Here's a nice exchange in the Wall Street Journal. First we have on opinion piece from Benjamin Zycher of the Manhattan Institute, extolling the role of the pharamceutical industry in new product innovation, and taking issue with the criticisms of Marcia Angell (among others) that the industry often just buys ideas from investigators sponsored by public funds, and then claims that their in-house staff invented the whole thing:
http://online.wsj.com/article/SB121460680460712083.html?mod=Letters
Marcia Angell, not about to take this lying down, fired off her letter in reply:
http://online.wsj.com/article/SB121539733302831535.html
...and in the process got off what I will nominate for the Zinger of the Week award: The only really innovative thing about this industry today is the claims of its apologists.
Monday, July 7, 2008
Saturday, July 5, 2008
If They Tell the Truth, Shut Them Down: Drug Industry Attacks the UBC Therapeutics Initiative
Both in writing HOOKED and in other work that I do related to evidence-based medicine, I periodically rely on the reports of the Therapeutics Initiative at the University of British Columbia. As there are relatively few bodies around the world that have adequate staff and budget to really comb through the published data on pharmaceuticals and look behind the industry spin for the scientific truth, groups that perform this role are especially precious to those of us who care about doing what's best for the patient. (Just to give one example, the group at the Therapeutics Initiative was among the first to lay out carefully the case against the COX-2 drugs like Vioxx, several years before the rest of the medical world caught on to their risks and nearly-absent benefits.)
You will now not be too surprised to learn that the reaction of the drug industry to the existence of such an operation is--shut it down.
As Anne Silversides reports in the Canadian medical association journal CMAJ(http://www.cmaj.ca/cgi/content/full/179/1/26) the Initiative is supported by a $1M grant from the province of BC. The provincial government was apparently arm-twisted to appoint a Pharmaceutical Task Force, made up almost completely of industry supporters. The Task Force has now issued a report accusing the Initiative of being "narrow, insular and resistant to meaningful stakeholder engagement," arguing ultimately that the Initiative must be replaced. The Initiative has previously been given high marks in several external reviews and is currently being reviewed by the Faculty of Medicine at UBC.
So what does "insular" and "resistant to significant stakeholder engagement" mean? Apparently for this Task Force it means--independent of the drug industry and those physicians who freely accept its money. The article in CMAJ quotes such international experts as Andrew Herxheimer and Jerome Kassirer as strongly defending the independence and integrity of the Initiative as it now functions.
There may indeed be problems with how the Initiative handles some of its work that require some tweaks in its procedures. As to any basic revisions in the way the Initiative operates, I hope that UBC and the province see through this transparent industry power play, and protect a vital international resource for evidence-based prescribing.
You will now not be too surprised to learn that the reaction of the drug industry to the existence of such an operation is--shut it down.
As Anne Silversides reports in the Canadian medical association journal CMAJ(http://www.cmaj.ca/cgi/content/full/179/1/26) the Initiative is supported by a $1M grant from the province of BC. The provincial government was apparently arm-twisted to appoint a Pharmaceutical Task Force, made up almost completely of industry supporters. The Task Force has now issued a report accusing the Initiative of being "narrow, insular and resistant to meaningful stakeholder engagement," arguing ultimately that the Initiative must be replaced. The Initiative has previously been given high marks in several external reviews and is currently being reviewed by the Faculty of Medicine at UBC.
So what does "insular" and "resistant to significant stakeholder engagement" mean? Apparently for this Task Force it means--independent of the drug industry and those physicians who freely accept its money. The article in CMAJ quotes such international experts as Andrew Herxheimer and Jerome Kassirer as strongly defending the independence and integrity of the Initiative as it now functions.
There may indeed be problems with how the Initiative handles some of its work that require some tweaks in its procedures. As to any basic revisions in the way the Initiative operates, I hope that UBC and the province see through this transparent industry power play, and protect a vital international resource for evidence-based prescribing.
