Ten percent of Americans—children, teens and adults—take antidepressants. Whether it’s Prozac, Paxil, Lexapro, Effexor or Cymbalta, 30 million of us take a pill daily in hopes it will keep dark moods at bay. Antidepressants are the most prescribed family of drugs in America, an $11.9 billion market in the U.S. in 2007.
In January, Erick Turner, a professor of psychiatry at Oregon Health & Science University and a clinician at the Portland VA Medical Center, shook up the medical community, provoked the pharmaceutical establishment and, perhaps, disappointed millions of depressed Americans. He published a paper in the New England Journal of Medicine that revealed antidepressants are not as effective as we’ve been led to believe. For years, he implied, pharmaceutical companies such as Pfizer (maker of Zoloft) and Forest Laboratories (Celexa and Lexapro) have vastly exaggerated the performance of their drugs.
Turner calls it the “dirty little secret” of the psychiatric world.
It was a disclosure that was felt ’round the medical world, and for the past two months Turner has fielded press inquiries by the dozens.
Turner’s “is the kind of a paper that makes you wonder why someone didn’t do it a long time ago,” says S. Nassir Ghaemi, an associate professor of psychiatry and public health at Emory University School of Medicine and a leading researcher on bipolar disorder.
“It’s damaging” to the reputation of antidepressants, says Peter Kramer, author of Listening to Prozac and a psychiatry professor at Brown University School of Medicine.
The paper has given Turner not rock-star status, perhaps, but at least a level of notoriety in a profession where physicians typically labor in anonymity. Since the paper’s publication, Turner has become a go-to source for reporters writing about depression and antidepressants.
But more important for Turner is how his work has shaken up the industry and raised questions about the integrity of the pharmaceutical industry and the weakness of the federal regulatory agency that’s supposed to protect the public from drugs that are dangerous or ineffective.
It has also had the effect of raising an uncomfortable question: If antidepressants don’t work that well, why are so many Americans taking them?
The great irony of his discovery is that, for 18 months, Turner pimped for antidepressants. He wouldn’t put it that way, of course, as many doctors do the same thing. But starting in 2004, Turner, who is the
medical director of the Mood Disorders Program at the Portland VA and has worked at the Food and Drug Administration and the National Institute of Mental Health, became a speaker for Eli Lilly, one of the world’s largest pharmaceutical companies.
It’s not unusual in pharmaceutical marketing for doctors to be hired as “consultants”—or members of a company’s “speakers’ bureau” in industry parlance—and then hit the road doing “doctor talks.” These are typically lunches or dinners where area M.D.s are invited by a company to eat and drink while listening to a respected physician describe the benefits of a particular drug.
Lilly approached Turner around the time the FDA was set to approve a new Lilly antidepressant named Cymbalta. He was an especially good catch for the company because, in addition to his academic appointment at OHSU, Turner had spent seven years as a researcher at the prestigious National Institute of Mental Health and another three years as a clinical trials reviewer at the FDA.
“They’re using your reputation and political capital, as it were, as sort of a frontman for the drug,” says Turner, 54.
After training in Indianapolis in the summer of 2004, Lilly sent Turner out into the field in the Northwest, receiving anywhere from $500 to $750 per talk. He says he did about 12 talks for Lilly over the next 18 months.
He says his motivation wasn’t so much the money—he netted less than $10,000—as it was his desire to keep up his reputation as an expert on clinical trials.
“In the beginning, I think I got narcissistic gratification,” he says. “They fly you somewhere else in the country and pick you up in a limo, and you stay in a nice hotel you could never afford otherwise.”
Some critics believe these relationships between industry and doctors—long common in all branches of medicine—are little more than an example of the corrupting influence of Big Pharma and its ability to turn doctors into sales tools.
“The practice of drug companies paying doctors to be their spokespeople is extremely problematic, because it creates a financial incentive for the physicians to intentionally be deceptive in their lectures to other doctors,” says Daniel Carlat, an assistant clinical professor of psychiatry at Tufts University School of Medicine. Carlat himself was once on the dole for Wyeth Pharmaceuticals, makers of Effexor, until he found the arrangement too compromising and quit.
“It provides incentives to tweak the data to tell only part of the truth,” Carlat says.