Selling an illness helps pharmaceutical giant peddle its pill

By Shankar Vedantam

Washington, DC, July 17— To judge by press reports, two years ago Americans began to be afflicted by a little-known malady called social anxiety disorder.

Psychiatrists and patient advocates appeared on television and in print explaining that this debilitating form of bashfulness was extremely widespread but easily treatable. The disorder was referred to just 50 times in American media in 1997 and 1998, but there were more than a billion references to it in 1999, according to a marketing newsletter.

But the stories were not spurred by medical developments.

They were part of a campaign -- coordinated by a New York public relations agency -- that included pitches to newspapers, radio and TV, satellite and Internet communications and testimonials from advocates and doctors who claimed that social anxiety was America’s third most common mental disorder with more than 10 million sufferers.

And about 96 per cent of the stories, said the report in PR News, a marketing newsletter, “delivered the key message, ‘Paxil is the first and only FDA-approved medication for the treatment of social anxiety disorder.’”

The plug for the drug was no accident.

Cohn Wolfe, the public relations agency coordinating the campaign, did not serve at the pleasure of the doctors and patient advocates who participated in the education campaign. Instead, the agency worked at the behest of SmithKline Beecham, the pharmaceutical giant now known as Glaxo SmithKline, which makes the anti-depressant Paxil.

The campaign was supplemented by a multimillion-dollar marketing and advertising blitz. Sales of Paxil, which had been trailing those of Prozac and Zoloft, rose 18 percent last year.

The education and advertising campaigns have raised concerns that pharmaceutical companies, traditionally in the business of finding new drugs for existing disorders, are increasingly in the business of seeking new disorders for existing drugs.

“Pharmaceutical companies who are marketing psychopharmacological treatments have gotten into the business of selling psychiatric illness,” said Carl Elliott, a bioethicist at the University of Minnesota who studies the philosophy of psychiatry. “The way to sell drugs is to sell psychiatric illness. If you are Paxil and you are the only manufacturer who has the drug for social anxiety disorder, it’s in your interest to broaden the category as far as possible and make the borders as fuzzy as possible.”

Blurring the line between normal personality variation and real psychiatric conditions can trivialize serious mental illness, some experts said.

“Some marketing seems to imply that huge proportions of the population need pharmaceutical intervention for relatively common problems, and in the long run, I am concerned that may undermine the credibility of the concept of serious mental illness,” said Rex Cowdry, medical director of the National Alliance for the Mentally Ill, a patients’ advocacy group.

Glaxo SmithKline did not make company executives available for comment despite repeated requests. But doctors and advocates associated with the company’s campaign defended the effort, saying it informed thousands of people who previously did not know they were suffering from the disorder, spurring many to seek needed help.

Although many of the participants said they had served as paid consultants or scientific investigators for the company, they rejected any notion that they were being manipulated. Most said they had spent years toiling on social anxiety disorder and were delighted when SmithKline offered a way to get their message out.

“I know there’s lots of concern about, ‘Are we medicalizing normative things, and is the pharmaceutical industry trying to put SSRIs in the water?’” Mr. Stein said, referring to the class of drugs known as selective serotonin reuptake inhibitors, which includes Paxil. “The people I see talking about that have not seen these patients.”

Patients with social anxiety disorder are not the shy people who hang out at the edges of parties. Those truly suffering from the condition are profoundly debilitated, refusing promotions or taking night jobs because they cannot stand to be around people.

“Would somebody who is not having problems take a medicine that is costly and has side effects?” Mr. Stein asked. “I don’t think too many people would do that. The idea that this is cosmetic psychopharmacology I find offensive.”

The advocacy organizations that participated in the campaign - the American Psychiatric Association, the Anxiety Disorders Association of America and a Long Island-based group called Freedom From Fear - said that the only way for nonprofit groups to get out a potent public health message was to team up with a pharmaceutical company with deep pockets. Moreover, the groups demanded and received full control over the editorial content of the education campaign, said John Blamthin, a spokesman for the American Psychiatric Association.

“We have never, ever promoted any drug,” said Jerilyn Ross, the founder of the Anxiety Disorders Association of America. “If you look at our materials and on our Web site, we have never mentioned a drug.”

But if the experts did not want to be boosters for Paxil, the arrangement with the public relations firm - and the Paxil marketing campaign, which offered journalists interviews with some of the same experts - made that confusing. Cohn Wolfe said in its calls to the media that it spoke on behalf of doctors and nonprofit groups - not mentioning the pharmaceutical company paying the bill.