On Making Drugs Affordable and Fixing the Industry
Merrill Goozner has put together a thoughtful review of the book by Stan Finkelstein and Peter Temin:
http://www.nature.com/nature/journal/v453/n7197/full/453855a.html
In Reasonable Rx: Solving the Drug Price Crisis (FT Press, 2008), Finkelstein and Temin argue (as Goozner summarizes): For years, the industry has justified its high prescription-drug prices — at least in the United States, where there are no price controls and purchasers have little bargaining power — by claiming they are a prerequisite for innovation. That policy has been an abject failure. The failure is of two sorts--first, the new drugs emerging from the pipeline are unaffordable to far too many people; and second, there simply are very few truly useful and innovative drugs coming out of the pipeline. In short, from a social-benefit viewpoint, the entire blockbuster-dominated business model of the industry is a flop. (A point argued a bit less forcefully in the Epilogue of HOOKED.)
Ultimately, the authors argue (and Goozner seems to agree, though he wished they had provided more details) that the function of the industry must be split under two corporate structures. The first industry would perform R&D in the public interest under a sort of competitive prize system, where the public purse would pay out bigger prizes for discovering really useful and needed drugs. The second industry would function like the generic drug industry, putting out bids to manufacture newly discovered drugs at lower prices.
http://www.nature.com/nature/journal/v453/n7197/full/453855a.html
In Reasonable Rx: Solving the Drug Price Crisis (FT Press, 2008), Finkelstein and Temin argue (as Goozner summarizes): For years, the industry has justified its high prescription-drug prices — at least in the United States, where there are no price controls and purchasers have little bargaining power — by claiming they are a prerequisite for innovation. That policy has been an abject failure. The failure is of two sorts--first, the new drugs emerging from the pipeline are unaffordable to far too many people; and second, there simply are very few truly useful and innovative drugs coming out of the pipeline. In short, from a social-benefit viewpoint, the entire blockbuster-dominated business model of the industry is a flop. (A point argued a bit less forcefully in the Epilogue of HOOKED.)
Ultimately, the authors argue (and Goozner seems to agree, though he wished they had provided more details) that the function of the industry must be split under two corporate structures. The first industry would perform R&D in the public interest under a sort of competitive prize system, where the public purse would pay out bigger prizes for discovering really useful and needed drugs. The second industry would function like the generic drug industry, putting out bids to manufacture newly discovered drugs at lower prices.
Wednesday, July 2, 2008
Pfizer and CME Support: A Second Shoe Drops?
Thanks to the Pharmalot blog and Ed Silverman for this fascinating news:
http://www.pharmalot.com/2008/07/pfizer-ending-support-for-cme-by-third-parties/
Now, what Ed does not tell us is that this posture of Pfizer's--ceasing the funding of continuing ed for docs (CME) via the for-profit medical education and communication companies (MECCs to the trade)--is almost for sure a reaction to recent events on Capitol Hill; but the antecedents go back to a bit of old history that was reviewed in HOOKED.
Act One of the drama occurred in 2003, when the Office of the Inspector General, DHHS, issued a report that got the industry's attention--by threatening drug company execs with Federal prison on racketeering charges if they violated the anti-kickback law. OIG-DHHS helpfully explained to the drug companies (and to doctors, had any been listening) that in order to be in violation of this Federal statute, all you have to do is give anything of value, to a physician who receives reimbursement from a Federal program such as Medicare or Medicaid or the VA, with even the partial purpose of influencing whether or not she prescribes your product.
Having explained that every encounter between a drug rep and a physician in which a gift is given, is technically a violation of Federal law, the OIG reassured the companies that they were not out to police individual contacts with docs. Rather they were going to be looking in the future at broad issues of corporate practices, and would view certain practices as being in compliance, and others as raising red flags. One red flag behavior was paying for CME out of your marketing budget. The OIG said instead that if they ever investigated a drug company, they'd be seeking evidence that the company had erected a financial firewall between its CME funding actiity and its marketing activity.
