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Who Do The Drug Companies Cater To?

Tons of press on AstraZeneca and their antipsychotic drug Seroquel, lately, much of it dealing with one Dr. Michael Reinstein, a physician who, by all reports, will have to answer a lot of questions about his patients.
Here are the Cliffs Notes:

Dr. Reinstein is a Chicago physician who specializes in psychiatry. He was lead psychiatrist overseeing one nursing home, Maxwell Manor, which has been shut down for “inadequate care and wretched conditions.” Since then, he has continued his private practice in coordination with many nursing homes. One significant concern that many people have with Dr. Reinstein is that he may be overmedicating his patients—in 2007, he has prescribed medications to 4,141 Medicaid patients. That may not seem like a big deal, but he has single-handedly issued more prescriptions for clozapine (a last-ditch antipsychotic with five black box warnings used to treat schizophrenia) than all doctors in the state of Texas. I’ll let that sink in for a moment. The other side of the coin is that he maintains an improbable, if not impossible, practice. His filings indicate that he would have to work for 21 hours per day, seven days a week to see each of his patients for 10 minutes. Three patients under his care have died of clozapine intoxication, including one who had five times the toxic level of clozapine. Some court cases have been settled, some are continuing.

So, how do the drug companies figure into this? In addition to prescribing clozapine, he was prescribing prodigious amounts of AstraZeneca’s drug Seroquel (another antipsychotic medication, used to treat schizophrenia and bipolar disorder). In fact, he prescribed so much Seroquel (his group was in the top five prescribers in the United States, according to an AstraZeneca employee), and he demanded from AstraZeneca research funding because of their high use of Seroquel, that AstraZeneca bent over backward to accommodate Dr. Reinstein, despite noting that he and his colleagues “are generally held in poor regard among their peers in the greater Chicago area.” AstraZeneca did not want to give funding because his studies were poorly controlled; yet, they prominently featured quotes from Dr. Reinstein on Seroquel literature that served their needs: “In our experience, weight gain is not an issue with SEROQUEL, unlike some other antipsychotic medications.” That’s not what the research shows…

So what did AstraZeneca do to keep his business? They paid him over $490,000.00 over ten years to promote Seroquel. They did not want to alienate a psychiatrist worth up to a half-billion dollars to AstraZeneca.

The real question is whether AstraZeneca should have been concerned about the patients this man was treating. With his track record, people will get hurt (if they haven’t already, and the evidence is mounting on that point). But, AstraZeneca is more inclined to keep his business, rather than educate him to the proper uses of Seroquel—and, I cannot believe that Dr. Reinstein had a half-billion dollars worth of patients with schizophrenia. Clearly, a lot of off-label use was going on, encouraged by AstraZeneca.