The Cohn Wolfe Web site, however, made no secret of the fact that it was in the business of marketing, not public health: On a previous campaign to promote coverage about the 10th anniversary of the introduction of Prozac in Britain, the agency said it had helped the drugmaker Eli Lilly influence the coverage. The strategy? Offer journalists interviews with “independent Key Opinion Leaders” - doctors, advocacy groups and patients with “suitable debate.”

Cohn Wolfe declined to talk about its role in the Paxil campaign Marcia Angell, a former editor of the New England Journal of Medicine, said pharmaceutical companies could not be expected to act solely in the interest of public health. “They are no more in the business of educating the public than a beer company is in the business of educating people about alcoholism.”

The expensive ad and education campaign paid off in the crowded anti-depressant market. Glaxo SmithKline’s 2000 annual report told shareholders the drug “became No. 1 in the US selective serotonin reuptake inhibitor market for new retail prescriptions in 2000.”

Barry Brand, Paxil’s product director, told the journal Advertising Age: “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder.”

The campaign claimed that more than 10 million Americans suffered from social anxiety disorder, making it the most common mental disorder after depression and alcoholism - and that 13 percent of Americans were affected by it. But the National Institute of Mental Health says only about 3.7 percent of the US population has social anxiety disorder. The American Psychiatric Association says rates vary between 3 percent and 13 percent.

And although the campaign mentioned a psychological therapy called cognitive behavior therapy, it did not stress that the therapy was as effective as medication, had no side effects and did not require patients to stay in treatment indefinitely.

“In my opinion, social anxiety is not a chemical problem with the brain,” said Jonathan Abramowitz, a psychologist at the Mayo Clinic in Rochester, Minnesota. “I see it as a problem with normal thinking and behaviors that have gone awry.”

Source: Washington Post

Spies in the sky keep track of ex-cons on the ground

By Susan Clary

July 4— There is no privacy for some of Florida’s convicted criminals. They cannot make trips to the grocery store, fill their cars with gas, travel to work or attend church without someone knowing about it.

A state employee follows their every move — around the clock — on every street corner.

These men and women, mostly sex and violent offenders, were released from jail on the condition that they be monitored closely. To do that, the state has turned to satellites — once used solely to track cars, animals and prime fishing spots.

Florida is a pioneer in the use of the Global Positioning System — better known as GPS — to supervise lawbreakers released on community control or probation. Today, the state is watching almost 600 people.

In Broward County, 62 people are tracked by GPS. There are 17,000 people on probation or parole. Of those, about 700 are on community control. Donald Monroe, who runs the program in Broward, said he is anxious to expand GPS tracking.

“We can track them anywhere within the county,” he said. “We can pinpoint an offender at any point in time. If he’s driving down [Interstate] 95, it can tell you how fast he’s driving.

“The reason we track is we want to know where they’re going,” he said. “We want to know the hot areas.”

With GPS, a small box the offender carries is monitored by satellite and sends a signal every 10 minutes to a computer.

The system pinpoints the location of the offender — right down to the street corner. It can track a person even from room to room in a house. Most offenders are on the program for two years.

The computer can be programmed with the person’s home and work addresses, and the usual route between the two locations. If the offender deviates from the route, tries to remove the bracelet, loses the box or breaks it, a page is sent to the offender’s probation officer.

Larry Spaulding, counsel for the American Civil Liberties Union, said the privacy argument is diminished considerably in the criminal justice system. The public has little sympathy for lawbreakers who don’t like the intrusion or say they are embarrassed. He thinks GPS is the wave of the future.

“In the field of privacy, we are slowly giving away more rights and slowly becoming conditioned,” Spaulding said. “No one is shocked anymore to go to a public facility where they use cameras.”

GPS monitoring was launched in Florida in late 1998 and is now used in 18 of 22 judicial circuits, including Palm Beach, Broward and Miami-Dade counties. Two other states, California and Kansas, have followed Florida, while Texas and South Carolina have expressed interest.

Source: Orlando Sentinel

NY policy of jailing protesters on minor crimes revoked

By William K. Rashbaum

July 14— Facing two civil rights lawsuits, the New York Police Department yesterday rescinded a two-year-old policy under which people arrested for minor offenses at protests were jailed overnight rather than given summonses to appear in court later.

