I know why legislation was passed severely restricting how drug companies from wining and dining doctors. Because it’s AWESOME when they do. Granted, I am a poor case manager, so getting free stuff is a pretty big deal, where a doctor who’s paid off their school debt and living large might not be so easily swayed, but still? The makers of Latuda invited all the staff at our site- including us lowly case managers- to a very posh restaurant. They had a modified menu we ordered off of so I have no idea how much it cost, but I’m reasonably certain it was at least $50/plate. I can completely see how easy it would be to jump in a drug maker’s pocket and make yourself at home.
At any rate, they had a presentation about four drug studies on Latuda, and how it fared in short-term studies. It was a live feed, and evidently there were reps all over the country with groups from various agencies all watching. It was also REALLY BORING. It was mostly the stodgy stuff about what specific receptors were activated and at what percentage, and it was all about four short-term studies. And by short-term, I mean six weeks.
Six weeks? In a chronic lifelong illness? Sure, it showed a lot of efficacy in that short amount of time, but that’s seriously all they’re bringing to the table? I need to know about long-term tolerability trials! I need to know how it stacks up against other antipsychotics to be able to tell my clients if their side effects are merely annoying but temporary, or if it’s something that’ll likely never go away, and get them switched as quickly as possible. I work with people who are sicker than I am and they have terrible insight into their illnesses. If there’s the slightest hiccup in their lives it’s immediately blamed on the medication and they quit taking it. (It’s sort of like that Bear Grylls meme, with the default being “better quit my medication,” no matter WHAT is happening in their lives. I swear my clients look for the most bizarre excuses they can think of.)
Anyway, we were all pretty bored of listening to the old white guys drone on about all the parts of the drug studies we don’t particularly care about. I’m not a research psychiatrist. I’m a case manager, and at most I’ll become a clinical psychologist. Knowing the specific receptors activated is not really something that means much to me, other than in a “huh, that’s sort of interesting” way, and it means negative nothing to the people I work with day in, day out.
We did get to call in questions, and my team’s nurse did get his answered. He asked why they only did six-week studies. The answer? “We weren’t looking at long-term tolerability yet, and six weeks was adequate to look for short-term efficacy.”
Of course you were.
Sometimes I wish the folks developing the medications had a clue about how it all works in real life. A six-week trial is nice to make sure the drug works, sure, but the immediate next step should be long-term studies. Something that’ll help someone stabilize while in the controlled setting of the hospital is not very useful if it does nothing once that person’s out in the community, missing most of their doses despite our best efforts, either through losing the meds, cheeking it when we observe them, or completely disappearing off the face of the earth when it comes time for us to do meds…
At least the food was fantastic, and I had a great time hanging out with coworkers in a place none of us could afford. I’ll just be holding out on singing the praises of the medication until I see some long-term tolerability and compliance studies on it.