When the nation's top psychiatrists gather
May 17-22 in San Francisco for the annual meeting of the American
Psychiatric Association, they will be struggling with a vexing
They will also be closely watched by
personal injury lawyers.
At issue: allegations that new drugs
proving effective for schizophrenia might contribute to the risk
of diabetes -- and the desire of some lawyers to sue "deep-pockets"
drug manufacturers without waiting until the facts are known.
Schizophrenia is a severe, often dangerously
debilitating mental illness, probably the most difficult mental
illness for sufferers and their families. Symptoms include hallucinations,
delusions, disordered thinking and unusual behavior. Victims
of the disease find it difficult to have careers and relationships,
and often suffer acute social stigma.
The drugs at issue, atypical antipsychotics
such as Eli Lilly's Zyprexa and Janssen's Risperdal, have been
proven in many cases to be a more effective treatment than older
drugs, with outcomes that are more favorable and fewer side effects.
However, as personal injury lawyers in
search of plaintiffs have begun buying newspaper ads and establishing
websites, the lawsuits, at best premature, are becoming better
known than the facts.
When vulnerable schizophrenia patients
read about the lawsuits, they can become prone to halting their
medication, causing harm to themselves and possibly to others.
Failure to take medications at all or regularly already is a
huge barrier to schizophrenia treatment, and news about lawsuits
Meanwhile, some cash-strapped state budget
managers, seeking to cut Medicaid costs, are blocking access
to the drugs. Private insurers are doing the same, insisting
that patients "fail" on older, often less effective,
Irresponsible publicity is partly to
blame for the danger that these drugs won't be used to best advantage.
Newspaper ads and web sites essentially are implying what science
itself does not yet know and may never conclude: that the drugs
negligently increase a patient's risk of developing diabetes.
For decades, long before the advent of
antipsychotic drugs, science has recognized that people with
schizophrenia are two to four times more likely to develop diabetes
than the general population. What isn't known is why.
Can the disease itself somehow be causing
diabetes? Are lifestyle factors involved? Could genetic predispositions
be the trigger? Or, as a few inconclusive studies now speculate,
is the diabetes link related to medications?
Tough questions that should be settled
by scientists and doctors, not by lawyers in search of big checks.
Schizophrenia patients are already among
the most difficult patients to treat. Many struggle simply to
survive, sometimes living on the margins of society or mired
The public debate so far has been dominated
by inadequate science. None of the reports linking the drugs
to diabetes stem from the gold standard of clinical science:
double-blind, randomized, long-term research trials in large
populations. Still, the results made headlines.
Psychiatry isn't about leather couches
and pipe-smoking. Today, the top doctors in the mental health
profession must call on a host of divergent skills to tackle
confounding issues that involve politics, ethics, economics and
the law as much as medicine itself.
Psychiatry is far more nuanced than lawsuits
can lead you to believe. While lawyers might claim that an effective
treatment should instantly be tossed aside because of possible
side effects, doctors seek to tailor the best solution for individual
patients from competing alternatives.
While we wait for science to speak definitively
about the diabetes link, a partial solution to the current dilemma
is to make routine screening for diabetes a part of what's called
"standard of care" for schizophrenia. That means it
would be an automatic part of the diagnosis and treatment regimen
provided to all schizophrenia patients.
Another solution is a partnership between
the medical establishment and the Food and Drug Administration
to produce definitive, top-notch research to resolve where the
diabetes link truly lies.
Other measures are right-before-your-eyes
easy, such as providing warning labels with the medications.
Patients, of course, read. Including patients in the framework
of solutions is deceptively simple -- and effective.
It is crucial that we keep these two
terrible diseases in their proper perspective. Though it affects
fewer people than diabetes, schizophrenia is a grave illness
that can engulf the entire lives of not just patients, but family
members. It must be treated as effectively as possible.
Going to court in the absence of solid
science solves nothing, yet may hurt many.
# # #
Amy Ridenour is president of
The National Center for Public Policy Research, a Washington,
D.C. think tank. Comments may be sent to [email protected].