Friday, June 15, 2007

Zyprexa "Lawyer Ads" adding to Noncompliance

I am a little behind the times, but I just read an article about the “lawyer’s ads” for Zyprexa that are scaring patients into not being compliant with their mental illness medications. This does not sound good. Lilly (maker of Zyprexa) is in the middle of settling some 30,000 lawsuits and has spent over $1.2 billion already. The ads feature the drug’s side effects and the amount Lilly has spent to settle their lawsuits.

One lawyer who is creating some of these ads is William Berg. His firm is Berg Injury Lawyers. What is his motivation? "If we advertising lawyers don't tell people about their legal rights, who will? Eli Lilly sure isn't going to," he said.

I am unfamiliar with Zyprexa, but it treats schizophrenia and bipolar disorder and had over $4.4 billion in sales last year. The problem is that is causes diabetes or high blood sugar. I can’t believe that prescribing doctor’s did not know the risks – it’s just foolish. Also with any new treatment, I would imagine the psychiatrists would monitor their patients’ blood levels to see what effects the drug has on them. Lilly says all doctor's knew the side effects since the drug's launch in 1996 whereas Allen Rothberg, another lawyer representing the patients, claims that Lilly withheld information from patients and doctors alike.

The worst part about this, other than patients’ suffering, is that the advertising blitz is causing all these other patients to stop taking their other medications. I know that schizophrenics and bipolars can be paranoid – so just imagine what could happen to a patient after seeing ads reinforcing negative side effects. Couple that with claims for financial gain, and you have a bipolar fiesta. They stop taking their meds, let a little mania take hold and then they believe they can claim some of the billion dollar pot for themselves.

The wave of noncompliance among these patients could turn into a horrible mess. Here are the facts from a Lilly survey released on Wednesday: 402 psychiatrists who treat patients with bipolar disorder or schizophrenia completed an online questionnaire and more than half of the psychiatrists said they believed their patients stopped medication or reduced their dosage after seeing lawyers' advertisements about anti-psychotic drugs.

This is really big and really bad. 201 psychiatrists. Let’s say 20 patients each? That is 4000 unstable patients running around. A few years ago, after the media reported the FDA mandated severe "black box" warnings for a group of common antidepressants, suicide rates rose among those patients on the drugs.

Dr. Nada Stotland, president-elect of the American Psychiatric Association, said: "You can't prove a cause-and-effect, but you can draw a pretty good hypothesis that there's a relationship between suicides going up and people not being treated for depression." I hope this doesn’t happen again. The good thing is, Berg assured us all in saying, “In all of our ads, we tell folks, 'Do not stop taking any medication without consulting your doctor.'" I’m glad he is looking out for possibly already unstable patients, who will definitely heed that warning.

Another concern is what side effects are these patients going to suffer. These are not addressed in the regular side effect warnings for these drugs. A friend of mine went off Paxil or another antidepressant and was in bed for two weeks. Not so bad, but again just not taking medication for people with schizophrenia and bipolar disorder is bad enough.

On another note, what are the financial implications of this noncompliance for 4,000 patients? On the pharma end, let’s say the average medication is $250 a month. That’s $1M if these patients don’t refill their medications. That’s like 1/8 of a penny to pharma so they aren’t worried. Let’s say 1/3 go into a mental ward since they have adverse effects – let’s call it $1000 a night for 4 nights. Not bad only $5.2M in expenses. I’m sure insurance will cover it.

I am going to assume at least 3/4ths of these patients have jobs (@ $30K a year) and will not work for a week. That’s about $1.8M in lost revenue, plus another $2.5M to cover the jobs with temp help - that's just for the week. And a fair portion of these people might not return to their jobs if they don't get sorted out with the proper medication so you can add another $3M of lost revenue. Put that all together and you get $13.5M. I think I did the math correctly.

That might not be a lot to some, but it sure will cost us all down the road if noncompliance continues at this rate. I mean this is just fallout from 402 psychiatrists polled. I don’t know how many patients are out there on bipolar and schizophrenia medication, but Zyprexa did make $4.4 BILLION dollars last year, so go figure.

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