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Schizophrenic Coverage of Zyprexa
By Jeff Stier, Esq.
The media's coverage of the Zyprexa story is schizophrenic. When we released our peer-reviewed report, Weighing Benefits and Risks in Pharmaceutical Use: A Consumer's Guide, health reporters gave it a collective yawn. They said we stated the obvious -- that all drugs have risks, and patients and physicians together should balance those risks with the potential benefits according to each patient's unique profile to make an informed decision accordingly.
Conceptually, the reporters get it. Yet anytime allegations are made about a specific risk of a certain drug, reporters are all too quick to jump on the plaintiff's bar scandal bandwagon. When the issue is conceptual, reporters are calm and rational. When they sniff scandal, common sense goes out the window.
The story line is all too predictable. Since the allegations of risk alone are not enough to nail down huge punitive damages, they must also charge a cover-up. This is exactly what played out over the weekend when the New York Times alleged that Eli Lilly engaged in a campaign to downplay the risks of their top-selling drug, Zyprexa, a key treatment for two devastating mental illnesses: schizophrenia and bipolar disorder.
Zyprexa is known to cause weight gain, and some have charged that it increases the risk of diabetes as well, but that charge has not been fully substantiated.
Surely, pharmaceutical companies must be fully forthright with the FDA, physicians, as well as patients, regarding the risks of any drug. If a drug company did not reveal all the potential downsides of their product, their actions would make it impossible for a patient and physician to make a proper and fully informed decision. However, a thorough discussion of the allegations made in the Times article is outside the scope of this analysis.
My concern from a public health perspective is that with the media now in an anti-Zyprexa feeding frenzy, patients, such as those diagnosed with paranoid schizophrenia, may go off their medication without consulting with their physicians. And worse, there may be a tendency for some physicians to practice defensive medicine by abruptly discontinuing treatment -- not because such a reaction is in the best interest of the patient, but rather because it seems like the safest choice for the doctor and his or her insurance company. Yes, Zyprexa (like all drugs,) has its risks, but especially for patients with serious mental disorders, not assuming certain risks could expose them to increased risks associated with inadequate treatment.
When faced with the devastating consequences of schizophrenia, many patients, together with their care-takers, may be willing to accept the risk of weight gain, and perhaps even diabetes, if it is indeed a risk, for the huge benefit of keeping their disorder under control.
More broadly, another negative public health consequence of over-reacting to this story is that it portends a huge transfer of wealth from investors who put their capital at risk to make life saving drugs to unscrupulous lawyers. Such an outcome will inevitably lead to less investment in drug research, and as such, less innovation to develop the new drugs that benefit consumers.
Mentally ill patients and their physicians must already overcome stigma to begin the road to a more normal existence. Anti-pharmaceutical activists, the plaintiff's bar, and their allies in the media must take extra care to deal with this matter responsibly, so as not to unnecessarily further complicate a well-thought out treatment plan for patients who have found Zyprexa to be a path toward a more normal life.
Erica Schachne (January 3, 2007)
Coming from a psychiatric perspective, I agree with what you said. Many, many anti-depressant and anti-psychotic drugs cause weight gain and there is nothing earth shattering about this side effect. As you said, the benefit of better mental health and life functioning outweighs the discomfort of the side effect in many cases. In addition, while diabetes is an important health issue, many patients will be willing to accept the risk of this side effect as well. First of all, there is a risk for it - I don't think everyone is guaranteed to develop it. Did they post the probability? Also, it is the type of condition that can be kept under control with the proper daily/medical attention. Other accepted drugs also have potential medical side effects. For example, Wellbutrin, an anti-depressant that doesn't cause weight gain or sexual disfunction (it is not an SSRI) does carry the risk of possible epileptic seizures. But the drug is widely accepted.
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