A lawyer who filed one of the lawsuits said that as many as 1,000 people may have been jailed under the policy. Both suits, filed in Manhattan federal court, argued that holding people overnight after such arrests violated their civil and constitutional rights because it treated demonstrators more harshly than others arrested for the same offenses.

Lawyers in both cases argued that the policy was intended to discourage people from exercising their First Amendment rights - a charge city officials denied.

“The unmistakable message that is sent by this policy is that people who demonstrate risk spending the night in jail because of their part in a demonstration,” said Christopher Dunn, a lawyer for the New York Civil Liberties Union, which brought one of the lawsuits. “And I think what follows from that is that it is a clear effort to discourage people - and indeed punish people - from participating in demonstrations.”

Jonathan C. Moore brought the other lawsuit, which seeks to represent everyone arrested under the policy as a class of plaintiffs. Moore praised the decision to withdraw the policy but said that people who were wrongly jailed should be compensated.

The Police Department yesterday referred inquiries about the change to the office of Corporation Counsel Michael D. Hess, who is defending the department and the city in the lawsuits. Daniel S. Connolly, special counsel to Hess, said the policy was intended to discourage crime, not lawful protest, and he denied that the change was an admission that the practice was unconstitutional.

He said the decision, which came after a review prompted by the lawsuits and was made by the Police Department in consultation with his office, was an effort at “balancing people’s First Amendment rights with issues involving public safety.”

Yesterday, the Police Department notified commanders of the change with a single-sentence message.

The policy was informally started in the spring of 1999 under former Commissioner Howard Safir, who is named in one of the lawsuits. At the time, daily protests over the shooting of Amadou Diallo choked the wide red brick plaza in front of police headquarters, where the chanting demonstrators became a fixture on newscasts. For reasons that remain unclear, the policy was not formalized until May 1, 2001, in a brief message to police commanders.

It represented a significant change in handling arrests at peaceful protests and demonstrations. In the past, those arrested for offenses like disorderly conduct and obstructing governmental administration, both misdemeanors, would get a summons, known as a desk appearance ticket, to appear in court at a later date.

Source: New York Times

Financial aid denied for students with drug convitions

By Arlene Levinson

July 15— A ban on giving federal aid to college students with drug convictions could mean more than 34,000 people will be denied loans and grants in the coming school year — more than triple those turned away in 2000-01.

The increase reflects a clarification in the US Education Department’s aid application, which screens for people with drug records. But the change has brought louder protests against the law; even the measure’s author says enforcement has been taken too far.

US Rep. Mark Souder, an Indiana Republican, intended the aid ban to apply only to college students already getting loans or grants when convicted, an aide said. Instead, education officials in the Clinton administration and now under President Bush are denying aid to people with previous drug convictions.

US Rep. Barney Frank, D-Mass., has introduced a bill seeking the law’s repeal. Repeal is also the aim of Students for Sensible Drug Policy and its 140 campus chapters.

The law is “fundamentally flawed,” and amounts to “double punishment” — and bias — against low-and middle-income students who must undergo screening while their wealthier peers do not, the head of the American Council on Education wrote in May to US Rep. Asa Hutchinson, R-Ark. Hutchinson is Bush’s nominee to run the Drug Enforcement Administration.

The law, which was approved in 1998, bars federal grants, work-study money and US-backed and subsidized student loans to any students convicted of selling or possessing drugs.

Source: Reuters

Web portal censors gay e-mails claims activist

July 12— A new internet portal offering users “safe” web access came under fire today when transgender rights campaigners accused the service of homophobia.

The accusation was made after Dani Jackson, an activist with transgender rights group Press for Change, discovered that e-mails sent from the new site, V21.co.uk, erased words related to homosexuality.

“They claim to offer safe internet access with screening for lewd and rude content,” said Jackson.

“In reality, they are practicing ridiculous censorship, rooted in homophobia.”

According to Jackson, users who have utilized the site’s e-mail service have found that when e-mails reach their destination the word ‘gay’ has been changed to ‘friend’ and ‘lesbian’ becomes ‘girl.'

“It would be comic if the underlying issue was not so serious,” said Jackson.

“Viewing the very terms lesbian and gay as either rude or lewd and subject to removal and substitution is a totally unacceptable homophobic practice. Many other everyday words clearly go the same way regardless of context,” said Jackson.

Press for Change are now urging people to challenge V21 by e-mailing them about the issue.

Source: www.gay.com