Mental health takes industry pills
August 8, 2006
IN OCTOBER 2004, the nation's most influential mental illness advocacy group
signed a deal that financially tied it to some of the world's biggest
pharmaceutical companies.
The so-called "Pharma Collaboration", unreported in the Australian media,
linked the Mental Health Council of Australia directly to global
pharmaceutical giants Pfizer, Eli Lilly, Glaxo SmithKline, Bristol Myers
Squibb, Lundbeck, Wyeth and Astra Zeneca.
It has been a good deal for the non-profit council, which promotes itself as
Australia's peak mental health group, providing 8 per cent of its total
income. It also seems to have benefited the drug companies, which have a
strong financial interest in selling medication to treat mental illness,
especially the "new epidemic" of depression.
In an example of the close relationship that has developed between drug
companies and the advocacy group, the council agreed to write and distribute
a "health report" on young people and depression that was fully funded by
Pfizer, the world's biggest drug company and maker of blockbuster
antidepressant Zoloft. The Pfizer-funded report, released in early 2004
before the Pharma Collaboration deal was signed, included a survey that
found young people were "ignoring the signs of depression".
The Mental Health Council was quoted saying young people were dismissive of
depression, which was an illness that required professional treatment.The
council's lobbying activities have also been supported by drug company
money. A December 2004 council submission to the Federal Government calling
for more investment in mental health was fully funded by Pfizer,
Janssen-Cilag, Eli Lilly and Bristol Myers Squibb. Yet the council insists
that it retains full editorial independence.
Depression is a major illness in Australia and awareness of its debilitating
effects has risen markedly in recent years. Few suggest that antidepressant
drugs do not have an important role to play in treatment. Yet the Mental
Health Council of Australia's close links to drug companies, which have
funded political lobbying and disease awareness campaigns, raise questions
about whether the agendas of a consumer group and that of a multinational
drug company are the same, and, more seriously, whether the enormous
increase in prescriptions for antidepressant drugs in Australia in the past
decade is at least in part due to pharmaceutical industry influence.
"The strategy is all about growing markets and increasing sales," says Dr
Jon Jureidini, chairman of Healthy Skepticism, a South Australia-based
organisation that exposes pharmaceutical marketing techniques.
An Age investigation has found that the mental health agenda in Australia
has been heavily influenced by some of the world's biggest drug companies.
The pharmaceutical industry has used its financial muscle to establish
relationships with Australia's top mental health groups and opinion-leading
psychiatrists — who in turn shape the way depression is viewed and treated.
The investigation found:
â– Thousands of GPs have attended Federal Government-approved mental health
training programs that are fully sponsored by Pfizer. Many GPs have attended
a Wyeth-sponsored educational seminar called "Time Efficient Mental Health".
â– The Pfizer-funded GP training program, known as SPHERE, tells GPs that
they will, as a result of the course, be able to better diagnose depression,
and will therefore prescribe more antidepressants. A 2003 analysis of the
SPHERE screening tool by Monash University researchers found problems and
claimed most people taking the test were being diagnosed with a mental
disorder when most did not have one.
â– Major drug companies are now principal sponsors of mental health advocacy
groups, which critics say is a deliberate method to get around Australia's
ban on direct advertising to consumers.
â– The Schizophrenia Fellowship of NSW also lists Pfizer, Lundbeck and
Janssen-Cilag as sponsors. The NSW Mental Health Association is backed by
Pfizer and Wyeth. The Anxiety Disorders Alliance, which gets support from
Pfizer, Lundbeck and GlaxoSmithKline, also agreed to participate in a
Pfizer-funded report on anxiety.
â– Federal Health Department data released to The Age shows that 20.4 million
prescriptions — nearly one for every Australian — were written in 2003, 2004
and 2005 just for the newer type of antidepressant known as SSRIs. Two of
the 10 top-selling drugs in Australia are antidepressant Efexor and
anti-psychotic Zyprexa.
Melissa Raven, adjunct lecturer in public health at Flinders University,
says non-profit advocacy groups are used by drug companies to lobby
governments to approve and subsidise specific drugs, as well as raise the
prevalence, severity and need for treatment of certain disorders.
