Pharmaceutical Industry Donations May Affect State Mental Health Guidelines
The New York Times on Sunday examined efforts by pharmaceutical companies to influence state officials to include more expensive new generation antipsychotic treatments in prescribing guidelines for Medicaid beneficiaries with mental illnesses and patients in state-run institutions. According to the Times, a campaign by a "group of drug companies ... led by Johnson & Johnson" since the mid-1990s has prompted at least 12 states to adopt "guidelines for treating schizophrenia that make it hard for doctors to prescribe anything but the new drugs." As a result, states have become "among the largest buyers of antipsychotic drugs," and the new-generation treatments have become blockbusters, the Times reports. The Times profiled the role of some drug makers in the development of drug guidelines in Texas and Pennsylvania. The Texas guidelines -- first enacted in 1997 and revised in 1999 -- advise doctors to prescribe J&J's Risperdal, Eli Lilly's Zyprexa, AstraZeneca's Seroquel, Pfizer's Geodon or Bristol-Myers Squibb's Abilfy unless they can explain in writing why a patient would benefit more from an older, less expensive drug. Texas spends about $3,000 per patient per year for the new drugs, compared with about $250 per patient per year for older drugs. Dr. Steven Shon, medical director of the Texas Department of Mental Health and Mental Retardation, said that 11 drug companies gave the state about $285,000 out of a total cost of $6 million to create and implement the guidelines. In Pennsylvania, which has adopted similar guidelines, a former state manager alleges that he was removed from an investigation in an effort to hide evidence that drug companies "were trying to buy the loyalty of state officials," according to the Times. Allen Jones in May 2002 determined that mental health officials had allegedly set up a bank account to receive payments from drug companies; the state's ethics code prohibits state employees from taking gifts designed to influence their decisions. Stephanie Suran, a spokesperson for the Pennsylvania Department of Public Welfare, said she could not comment on Jones's allegations because of an ongoing investigation, the Times reports.
Officials from drug firms say that they have done nothing "untoward" and that it is "appropriate" to pay for developing state guidelines and educating physicians about their products, the Times reports. Mariann Caprino, a Pfizer spokesperson, said the company finances such projects to ensure that patients receive the best care. State officials in Texas and Pennsylvania also cite improved care under the new guidelines. However, Dr. Peter Weiden, professor of psychiatry at the State University of New York Downstate Medical Center, maintains that drug companies may have too much influence in physician education, saying, "The industry drives education right now" (Petersen, New York Times, 2/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.