As I went on to report in HOOKED, the industry sat up and paid attention. The budding industry attack on strict new CME guidelines issued by the national accrediation counsel (ACCME) melted away and ACCME adopted its tougher guidelines with nary a whimper from industry. Companies reportedly were working to construct the needed firewalls and to separate much more formally their marketing budget from CME support and to make the latter more obviously no-strings-attached.
However, the result of Act One was not a refusal to channel industry CME money through MECCs. Rather it was the creation of the needed firewall to be able to claim that CME and marketing were being kept separate.
Now we come to Act Two--the newly aggressive efforts in the Senate (especially) to push for a sunshine law revealing all industry payments to docs, and Sen. Grassley's recent campaign to publicize egregious cases of conflicts of interest among academic physicians. I interpret the Pfizer move to demonstrate that at least some companies have decided that the heat is now turned up too high to permit things that seemed okay even after the OIG-DHHS report, and so the companies are responding to the heat by getting out of the MECC kitchen. But it's my guess that Act One was a necessarily prelude to this more recent development.
When I initially logged onto the Pharmalot blogsite, there were two comments to the story about Pfizer, each of which raised an interesting point. The first suggested that this is not necessarily going to improve integrity in CME, but rather drive the funding stream deeper underground; Pfizer admitted that it would keep sending its money to the MECCs if they could do so via a third-party broker. (Example: Pfizer gives a professional medical society a major grant to fund a stop-smoking campaign; the professional society independently contracts with a MECC to manage the campaign; and merely by chance, the campaign urges that docs prescribe Pfizer's Chantix to get people to quit smoking.) A second commentor suggested that this development is a good thing because now instead of giving their money to slimy MECCs, the drug company will give its CME money to groups of integrity, like "university-based CME providers." I am afraid that this commentor has not been to a university-based CME event lately to see how commercial even those venues have often become when they are heavily funded by industry.
http://www.pharmalot.com/2008/07/pfizer-ending-support-for-cme-by-third-parties/
Now, what Ed does not tell us is that this posture of Pfizer's--ceasing the funding of continuing ed for docs (CME) via the for-profit medical education and communication companies (MECCs to the trade)--is almost for sure a reaction to recent events on Capitol Hill; but the antecedents go back to a bit of old history that was reviewed in HOOKED.
Act One of the drama occurred in 2003, when the Office of the Inspector General, DHHS, issued a report that got the industry's attention--by threatening drug company execs with Federal prison on racketeering charges if they violated the anti-kickback law. OIG-DHHS helpfully explained to the drug companies (and to doctors, had any been listening) that in order to be in violation of this Federal statute, all you have to do is give anything of value, to a physician who receives reimbursement from a Federal program such as Medicare or Medicaid or the VA, with even the partial purpose of influencing whether or not she prescribes your product.
Having explained that every encounter between a drug rep and a physician in which a gift is given, is technically a violation of Federal law, the OIG reassured the companies that they were not out to police individual contacts with docs. Rather they were going to be looking in the future at broad issues of corporate practices, and would view certain practices as being in compliance, and others as raising red flags. One red flag behavior was paying for CME out of your marketing budget. The OIG said instead that if they ever investigated a drug company, they'd be seeking evidence that the company had erected a financial firewall between its CME funding actiity and its marketing activity.
As I went on to report in HOOKED, the industry sat up and paid attention. The budding industry attack on strict new CME guidelines issued by the national accrediation counsel (ACCME) melted away and ACCME adopted its tougher guidelines with nary a whimper from industry. Companies reportedly were working to construct the needed firewalls and to separate much more formally their marketing budget from CME support and to make the latter more obviously no-strings-attached.
However, the result of Act One was not a refusal to channel industry CME money through MECCs. Rather it was the creation of the needed firewall to be able to claim that CME and marketing were being kept separate.
