Dr Daniel Carlat's article in The New York Times is a stunning first person account of the kind of friendship and influence that pharmaceutical industry money can buy. Dr Carlat, an assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report, is astonishingly candid about how he became an industry-sponsored speaker and why he gave it up in favour of running a blog and a report (that takes no drug industry money) that is meant to help doctors critically assess drug research and marketing claims.
His moment of truth arrives when a fellow psychiatrist asks him some tough questions about the side effects of Effexor-- the drug that Dr Carlat is being paid to talk up. This is perhaps the most powerful passage in the story. Dr Carlat is quoting from an industry-sponsored study which reports that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 mg per day, when the skeptical psychiatrist says many of his patients developed hypertension on much lower doses. Dr Carlat describes his own nervousness, how he speeded up the talk and presented more data in support of Effexor. But this is also when his conscience kicks in:
"Driving home, I went back over the talk in my mind. I knew I had not lied — I had reported the data exactly as they were reported in the paper. But still, I had spun the results of the study in the most positive way possible, and I had not talked about the limitations of the data. I had not, for example, mentioned that if you focused specifically on patients taking between 200 and 300 milligrams per day, a commonly prescribed dosage range, you found a 3.7 percent incidence of hypertension. While this was not a statistically significant higher rate than the placebo, it still hinted that such moderate doses could, indeed, cause hypertension. Nor had I mentioned the fact that since the data were derived from placebo-controlled clinical trials, the patients were probably not representative of the patients seen in most real practices. Patients who are very old or who have significant medical problems are excluded from such studies. But real-world patients may well be at higher risk to develop hypertension on Effexor.
I realized that in my canned talks, I was blithely minimizing the hypertension risks, conveniently overlooking the fact that hypertension is a dangerous condition and not one to be trifled with. Why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn’t I asking this obvious question out loud during my talks?"
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