11/7/2015

Drugs, Greed and a Dead Boy - The New York Times

http://nyti.ms/1MBlh89

TheOpinionPages

OPEDCOLUMNIST

Drugs,GreedandaDeadBoy
NOV.5,2015

NicholasKristof

AndrewFrancescowasarambunctious,athleticandjoyfulchild,butalsoa
handful.Whenhewas5yearsold,apsychiatristprescribedRitalin.Ashe
grewolder,hedisruptedclassesandwasgivenagrowingnumberofpotent
antipsychoticandothermedications.
Thesedidntwork,sohewasprescribedmore.Pushedoutofone
schoolafteranother,Andrewgrewfrustrated,unhappyandsometimes
alarming.Hisparentshidthekitchenknives.Thenhismotherdiedat54
thefamilybelievesthatthestressofraisingAndrewwasafactor.
WhenAndrewwas15,themedicationscaughtupwithhimandhe
sufferedararecomplicationfromoneofthem,Seroquel.OneFridayhewas
wellenoughtogotoschoolonSundayhewasbraindead.
ThatsthestorythatStevenFrancesco,alongtimepharmaceutical
industryexecutiveandconsultant,tellsinOvermedicatedand
Undertreated,hisharrowingmemoirofraisingAndrew,hisson.Hemakes
clearthatthelargerproblemevenfromhisviewasanindustryinsider
isasectorthatsometimesputsprofitsabovepublicwellbeing.
Heresthecentralissue:Childrenwithemotionalormentaldisorders
havebecomeagoldmineforthedrugindustry.Psychiatricmedicinesfor
childrenaccountforbillionsofdollarsinsalesannually,andthemarkethas

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Drugs, Greed and a Dead Boy - The New York Times

boomed.
Betweenthemid1990sandthelate2000s,prescriptionsof
antipsychoticsforchildrenroseaboutsevenfold.
Andnowtheindustryisgettingevengreedier.ItispushingforaFirst
Amendmentrighttomarketitsdrugsforofflabeluses,apaththatwould
leavechildrenlikeAndrewwithmentalhealthissuesparticularly
vulnerable.Youmaythinkoffreespeechasacitizensrighttodissent
pharmaceuticalexecutivesseeitasatooltomarketdrugsforunapproved
uses.
Twocourtshaveruledforthedrugcompanies.Thatsthetriumphof
anideologythatseescorporationsasvirtuousplayersendowedwith
individualfreedoms,andregulatorsasuntrustworthyLuddites.
TherecentcourtdecisionscoulderodetheF.D.A.approvalprocess
putinplacetoprotectthepublicandthreatenpublichealthandpatient
safety,warnsDr.MargaretHamburg,untilrecentlytheFoodandDrug
Administrationscommissioner.
Expertsonmentalhealthfearthattheserulingscouldleadtoterrible
troublebyconfoundingsciencewithmarketing,saysDr.StevenE.Hyman,
aHarvardexpertonpsychiatryandformerdirectoroftheNational
InstituteofMentalHealth.
Already,80percentofthepsychiatricmedicineadministeredto
childrenisofflabel,Francescoestimates,meaningthattheF.D.A.hasnt
approveditsuseforthatpurpose.Sometimes,offlabelusemakessense,
butitmustbedonewithcare,notjustasaresultofaggressivemarketingby
pharmaceuticalcompaniessimplyaimingtoboostquarterlyprofits.
Children,becausetheirbrainsarestilldeveloping,arenotjustsmall
adults,Hymannotes.
Thepharmaceuticalindustryrepeatedlyhasshownwhyregulation
shouldntbeadirtywordinAmericanpolitics:

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Drugs, Greed and a Dead Boy - The New York Times

Intheearly1960s,manycountriesallowedthewonderdrug
thalidomidetotreatmorningsicknessinpregnantwomen.Aheroicfemale
doctorattheF.D.A.,FrancesKelsey,resistedindustrypressuretoapprove
thalidomideintheUnitedStates,thusavertingthousandsofhorrificbirth
defectslikethoseitcausedabroad.
Inthemid1990s,pharmaceuticalcompaniesarguedthatdoctors
systematicallyundertreatedpain,andasasolutionthemanufacturers
aggressivelymarketedopioids.Thecompaniesbehaviorwassometimes
criminal(executivesofthecompanythatmadeOxyContinpleadedguiltyto
criminalcharges),butalsohugelyprofitable.Thishelpedleadtoacrisisof
addictiontoprescriptionpainkillersandherointoday,drugoverdoseskill
moreAmericansthangunsorcarsdo.
Inarecentcolumn,IrecountedhowJohnson&Johnsondeceptively
marketedanantipsychoticmedicinecalledRisperdal,concealingfor
examplethefactthatitcancauseboystogrowlarge,pendulousbreasts
(oneboydevelopeda46DDbust).J&Jgotcaught,pleadedguiltyandpaid
morethan$2billioninpenaltiesandsettlementsbutalsoregistered$30
billioninRisperdalsales.Theexecutivewhooversawthisillegalmarketing
effortwasAlexGorsky,whothenwaspromotedtochiefexecutiveofJ&J.If
youreapharmaceuticalcompany,crimesometimespays.
Itstrueofcoursethatpharmaceuticalsare,literally,lifesaversindeed,
theymayhavesavedmylifefrommalaria.StevenFrancescosaysthatwhile
onedrugkilledAndrew,anotherseemedtohelphim,althoughhealsosays
thatanimaltherapy,intheformofadog,seemedtohelphimmore.
Childrensmentalhealthinparticulariscomplicated,withdifficulttrade
offs,requiringoversight.
Thinkofcars:They,too,offerahugebenefitbutstillrequirecareful
regulation.
Soifyouagreewithtodayspoliticiansthunderingagainstregulation,
orifyouthinkthatpharmaceuticalcompaniesshouldenjoyafreespeech
righttopeddledrugs,thentalktoafamilyfightingopiateaddiction.Ora

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Drugs, Greed and a Dead Boy - The New York Times

parentofathalidomidechild.OrconsultthegrievingfamilyofAndrew
Francesco.
GailCollinsisofftoday.
Iinviteyoutosignupformyfree,twiceweeklynewsletter.Whenyoudo,
youllreceiveanemailaboutmycolumnsastheyrepublishedandother
occasionalcommentary.Signuphere.
Ialsoinviteyoutovisitmyblog,OntheGround.Pleasealsojoinmeon
FacebookandGoogle+,watchmyYouTubevideosandfollowmeonTwitter
(@NickKristof).
AversionofthisopedappearsinprintonNovember5,2015,onpageA27oftheNewYork
editionwiththeheadline:Drugs,GreedandaDeadBoy.

2015TheNewYorkTimesCompany

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