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Big Pharma Gone Wild

How Risperdal, a drug meant for treating rare psychiatric disorders, became the seventh best-selling medicine in the world.

The e-mail did not beat around the bush.

"The rationale of this center," Christine Cote, vice president of Janssen's Medical Affairs, wrote about the planned MGH-Johnson & Johnson Center for the Study of Pediatric Psychopathology at Massachusetts General Hospital, "is to generate and disseminate data supporting the use of risperidone in this patient population."


But even as postmortems are performed on the unholy alliance between Massachusetts General Hospital and Johnson & Johnson, which surfaced last year, the drug giant is at it again.

In January, Janssen Pharmaceutica N.V., a unit of Johnson & Johnson, announced it was funding a research venture at Vanderbilt University in Nashville, Tenn., to discover "novel drugs for the treatment of schizophrenia," to be led by Jeffrey Conn, former head of Merck's department of neuroscience.


Of course you can't blame J&J for seeking new academic stomping grounds. Its chief academic cheerleader, Harvard child psychiatrist Joseph Biederman, who headed its center at Mass Gen, has been benched for apparent psychopathology-for-pay schemes under which he increased the diagnosis of pediatric bipolar disorder fortyfold.

Janssen is being sued by Texas, New Mexico and other states for hiding Risperdal dangers, marketing it for unapproved uses, ghostwriting, misleading doctors, falsifying science, kickback schemes and wholesale Medicaid fraud.

And -- Risperdal's U.S. patent expired in 2008!

Risperdal (risperidone), an atypical anti-psychotic, may have contributed to the deaths of 31 children since its 1993 approval according to the New York Times -- including 11 treated for unapproved uses. It may have squandered millions of tax dollars, but it is a branding success story.


How else do you explain a drug for schizophrenia (1 percent of the population), bipolar disorder (2.5 percent) and autism-related irritability in children 5 to 16 years old (less than 1 percent of kids) becoming the seventh best-selling pharmaceutical in the world in 2007?

Of course, some of Risperdal's success came from the award-winning "Living Nightmares" campaign by London ad agency Junction 11, which used Welsh artist Mark Moran's evocative oil paintings "Dog-Woman," "Witches," "Rotting Flesh and Boiling Rain" -- get it? -- based on case histories to "own the relapse/prevention space" as art director John Timney put it.


And don't forget the "Prescribe Early" campaign by ad agency Torre Lazur McCann, which used a macabre abandoned wallet, teddy bear and keys on a barren street to "to reposition a drug that was being used too late to achieve its maximum benefits" -- look what happens when you wait! -- according to Pharma Times magazine.

Nor did the continuing-medical-education courses like "Individualizing ADHD Pharmacotherapy with Disruptive Behavioral Disorders" taught by the J&J-funded Robert L. Findling and referring to Risperdal/risperdone 13 times hurt. Credit was available until 2009.

But most of Risperdal's success comes from the unsung doctors -- you know who you are -- who extolled the drug for unapproved use in pediatric bipolar disorder, ADHD, depression, "agitated, expansive, grandiose" "psychopathologies" [per Biederman], Alzheimer's, jealousy, "oppositional" disorder, borderline states, assorted neurological diseases, sleep and mood disorders and whatever else would stick to the wall.

Like the doctors who upheld the "long-term safety and effectiveness of risperidone for severe disruptive behaviors in children," on the basis of a one-year study in the Journal of the American Academy of Child and Adolescent Psychiatry in 2005. Hello?

How else could a drug known to cause diabetes, obesity, breasts in men, lactation in women and the very tardive dyskinesia it was supposed to prevent be a first-choice drug in state formularies and on Medicaid protocols? Given to children?