Bipolar Today

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A total of twelve states have sued or are suing the drug company Johnson & Johnson over marketing tactics for their atypical antipsychotic medication, Risperdal. Louisiana and South Carolina have each won judgements of over $250 million each in their law suits. The lawsuit stems from the much higher price of Risperdal compared to previous generations of drugs that were generic at the time. The states charge that Johnson & Johnson made false claims that Risperdal had been shown to be more effective than typical antipsychotics like Haldol, so they lost money when Risperdal was prescribed over cheaper medications. Johnson & Johnson allegedly paid kickbacks to middlemen like Omnicare (which has itself paid $100 million to states in a separate agreement), allegedly paid significant money to researchers who allowed company employees to edit the text of research trials, and allegedly paid a computer programmer who developed a program that suggested atypical antipsychotics over typical antipsychotics as a part of an algorithm to provide treatment advice, and allegedly included claims about the comparative safety of Risperdal compared to its competitors (which contradicts explicit FDA rules). A full story discussing the lawsuit can be found here on the Daily Record.

Commentary

There are a lot of issues here. What this shows it the ways in which drugs that are not generic are heavily promoted, while others are not. Most of the atypical antipsychotics are due to become generic in the next few years, so hopefully, a lot of the hefty promotion will start to wane. Since non-generic medications are so much more expensive than generic medications, heavy prescription of them can quickly deplete health care budgets.

However, I don’t want to let the medical profession off of the hook here, either. Since the thalidomide disaster in the 1950s, the FDA has had the primary responsibility of ensuring that drugs are safe, and this has expanded to ensuring that drugs are not promoted for off-label uses, for example. However, at the end of the day, knowing which medications are better or worse is the responsibility of the medical profession. What does it say about the medical profession that millions of dollars are being wasted because a computer program is telling physicians to prescribe one medication over another? Why are physicians prescribing by algorithm, anyway? Why are physicians trusting letters about relative safety and efficacy written by companies that are trying to sell them a product? These are the kinds of questions that this case raises, and, while more government oversight might be required, more professional oversight is required as well.

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5. Some Antipsychotics Better For Acute Mania: The Lancet