Now we come to Act Two--the newly aggressive efforts in the Senate (especially) to push for a sunshine law revealing all industry payments to docs, and Sen. Grassley's recent campaign to publicize egregious cases of conflicts of interest among academic physicians. I interpret the Pfizer move to demonstrate that at least some companies have decided that the heat is now turned up too high to permit things that seemed okay even after the OIG-DHHS report, and so the companies are responding to the heat by getting out of the MECC kitchen. But it's my guess that Act One was a necessarily prelude to this more recent development.
When I initially logged onto the Pharmalot blogsite, there were two comments to the story about Pfizer, each of which raised an interesting point. The first suggested that this is not necessarily going to improve integrity in CME, but rather drive the funding stream deeper underground; Pfizer admitted that it would keep sending its money to the MECCs if they could do so via a third-party broker. (Example: Pfizer gives a professional medical society a major grant to fund a stop-smoking campaign; the professional society independently contracts with a MECC to manage the campaign; and merely by chance, the campaign urges that docs prescribe Pfizer's Chantix to get people to quit smoking.) A second commentor suggested that this development is a good thing because now instead of giving their money to slimy MECCs, the drug company will give its CME money to groups of integrity, like "university-based CME providers." I am afraid that this commentor has not been to a university-based CME event lately to see how commercial even those venues have often become when they are heavily funded by industry.
Tuesday, July 1, 2008
New Survey: Yes, the Public Wants Sunshine
Our friends over at the Prescription Project have recently completed an important survey--see news release and summary at http://www.prescriptionproject.org/assets/pdfs/PPSA%20Survey%206-18-08.doc, and the complete survey results at http://www.prescriptionproject.org/assets/pdfs/Prescripton%20Project%20Survey_0618.pdf.
The basic question is: does Jane Q. Public really care about the debate now going on in Congress about physician payment sunshine laws? Or is this really a public non-issue that politicians are jumping on for the bandwagon ride? The survey offers a resounding affirmation that the public at large is truly concerned and that the pols may actually be responding to real public pressure. (Indeed, I have to admit, almost too resounding--had the results been the opposite, and had the survey been paid for by the drug industry, it would never pass the sniff test. But I cannot offhand spot any methodological flaws.)
Some key data from the telephone poll of about 1000 Americans conducted in early June by International Communications Research for the Prescription Project: more than half (52%) believe that the pharmaceutical industry has a large or extermely large influence on the physician's choice of a medication. Significant majorities believe that many common gifts or payments (which I have taken to calling "bribes") to physicians should be prohibited:
By contrast, only 51% favored banning "free" drug samples, but note that that is still a majority.
Sixty-four percent said it was important to know about their physician's ties to the pharmaceutical industry. (Though only 36% said they personally would be likely to ask their physicians this question directly.) Sixty-eight percent said they supported legislation requiring companies to disclose payments to docs. And 71% were likely to support legislation that would provide non-commercially biased, expert drug information to physicians (such as "academic detailing").
So in sum it appears that people are very concerned about the influence exerted by these bribes, are unwilling to ask their physwicians flat out about their industry ties, and so would like the reassurance of knowing that these ties are being reported through some public oversight mechanism--as well as to be sure their docs have access to an alternative, less biased source of information.
The basic question is: does Jane Q. Public really care about the debate now going on in Congress about physician payment sunshine laws? Or is this really a public non-issue that politicians are jumping on for the bandwagon ride? The survey offers a resounding affirmation that the public at large is truly concerned and that the pols may actually be responding to real public pressure. (Indeed, I have to admit, almost too resounding--had the results been the opposite, and had the survey been paid for by the drug industry, it would never pass the sniff test. But I cannot offhand spot any methodological flaws.)
