogging heads think are so goddamn important.

The real world is way different than the one they imagine.

Michelle Routhieaux said...

I wish with all of my heart that some organization, reputable and large, would just OUT the generic industry. According to my doctor, the active ingredient only has to be within TWENTY PERCENT of the amount of the active ingredient in the brand name drug. They do not have to be proven effective on humans, just to disperse the same (within 20%) amount of the active ingredient IN A TEST TUBE, not even through the same means or in the same amount of time. Generics just piss me off. Someone needs to educate the public and Obama! Grrrrr...!!!

Elizabeth said...

I'd be interested in joining any activist organization that is working toward reform of the psychiatric community, including the development of psychotropic pharmaceuticals. The AIDS movement is one we should look toward as a model, but unfortunately few of us feel comfortable sticking our necks out and publicly counting ourselves as among the mentally ill. We might well look to the homosexual community, whose bravery in speaking out and demanding the development of AIDS treatments--despite the societal stigma attached to their reality--succeeded both in decreasing that stigma and encouraging the development of treatment. As healthcare reform is unfolding, and the pharmaceutical companies are out of ideas, we could use a strong voice. Any ideas/leads as to what organizations do exist and what is being done?

John McManamy said...

HI, Elizabeth. I'm with you all the way on this. And I've been saying to people for years that we ought to use the AIDS movement as a model.

Yes! Yes! It's so great to hear this from someone else.

I hope to be blogging more about this, but I'm more interested in your ideas on this right now. Please contact me at and we can take this conversation further.