Did Eli Lilly cover up antipsychotic dangers?

The New York Times has obtained documents suggesting that drug company Eli Lilly deliberately tried to cover up life-threatening side-effects of one of its most widely used antipsychotic drugs – known as Zyprexa or olanzapine.

Antipsychotic drugs are largely used to treat hallucinations and delusions and seem to have their main effect by blocking ‘D₂‘ dopamine receptors in the mesolimbic pathway of the brain.

Antipsychotics are far from perfect. They all have serious side-effects and don’t seem to help about 25% of psychotic patients.

Nevertheless, as the first effective treatment for psychosis they are one of the most significant advances in the history of psychiatry.

The newer generation of antipsychotic drugs, called ‘atypical antipsychotics’, of which olanzapine is one, were originally marketed as having fewer side effects than the first generation ‘typical antipsychotics’.

However, it is now clear that the newer drugs don’t seem to have less side-effects, just different ones.

Instead of producing a Parkinson’s disease-like movement disorder (a big problem with the older antipsychotics), the newer medications are more likely to increase the risk of diabetes, heart disease and obesity.

In short, atypical antipsychotics make you fat, often dangerously so, and olanzapine is thought to have one of the strongest weight-gain effects.

So the fact that olanzapine has side-effects is not breaking news.

What is new, however, is that Eli Lilly seem to have known about these side-effects before they were common knowledge while simultaneously attempting to play-down and obscure them through marketing.

In 2002, for example, Lilly rejected plans to give psychiatrists guidance about how to treat diabetes, worrying that doing so would tarnish Zyprexa’s reputation. “Although M.D.’s like objective, educational materials, having our reps provide some with diabetes would further build its association to Zyprexa,” a Lilly manager wrote in a March 2002 e-mail message.

But Lilly did expand its marketing to primary care physicians, who its internal studies showed were less aware of Zyprexa’s side effects. Lilly sales material encouraged representatives to promote Zyprexa as a “safe, gentle psychotropic” suitable for people with mild mental illness.

This has only come to light because lawyer James B. Gottstein gave The New York Times internal documents that Eli Lilly originally released to someone else on the condition they wouldn’t be made public.

Despite their problems, psychiatric drugs are a valuable treatment for mental illness.

Unfortunately, as a number of recent exposés have highlighted, the drug industry is rife with spin, cover-ups, dodgy data and questionable marketing strategies.

This makes it difficult to make a reasonable assessment of the costs and benefits of these drugs for both working psychiatrists and the general public.

We can only hope that in the future pharmaceutical companies will be more honest about the negative effects of their drugs as well as the positive, meaning better treatment for all.

In the mean time, No Free Lunch is a campaign group asking doctors not to take drug company gifts and to take a critical look at corporate promotion.

Whether you’re a clinician or consumer, their web site has plenty of research and material which is an effective antidote to healthcare hype.

Link to NYT article ‘Eli Lilly Said to Play Down Risk of Top Pill’ (via TWS).
Link to No Free Lunch.