Some key data from the telephone poll of about 1000 Americans conducted in early June by International Communications Research for the Prescription Project: more than half (52%) believe that the pharmaceutical industry has a large or extermely large influence on the physician's choice of a medication. Significant majorities believe that many common gifts or payments (which I have taken to calling "bribes") to physicians should be prohibited:
- Travel--86%
- Free dinners--84%
- Fees for speaking at company-sponsored conferences--80%
- Free lunch for office staff--78%
- Free pens and note pads--70%
- Free attendance at continuing ed courses--62%
By contrast, only 51% favored banning "free" drug samples, but note that that is still a majority.
Sixty-four percent said it was important to know about their physician's ties to the pharmaceutical industry. (Though only 36% said they personally would be likely to ask their physicians this question directly.) Sixty-eight percent said they supported legislation requiring companies to disclose payments to docs. And 71% were likely to support legislation that would provide non-commercially biased, expert drug information to physicians (such as "academic detailing").
So in sum it appears that people are very concerned about the influence exerted by these bribes, are unwilling to ask their physwicians flat out about their industry ties, and so would like the reassurance of knowing that these ties are being reported through some public oversight mechanism--as well as to be sure their docs have access to an alternative, less biased source of information.
Saturday, June 28, 2008
Alison Bass's SIDE EFFECTS: Another Hall of Shame candidate
The most recent book on Pharma issues that I've seen is by Alison Bass, formerly of the Boston Globe, called Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial (Algonquin Books, Chapel Hill, NC, 2008). Essentially it tells the story of Paxil and the suit filed by then-NY-Attorney-General Eliot Spitzer in 2004, charging GlaxoSmithKline with fraud in state court for concealing unfavorable evidence about the antidepressant's effectiveness and adverse-effect profile in children. She particularly profiles Rose Firestein, the assistant AG in Spitzer's office who led the GSK suit; and Donna Howard, a whistleblower who revealed the concealment of adverse research outcomes in the key Paxil study in adolescents. (She also discusses Martin Teicher, a Boston psychiatrist who reported the first cases of suicidality related to SSRI drugs and was roundly vilified by his colleagues as a wacko or anti-psychiatry cultist.)
At one level the book tells us experienced Pharma watchers little that we did not already know. In HOOKED, I suggested that the filing of the New York suit against GSK in the spring of 2004 might have been a critical tipping point, after which the momentum that had previously favored the influence and dominance of the pharmaceutical industry first started to swing in the opposite direction. Many would have said that this was silly, an the real tipping point came later, on September 30, 2004, when Merck withdrew Vioxx from the market and admitted its link to excess heart attacks. So it is at least somewhat reassuring to read a book that views the New York AG lawsuit as a critical event. Bass even goes so far as to suggest that the way Merck elected to deal with the Vioxx expose later that same year was predicated in part on the drubbing that GSK had taken in its legal tussle with the NY AG; so that the two "tipping points" are more closely linked than might at first appear. Still, the "smoking guns" in the GSK suit seem rather cool to the touch; for example, we discover that Rose Firestein became aware of the single most incriminating internal GSK memo, on how the critical negative study of Paxil in kids was spun deliberately to make it seem positive, by the simple expedient of reading an article about it in the Canadian Medical Association Journal--whose editor kindly then faxed her a copy of the original memo itself.
At another level, the book solidifies the case against another academic psychiatrist whose ties to Pharma seem to have reached legendary proportions. Dr. Martin Keller, chair of psychiatry of Brown University and the principal investigator of the major Paxil study in adolescents (the now-infamous Study 329), was originally outed by Bass years ago in the Boston Globe, as earning the princely sum of nearly a half million dollars annually in drug company money, on top of his salary as department chair. The book makes a strong case to show that Keller acquiesced, at the very least, in a ghostwritten version of the study that re-spun a study that actually was negative and made it appear to be positive. Moreover, the testimony of the Brown whistleblower suggests just as strongly that Keller deliberately concealed and misclassified serious adverse reactions among study participants--saying, for instance, that teens who had to stop taking the drug because of suicidal impulses or serious bizarre behavior quit the study due to "non-compliance" rather than due to adverse effects.
