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A reformed MD drug rep examines anti-depressants

        Dr. Daniel Carlat has written about his year as a drug rep on behalf of Wyeth.  He is a psychiatrist who was courted to persuade other physicians to prescribe Effexor XR as a treatment for depression.  Carlat explained that between fancy conferences in New York City (with theater tickets, haute cuisine, etc., and a $750 honorarium) and weekly medical lunches with potential prescribers ($500.00 or $750.00, depending on whether he had to drive an hour), he had supplemented his $140,000.00 private practice income with an additional $30,000.00 from Wyeth.   Not an insubstantial annual salary enhancement.

          Carlat explained that at first, he relied on metastudies which suggested that Effexor was ten percent more effective than serotonin reuptake inhibitors--the more common antidepressant--in achieving remission, and was completely comfortable serving as a salesman for Wyeth.  Over the course of the year, however, he studied the issue more carefully and learned that Effexor had originally been compared only with Prozac, and was only five percent more effective than other SSRIs when compared with SSRIs other than Prozac.  He was equally troubled by data showing that it was often very difficult to withdraw from Effexor--a serious issue when caregivers take into account the high likelihood that a particular drug regimen will need to be tweaked to achieve a response.  In addition, Effexor caused problems with high blood pressure fifty percent more often than SSRIs did.  Carlat began to wonder whether it made sense to prescribe a marginally more effective anti-depressant that would be more likely to cause problems with high blood pressure and be difficult to switch or withdraw.

          Ultimately Carlat gave up his $500 dollar lunches when he began to feel intellectually dishonest and recognized that the Wyeth salespeople who accompanied him to the doctors' offices would not retain him if he gave up his role as a cheerleader for Effexor.  When he honestly displayed equivocation on legitimate issues, his Wyeth companions made their displeasure clear immediately.  And Carlat used his free time to began producing a pharmacological newsletter that reflected his own opinions without editing--or support--from drug manufacturers.  He is on the faculty at Tufts and his newsletter is called the Carlat Psychiatry Report.  We hope the satisfaction he feels as a result of practicing intellectual honesty makes up for the income he sacrificed.

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