In an installment of Slate‘s “Hot Documents” series, a 2001 memo from Lilly’s marketing department lays out the battle plan for marketing the antipsychotic medication Zyprexa (Lilly’s brand of olanzapine). It is commonplace to observe that the health of the American people is hostage to Big Pharma these days; several important aspects of just how this has been brought about are highlighted here.
The major therapeutic advances in psychopharmacology during my professional career in psychiatry have been the development of new types of two classes of medications, antidepressants and antipsychotics, the rationale for developing which has been the notion that they are less prone to cause side effects than older antidepressants or antipsychotics, and thus far more tolerable and less complicated for our patients to take. Eli Lilly has been at the forefront of these developments with its products Prozac (fluoxetine), the first of the SSRI antidepressants, and Zyprexa (olanzapine), one of the first two new-generation “atypical” antipsychotics.
I have long ranted about prescribing trends in psychiatric medications which follow from these developments. The vast expansion in prescribing of these classes of drugs, often for inappropriate or marginal indications, and decreasing intensity of followup and supervision of their use, leads to rampant problems. These have included the highly-publicized seeming association between antidepressant prescribing and suicidality and (to a lesser extent) incidents of violence and rage; the discomfort associated with discontinuing antidepressants too rapidly; and, as the current article highlights, the epidemic of serious and supposedly unanticipated metabolic complications emerging with the use of the atypical antipsychotic medications.
A more pervasive and perhaps more serious complication than these has been the changing message we are giving our patients — that reaching for the prescription pad can replace the careful crafting of a relationship with an afflicted individual that allows them to come to grips with their life problems; that people do not need to be seen as individuals but rather merely instances of a diagnostic class; that an external agent (a doctor; a medication) can fix them with little effort on their part; that they are passive witnesses rather than active agents in their recovery and, by extension, in their lives; that there is less and less room for personal responsibility in life; that there is little value to careful diagnosis and little distinction between diseases requiring treatment and “cosmetic” personality variants one must either accept or modify slowly and painstakingly.
The leaked memo confirms what I have assumed — that Big Pharma has had deliberate and explicit strategies to persuade less qualified practitioners to prescribe these medications; to prescribe them with less care and supervision; to prescribe them for a broader range of conditions for which they are less appropriate; and to disregard the serious complications they can cause.
All of these, of course, have one goal and one goal only — to maximize profit and commodify already horribly disenfranchised patients with mental health problems. And, when the medications rather than the marketing practices are blamed for the complications and adverse outcomes that follow, mental health treatment is vilified, psychiatric illnesses further stigmatized, and suffering individuals dissuaded from seeking appropriate care that could alleviate their serious distress.
