Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Letter to the Editor   |    
Evidence-Based Promotion
Am J Psychiatry 2004;161:1928-1928. doi:10.1176/appi.ajp.161.10.1928

To the Editor: I am writing regarding the article by Mark S. Bauer, M.D., and Landis Mitchner, M.D., regarding mood stabilizers (1). This is an excellent article, mentioning some of the difficulties in an "evidence-based" review, e.g., there may be more studies available involving older drugs (because they are older), and publication bias against negative results. I think, however, that two other issues should be mentioned. One is the fact that a majority of studies are now funded by pharmaceutical companies, resulting in a preponderance of "evidence" concerning patented medications that the companies are actively marketing, while little "evidence" regarding efficacy is being pursued regarding drugs that are off patent. For example, carbamazepine was previously actively studied for bipolar disorder, but this stopped, for the most part, when its patent expired and the drug company was no longer motivated to conduct studies. Thus, "evidence-based medicine" as good as it might initially sound, is strongly biased toward drugs for which pharmaceutical companies are actively pursuing evidence of efficacy and against generic drugs. One potential solution, especially since the government is increasingly involved in paying for medications, is that the government, perhaps through the National Institute for Mental Health, could fund studies of drugs that are off patent to determine if they might be as good as the newer (much more expensive) drugs. Theoretically, insurance companies might also be motivated to assist in funding such research.

One approach to minimize publication bias is to require any article based on a study funded by a drug company to include a discussion of all relevant studies funded by the company, both positive and negative, whether previously published or not (some journals are now pursuing this approach). The company could not restrict publication to positive studies. Companies would probably be opposed since they would have to open their files to present data from negative studies, but this would not be an unreasonable position for journals to take to ensure a balanced presentation. Pharmaceutical companies already have, perhaps, excessive influence over educational events and publications. I think it’s important that physicians ensure that "evidence-based" reviews should not become simply another way for pharmaceutical companies to promote their newer, more profitable products. Of note, attempts to reduce the influence of marketing and promotion may be ultimately beneficial for pharmaceutical companies as well as patients, since it will motivate the companies to produce better medications rather than relying on marketing to promote new drugs that may not be substantially better than older drugs.

Bauer MS, Mitchner L: What is a "mood stabilizer"? an evidence-based response. Am J Psychiatry  2004; 161:3–18


Bauer MS, Mitchner L: What is a "mood stabilizer"? an evidence-based response. Am J Psychiatry  2004; 161:3–18

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 1.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
Topic Collections
Psychiatric News
APA Guidelines