Posted by dr dave on August 27, 2002, at 16:36:52
In reply to Dr. Dave - why do you hate this drug?, posted by moxy1000 on August 23, 2002, at 11:58:34
The time has come to reveal my connections with the drug industry. In the last five years I have had about five meals in restaurants paid for by drug companies but I can't remember which ones. I have also eaten countless sandwiches provided by drug companies at many many lunchtime meetings, but I am entirely indiscriminate as to which company are paying. I have no other financial connections with drug companies, and never have. I have no connections with drug companies apart from seeing drug reps. Oh, and I did accept a small clock from the Lundbeck rep approx value £5 (about $8).
Why am I saying all this stuff? Because I am angry. My reading of the research is that Lexapro hasn't been proved to be superior to any anti-depressant. All independent bodies which have assessed the evidence agree, including the FDA (see Associated Press article quoted above). Claims for this drug are being made which are just not justified, and they are legitimated by vague referrals to 'positive studies', which when you examine them closely don't really show convincing results.
I am angry because I think science is being corrupted. There is no known mechanism whereby removing r-citalopram could make s-citalopram work better. The clinical studies, when you look at them in detail and peel away the hype, confirm this to be the case. The biggest analysis so far of which I am aware, by Gorman in collaboration with Forest, shows no statistically significant difference between Lexapro and Celexa at end-point when drop-outs are factored in (LOCF analysis) on the two main measurements used (MADRS and CGI).
I am so sick of my patients hoping desparately that a new pill will relieve their misery and then being cruelly disappointed when it doesn't, confirming in their own minds that they will never get better. It is monstrous not to tell people the truth about what they can expect from changing antidepressant - of course sometimes it can be miraculous, but you can't guarantee it and you have to be straight with people about the likelihood of a new antidepressant helping. If people believe they are being put on a far superior drug which is very effective against depression, how do they feel when it doesn't work? Often they will feel that it proves they have an untreatably severe condition, so they lose hope, are more depressed, and question whether it's worth continuing to try to change things.
So when I see claims being made which I think are as misleading as this, I get angry. This is not about claims for how well a new, improved washing powder works, this is about untold human misery. We must be as truthful and realistic about things as we can possibly be, and that is very, very far from being the case with the marketing of this product.
The use of single-enantiomer drugs to extend patent protection is no secret and you can read more about it more in this article from 'Chemical & Engineering News'
http://pubs.acs.org/cen/coverstory/7843/7843scit1.html> Dr. Dave, I have spent a few hours this morning reading your recent posts, and the more I read, the more I am convinced that you have some sort of hidden agenda against Lexapro.
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> I'm surprised I didn't notice it sooner. I am taking a "wait and see" attitude with Lexapro. I know you're in Europe, But I would like to ask what your opinion is of Lexapro's release in the U.S. I ask because Forest has a U.S. patent on Celexa until at least 2005. Why would they stop marketing a billion dollar drug and start marketing Lexapro if it had, as you say repeatedly, no advantages over Celexa?
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> Also, I think it's worth pointing out that this company (Forest) has a vested interest in Depression. Did you know Howard Soloman, the CEO of Forest, has a son who has battled depression his entire life? Andrew wrote a book about his battle, called the "Noonday Demon." (Andrew, by the way, mentions nothing of Celexa or any Forest product in his book.) Also, did you know Howard's wife committed suicide? This is common knowledge in the U.S. Business Week did a cover story about this a few months ago.
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> My point is that I believe this company has been touched to the core by this disease called depression. I also believe that they are releasing Lexapro in the U.S. because it would be unethical to delay the release of a superior treatment like Lexapro, simply because Celexa still had life left in it's patent.
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> I would be interested to hear your response.
poster:dr dave
thread:109458
URL: http://www.dr-bob.org/babble/20020821/msgs/117958.html