"Disease awareness campaigns are a form of de facto direct-to-consumer
advertising," says Ms Raven. "Disease awareness campaigns are very important
in countries like Australia where direct-to-consumer advertising is
prohibited."
A spokesman for Medicines Australia, the peak national body representing the
pharmaceutical industry, says the aim of collaboration with patient advocacy
groups is to benefit patients. "Patient groups and pharmaceutical companies
have common goals, including treating and managing disease," the spokesman
says. "The partnership between patient groups and pharmaceutical companies
is important in raising awareness of chronic and life-threatening
conditions … the medicines may provide an essential part of a patient's
treatment."
But a recently published US pharmaceutical marketing report called
Harnessing Patient Power: Strategies for speeding drug approval, building
and retaining market share reveals another motivation for drug companies
wanting to financially support patient advocacy groups.
The report, which drug companies can buy for about $3000, says the financial
support offered by drug companies is no longer just about "creating goodwill
with no expectation of measurable return for the company".
The report includes case studies to show how drug companies can "convert
such relationships into important business tools to meet their corporate
objectives".
Mental Health Council of Australia chief executive John Mendoza says mental
health services and research have been hugely under-funded in Australia by
governments. The drug company money allows the council to supplement its
resources and be a more effective advocate. He stresses that the deal with
the pharmaceutical industry places no conditions on the council other than a
need to report on the status of projects.
SANE Australia executive director Barbara Hocking says her organisation, the
peak body for schizophrenia sufferers, retains control over any projects or
research that have been supported by drug companies. "The relationships
usually turn out to be a win-win situation for both parties," Ms Hocking
says.
But Martyn Goddard, a former Pharmaceutical Benefits Advisory Committee
member, says patient advocacy groups cannot help having their independence
compromised when they accept drug company money. "The problem is that there
is no such thing as clean money," says Mr Goddard. "They like to think they
are independent but they are not."
Another major target for drug company money in Australia is psychiatrists.
Janssen-Cilag, Eli Lilly and Bristol Myers Squibb are the major sponsors of
this year's Royal Australian and New Zealand College of Psychiatrists annual
congress, with Janssen-Cilag providing the ubiquitous pads and pens. Bristol
Myers Squibb has also been the major sponsor of the Institute of Australian
Psychiatrists conference.
When it comes to influential psychiatrists in Australia, few rival Sydney's
Ian Hickie, the executive director of the Brain and Mind Research Institute,
the clinical adviser and editorial director of the Jeff Kennett-led
beyondblue, a board member of the Mental Health Council of Australia and a
former chairman of a Federal Government committee overseeing a $263 million,
eight-year program to educate GPs on mental health.
Nobody doubts he has done a great deal to raise the profile of mental
illness and has successfully lobbied governments to dedicate serious money
to mental health. In the course of his work, Professor Hickie has received
financial support or "honoraria" from several drug companies, including
assistance to attend international meetings. He has also participated in
educational programs sponsored by companies such as Pfizer, Bristol Myers
Squibb and Wyeth. These facts are declared in his work.
At last year's Pharmacy Australia Congress, Professor Hickie was a guest
speaker. He was introduced as a "staunch supporter of pharmacy's
complementary role with doctors" in treating mental illness.
But Professor Hickie says that he also rejects drug company money — for
instance, he advised groups such as beyondblue not to accept financial
support from drug companies, such as Pfizer's attempt to give the
organisation a $1.2 million grant a few years ago. He says most drug company
money associated with his work in the past 20 years has gone to departments
at the University of Sydney and the University of NSW.
"My own involvement with the industry has never been that of an ongoing paid
consultant," he says. "I only become involved in projects that are
consistent with my community and academic role, are independently directed
and serve a specific academic or community purpose."
One of Professor Hickie's most influential projects began almost 10 years
ago. Between 1997 and 1999, he received government funding and $70,000 from
Bristol Myers Squibb to develop a depression screening tool — a check list
of questions — for GPs, known as SPHERE, a national depression initiative.
Although there was a need to better educate GPs on signs of mental illness,
the SPHERE screening tool was and is controversial. In 2003, researchers at