Source: British Medical Journal (UK) , No 7132 Volume 316
Contact:  Sat, 28 Feb 1998

MARKETING OF ANTIPSYCHOTIC DRUGS ATTACKED

Drug companies in the United States are facing criticism for
advertising psychotrophic drugs directly to the general public and to
patients. One drug company is even offering university scholarships to
schizophrenic patients who switch to their new antipsychotic drug.

Last August the Food and Drug Administration changed the rules to
allow advertisers to market drugs directly to the public, as long as
they provided adequate information about a drug's indications and side
effects, or the advertisement directed the consumer to where this
information could be found. Consumers in the United States are now
deluged with glossy pharmaceutical advertisements in magazines, on
television, and on the internet.

Eli Lilly has been inviting schizophrenic patients to switch over to
its new antipsychotic drug, Zyprexa (danzapine), and offering
university scholarships for those who do. The campaign was criticised
for pressurising doctors to prescribe Zyprexa and for unduly raising
the hopes of people with schizophrenia, as most of them cannot cope
with the stresses of higher education. Interestingly, a similar
scholarship offer by Eli Lilly for students with insulin dependent
diabetes did not require the patient to be taking a Lilly product.
Aggressive marketing of Zyprexa seems to have paid off as the new drug
grossed $550m (£343m) in its first year of sales.

Eli Lilly also sponsors a "psychoeducational" campaign for
schizophrenic patients, which provides educational material and a
social structure for patients and their families. Visitors to the
Janssen pharmaceutical internet website are invited to register for
drug updates, and people with schizophrenia who take Janssen's drug
Risperdal (risperidone) can register for a person to person telephone
call to remind them to take their medicine.

While many of these initiatives may be laudable, Dr Sidney Wolfe of
the consumer group Public Citizen warned that mentally ill people
often have poor judgment and are therefore particularly vulnerable to
advertisements.

Manufacturers defend their direct advertisements as educational. Alan
Holmer, the president of the pharmaceutical manufacturers association,
said: "This is the information age, and more information empowers
patients to have more meaningful conversations with their doctors
about cures and treatments."

The increase in direct public marketing has also resulted in higher
treatment costs to deflect the price of advertising. Dr Sam Ho, the
vice president for Pacificare Health Systems, a California based
health maintenance organisation estimates that Prozac, the most widely
promoted antidepressant drug, costs 50% more than similar, but less
advertised drugs in its class.

Prescriptions for antidepressant drugs have also reached record
breaking rates in recent years. According to a recent study led by Dr
Harold Pincus and reported in JAMA,the journal of the American Medical
Association, the number of prescriptions for mental health problems
rose from 32.7 million to 45.6 million from 1984 to 1994, with the
greatest increase occurring for antidepressant drugs. Although it is
unclear how much of this increase is due to direct drug marketing,
many psychiatrists believe that up to 80% of the antidepressant
prescriptions are unwarranted and are prescribed for people who are
not clinically depressed. Others have attributed the increase to a
greater acceptance of depression as an illness warranting medical
attention, with a consequent reduction in stigma.

Deborah Josefson San Francisco