I read Dr. Henry Nasrallah’s plea for “disruptive” new drugs (“Innovation deficit disorder: Psychiatry needs ‘disruptive’ new drugs,” Current Psychiatry, May 2007) with incredulity. I do not know if Dr. Nasrallah has ties to the pharmaceutical industry, but I do know that only a fierce critic of pharmaceutical companies could credibly suggest that we take steps to make this enterprise more lucrative than it already is. With all due respect, his 3 ideas bore an uneasy resemblance to a corporate lobbyist’s speaking points.
His recommendation that drug companies receive a pass in terms of product liability particularly is outrageous. I shudder to contemplate the consequences of allowing pharmaceutical companies to introduce drugs to the market with no meaningful consequences should they turn out to be unsafe or inadequately investigated.
If our government was not dominated by special interests, we might be able to spend fewer public dollars on medication purchases and more money on research. A properly funded National Institute of Mental Health (NIMH) is quite capable of independently developing innovative drugs without the encumbrance of profit seekers. If we allow the private sector to guide research and development, then we should expect continued recycling of existing treatments—or slightly tweaked versions—to treat exciting newly created niches such as jumpy leg disorder, excessive daytime apathy, and involuntary emotional unavailability syndrome. There are plenty of well-heeled, neurotic people who are eager to spend their money on such maladies, especially if advertised on television.
As Dr. Nasrallah mentioned, we applaud the profitability of high-tech or apparel companies. But there is one key difference: the consumer can choose not to purchase new clothing. Any physician who cannot appreciate this dilemma should be spending more time with patients and less with pharmaceutical representatives.
Douglas F. Steenblock, MD
Staff psychiatrist Iowa Veterans Home
Dr. Nasrallah responds
My editorial critiqued the pharmaceutical industry and its recent lack of innovation, but I understand its need to make a profit—like any other corporation. If a pharmaceutical company is not profitable, it will not invest in research to develop new medications.
Let’s consider the following:
- The pharmaceutical industry is the only U.S. entity developing psychiatric drugs. If we suffocate this industry, our patients might not have treatment options and we could return to locking up the mentally ill as we did before the psychopharmacology era.
- I would love for the National Institutes of Health (NIH) to fund psychotropic drug development, but it will never happen. The budget of the National Institute of Mental Health (NIMH) is approximately $1.6 billion, and the entire NIH budget is approximately $30 billion. To replicate pharmaceutical companies’ CNS franchise, the NIMH budget would have to increase more than 50 fold to approximately $80 to $100 billion per year.
- I did my psychopharmacology post-residency research fellowship in neuropsychopharmacology at NIMH. If pharmaceutical companies did not exist, psychopharmacology researchers, teachers, and clinicians like myself would not be able to conduct research or teach and would not have medications to treat patients. Everybody suffers if we do not have an industry incentivized to “invent” new agents to treat serious mental illness.
- Gaps in knowledge about the biological causes of psychiatric brain disorders make designing and developing new treatments particularly difficult. This is why I suggested a private-public partnership between NIMH and the pharmaceutical industry to expedite progress in discovering drugs to help treat patients with any of the 88% of DSM-IV-TR diagnoses that do not have an FDA-approved drug.
As clinicians and researchers, we must encourage innovations in drug development by any entity for the sake of our patients. At present, that entity is the for-profit pharmaceutical industry.
Henry A. Nasrallah, MD