Pharma, antipsychotic drugs and the Book of Woe

Inquirer colleague Tirdad Derakhshani wrote the other day (link here) about Connecticut therapist and science writer Gary Greenberg, who is a critic of trends in psychiatry and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The fifth edition is just out. So is Greenberg's book, "The Book of Woe: The DSM and the Unmaking of Psychiatry" (Blue Rider Press, $28.95).

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Greenberg writes about the efforts to add clear scientific measures to mental health care, in part because it helps drug companies sell more medicine because insurers, public or private, can base reimbursement on something. Greenberg's web site is here.

That has partly led to an explosion of use for antipsychotic drugs that were originally only approved for conditions such as schizophrenia, which has a small - and thus less profitable - population group.

But pharma likes measure only to a point. The vague and shifting definitions of mental health conditions allow doctors even greater latitude to prescribe medicine off-label in hopes that it makes their patient happier. And drug companies do all they can to encourage such prescribing.

Many of the largest financial penalties paid by drug companies followed federal investigations that looked at drugmakers' marketing practices related to antipsychotic and depression medicines.

The big one still pending relates to Johnson & Johnson's marketing practices around the antipsychotic Risperdal. J&J has mentioned the investigation in SEC filings and reports suggest the penalties could exceed $2 billion. There are also state and local suits related to marketing and safety of that drug. A Wednesday Inquirer story deals with a slice of that. A link is here.