Dr. Keller refused to be interviewed for Bass's book. Brown University responded to Bass's query by stating that "Brown takes seriously the integrity of its scientific research. Dr. Keller's research regarding Paxil complied with Brown's research standards." When a prestigious Ivy League medical school says that its research standards support ghostwriting and suppression and misclassification of data, then somebody has some explaining to do. (I know that some of our esteemed colleagues who are affiliated with Brown have protested this situation, based on information that was publicly available even before Bass's book was published.)
At one level the book tells us experienced Pharma watchers little that we did not already know. In HOOKED, I suggested that the filing of the New York suit against GSK in the spring of 2004 might have been a critical tipping point, after which the momentum that had previously favored the influence and dominance of the pharmaceutical industry first started to swing in the opposite direction. Many would have said that this was silly, an the real tipping point came later, on September 30, 2004, when Merck withdrew Vioxx from the market and admitted its link to excess heart attacks. So it is at least somewhat reassuring to read a book that views the New York AG lawsuit as a critical event. Bass even goes so far as to suggest that the way Merck elected to deal with the Vioxx expose later that same year was predicated in part on the drubbing that GSK had taken in its legal tussle with the NY AG; so that the two "tipping points" are more closely linked than might at first appear. Still, the "smoking guns" in the GSK suit seem rather cool to the touch; for example, we discover that Rose Firestein became aware of the single most incriminating internal GSK memo, on how the critical negative study of Paxil in kids was spun deliberately to make it seem positive, by the simple expedient of reading an article about it in the Canadian Medical Association Journal--whose editor kindly then faxed her a copy of the original memo itself.
At another level, the book solidifies the case against another academic psychiatrist whose ties to Pharma seem to have reached legendary proportions. Dr. Martin Keller, chair of psychiatry of Brown University and the principal investigator of the major Paxil study in adolescents (the now-infamous Study 329), was originally outed by Bass years ago in the Boston Globe, as earning the princely sum of nearly a half million dollars annually in drug company money, on top of his salary as department chair. The book makes a strong case to show that Keller acquiesced, at the very least, in a ghostwritten version of the study that re-spun a study that actually was negative and made it appear to be positive. Moreover, the testimony of the Brown whistleblower suggests just as strongly that Keller deliberately concealed and misclassified serious adverse reactions among study participants--saying, for instance, that teens who had to stop taking the drug because of suicidal impulses or serious bizarre behavior quit the study due to "non-compliance" rather than due to adverse effects.
Dr. Keller refused to be interviewed for Bass's book. Brown University responded to Bass's query by stating that "Brown takes seriously the integrity of its scientific research. Dr. Keller's research regarding Paxil complied with Brown's research standards." When a prestigious Ivy League medical school says that its research standards support ghostwriting and suppression and misclassification of data, then somebody has some explaining to do. (I know that some of our esteemed colleagues who are affiliated with Brown have protested this situation, based on information that was publicly available even before Bass's book was published.)
Bad News--Other Countries Also Have FDAs of their Own
The ever-alert Jon Judeidini sent this link out through the Healthy Skepticism network:
http://www.transworldnews.com/NewsStory.aspx?id=51672&cat=10
This is a news article and not a medical journal publication, but the claim is that the Swedish pharmaceutical regulatory agency, their version of the US FDA, is colluding with psychiatrists who are well known to be heavily beholden to the pharmaceutical industry, to publish a study that purports to show that antidepressants really do work very well and that studies that seem to indicate that they are little if any better than placebo are bunk. The article was of such stunning scientific quality that the two journals to which it was first submitted, Lancet and BMJ, both rejected it forthwith. The study then experienced a soft landing at European Psychopharmacology (I guess psychopharmacology on that continent is different from everywhere else, requiring a separate journal) , edited by Dr. Stuart Montgomery. According to the reporter, Dr. Montgomery is apparently the European version of our own Dr. Charles Nemeroff (see previous post, http://brodyhooked.blogspot.com/2008/01/can-anyone-explain-nemeroff-phenomenon.html). Dr. Montgomery was described as being almost singlehandedly responsible for previously concealing data on the paroxetine withdrawal syndrome.
