Thursday, March 5, 2009

We've seen this before

Why are anti-psychotic drugs a concern of a high school? One would think that a powerful drug, with immense-side effects, developed to treat adults who have had nothing but ineffective treatment and tremendous difficulty throughout their lives, would be used very, very cautiously in regards to children.

Wrong. Instead these drugs are though of in terms of "market share". The intent is to aggressively increase the pool of consumers far beyond those of us who suffer from the most crippling symptoms of schizophrenia. Depressed adults, sleepless teens, unruly children. It goes without saying that there is no research available concerning safety or long term effects of these drugs on children.

And no studies on the safety of mixing these with other drugs, proscribed or otherwise. But why would that give pause to those devoted to increasing market share, as if a medical treatment is just another consumer product? I doubt that there is much possibility for "informed consent" in this kind of project.

Seroquel is a newer drug; many thousands of teenagers now take it. It was developed to replace Haldol (which largely replaced Thorazine as the treatment of choice for psychotic symptoms). I have met numerous teenagers who take Seroquel, only one of them had a history of psychotic symptoms. This is called "off-label" usage. No empirical studies back this usage up. Evidence is almost purely anecdotal or via advertisement and company sponsored parties and conferences.

A total of ten clinical trials were included in the meta-analysis, which variously compared Seroquel to placebo, Haldol, and several other antipsychotic medications. Four trials compared Seroquel to Haldol. Several subscales of the BPRS (Brief Psychotic Rating Scale) were included in the analysis.

When examining the amount of change on the BPRS, Seroquel consistently outperformed placebo, both on the BPRS total score and on several of the BPRS subscales. However, in several analyses, Seroquel was outperformed by Haldol and by risperidone (Risperdal; Janssen's antipsychotic). The document states: "Against 'all doses' of Seroquel, each of the three significant p-values generated was in favour of Haloperidol (Total BPRS, Factor V, and Hostility Cluster). There was no evidence of significant differences between the treatments when Haloperidol was compared to high-dose Seroquel." This is a plain admission that Haldol outperformed Seroquel on several outcomes, but that high dose Seroquel yielded approximately equivalent results to Haldol.

This is an excerpt from A Closer Look. I recommend following this blog if these issues interest you. It would seem that a drug developed to eat up Haldol's share of the market doesn't work any better, but is much more expensive. Meanwhile the company pushes hard to have the drug used for symptoms and populations that have not been studied for safety or efficacy.

Typical, I am afraid.

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