The marketing of Seroquel
Seroquel is one of several medications called atypical antipsychotics that have changed psychiatric practice over the last decade. While older, “typical” antipsychotics, like thorazine, mellaril, and haldol, were very effective in the treatment of psychosis and schizophrenia, their use was limited by their serious side effects, especially movement disorders, which sometimes progressed to permanent disability. When the atypical antipsychotics were invented, they were heralded as safer medications without the risk of movement disorders, drug interactions, mental status changes, and other problems.
While there reportedly are 2.4 million patients in the US who have a diagnosis of schizophrenia, in most outpatient, private psychiatry practices, psychosis makes up only a small minority of patient problems, dwarfed in scale by depression, anxiety, and bipolar disorder, among other problems. Yet, over the last decade, the atypical antipsychotics, with Seroquel leading the pack, have come to dominate psychiatric prescribing in both the public and private sectors. According to Reuters, Seroquel generated $4 million in sales world wide, and is the leading seller of all antipsychotics.
AstroZeneca, the maker of Seroquel, has conducted a masterful marketing campaign for its product. Not only does it represent Seroquel as safer than typical antipsychotics, in marketing to physicians, Seroquel is promoted as not only being effective for psychosis, but also for bipolar disorder and as an adjust for depression. Some family doctors even use it as a sleeping pill and for anxiety.
Many physicians, including psychiatrists, get much of their pharmaceutical education from drug representatives. These salesmen and women are trained to appear concerned, compassionate, and well informed about their product. However, they conveniently neglect to mention, and the physicians seem unaware of, the CATIE trial, sponsored by the National Institute for Mental Health, and published in 2005. This large trial compared the newer antipsychotic medications with the older class of antipsychotic drugs, and showed that :
Contrary to expectations, movement side effects (rigidity, stiff movements, tremor, and muscle restlessness) primarily associated with the older medications, were not seen more frequently with perphenazine (Trilafon) (the drug used to represent the class of older medications) than with the newer drugs. The older medication was as well tolerated as the newer drugs (Including Seroquel) and was equally effective as three of the newer medications (including Seroquel). … Thus, taken as a whole, the newer medications have no substantial advantage over the older medication used in this study. NIMH
Also according to the NIMH, “about 80 percent of the prescriptions for antipsychotics are paid via the public sector. The new atypical medications, representing 90 percent of the current market, are approximately 10 times the cost of the older conventional antipsychotics.”
For regular folks who pay for medications out of pocket, perphenazine, which comes in generic, costs about $20 month, regardless of the strength. Older antipsychotics like thoridizine and haloperidol can be purchased at chain stores like Walmart or Target for $4 a month. Lithium, for bipolar disorder costs $4. Citalopram for depression costs $4. Seroquel costs $400 to $800 a month or more. For the non- public sector patient, that represents a 100 fold increase in the cost of their medications.
Seroquel is not a benign medication. There have been over 14,000 reports of Seroquel being associated with weight gain, diabetes, oversedation, movement disorders, and a myriad of other problems. AstroZeneca paid over $500 million to settle claims in 2009. And still, despite all the side effects, lack of superiority over traditional antipsychotics, lack of superiority over mood stabilizer for bipolar disorder, and lack of indications for sleep or anxiety, Seroquel continues to dominate the field among all antipsychotics. Because the company will lose its patent over Seroquel in 2012, it has already developed and patented a long acting form of the drug, which acts in the same way with the same side effects and is no more effective than Seroquel. They are aggressively marketing that form of the medication with the expectation that their new medication will have captured the market by the time Seroquel goes generic.
What I see now among the psychiatrists that work with patients in my statewide, managed practice, is that patients are frequently, if not usually, put on Seroquel or other atypical antipsychotics, and continued indefinitely, even in the face of unclear diagnoses. And these patients suffer the consequences. They get salivary gland infections and dry mouth, painful sustained erections, constipation, abdominal pain, acid reflux, weight gain, new diabetes, poor control of pre existing diabetes, medication interactions, and a host of other major and minor side effects. Even more frustrating is that when the prescribing psychiatrist is asked by the medical provider to reassess the use of Seroquel, invariably the psychiatrist simply switches the patient to a different, equally expensive, equally problematic antipsychotic. I suspect that the majority of these patients never needed an antipsychotic in the first place. Antipsychotics have become convenient medications for the management of problem patient behaviors even when the patients don’t have clear psychiatric diagnoses.
Certainly as patients, we all need to pay attention to unnecessary prescribing by our physicians, by asking for evidence-based information, by asking for generic medications, and for a treatment plan that is patient and diagnosis specific. This means that you not only know what you are being treated with and why, but how long the treatment is for and what you need to do in order to be able to get off the medication in the future.
And as citizens, we need to care about the enormous waste of money being generated by the undue influence of pharmaceutical companies. In order that our money is not continuing to be wasted on unnecessarily expensive medication that do not improve outcomes:
1. Drug companies should not be allowed to advertise prescription medications to the public. That practice is illegal everywhere else in the world and should be illegal here.
2. Drug company marketing to physicians should also be halted. They should not be allowed to sample medications to physicians, provide lunches or other sales pitches, and really should have no direct contact with the medical profession at all.
3. Access for physicians to accurate and evidence based information about drugs should be more accessible. Perhaps the AMA should get involved in informing physicians about reliable sources of information; perhaps licensing boards can require that physicians obtain unbiased pharmaceutical education for relicensing.
4. There needs to be oversight and regulation of medication use in public programs, including medicare, medicaid, community mental health, and others.
5. Physicians should be rewarded for practicing cost effective and evidence based medicine.
6. A national health program should include pricing limitations for pharmaceutical companies, federally supported and unbiased drug comparison research, and evaluation and monitoring of physician and hospital prescribing practices.