Now, just to be up front about the whole matter, I would like to go on record as admitting that I have somewhat the same reaction as the Swedish psychiatrists who are in bed with Pharma. In my years of practicing family medicine, during which I wrote a lot (in hindsight probably way too many) of scripts for newer-generation antidepressants, I did see a number of patients who had very significant therapeutic responses. In the best cases, they stated that they felt like their normal selves again for the first time in years. For this subgroup of patients, it might have been a placebo effect for all I could know scientifically, but it was a darn impressive placebo effect if so. I also saw a number of cases where the drugs did not work or seemed to stop working after about 6 months; and I saw a good many cases where the patient complained that the side effects ("I feel like a zombie" was a pretty common way to express them) were as bad or nearly as bad as the depressive symptoms. So my own very limited clinical experience is inconsistent with the notion that these drugs are no good at all. It is consistent with the assertion that the side effects of these drugs have been chronically underreported in the literature as well as in the curbside conversation of my colleagues, in both psychiatry and in primary care.
Anyway, back to Sweden--I suppose one element of incurable romanticism among Americans is that we imagine that other countries are wiser than we are and have solved many of the problems that continue to plague us (like providing universal health care). So it is sad to realize that other advanced countries have their own versions of the same issues with "regulatory capture" that we do in the U.S.
http://www.transworldnews.com/NewsStory.aspx?id=51672&cat=10
This is a news article and not a medical journal publication, but the claim is that the Swedish pharmaceutical regulatory agency, their version of the US FDA, is colluding with psychiatrists who are well known to be heavily beholden to the pharmaceutical industry, to publish a study that purports to show that antidepressants really do work very well and that studies that seem to indicate that they are little if any better than placebo are bunk. The article was of such stunning scientific quality that the two journals to which it was first submitted, Lancet and BMJ, both rejected it forthwith. The study then experienced a soft landing at European Psychopharmacology (I guess psychopharmacology on that continent is different from everywhere else, requiring a separate journal) , edited by Dr. Stuart Montgomery. According to the reporter, Dr. Montgomery is apparently the European version of our own Dr. Charles Nemeroff (see previous post, http://brodyhooked.blogspot.com/2008/01/can-anyone-explain-nemeroff-phenomenon.html). Dr. Montgomery was described as being almost singlehandedly responsible for previously concealing data on the paroxetine withdrawal syndrome.
Now, just to be up front about the whole matter, I would like to go on record as admitting that I have somewhat the same reaction as the Swedish psychiatrists who are in bed with Pharma. In my years of practicing family medicine, during which I wrote a lot (in hindsight probably way too many) of scripts for newer-generation antidepressants, I did see a number of patients who had very significant therapeutic responses. In the best cases, they stated that they felt like their normal selves again for the first time in years. For this subgroup of patients, it might have been a placebo effect for all I could know scientifically, but it was a darn impressive placebo effect if so. I also saw a number of cases where the drugs did not work or seemed to stop working after about 6 months; and I saw a good many cases where the patient complained that the side effects ("I feel like a zombie" was a pretty common way to express them) were as bad or nearly as bad as the depressive symptoms. So my own very limited clinical experience is inconsistent with the notion that these drugs are no good at all. It is consistent with the assertion that the side effects of these drugs have been chronically underreported in the literature as well as in the curbside conversation of my colleagues, in both psychiatry and in primary care.
Anyway, back to Sweden--I suppose one element of incurable romanticism among Americans is that we imagine that other countries are wiser than we are and have solved many of the problems that continue to plague us (like providing universal health care). So it is sad to realize that other advanced countries have their own versions of the same issues with "regulatory capture" that we do in the U.S.
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