The Media and Mental Illness
Recent coverage of a major study on antipsychotic drugs revealed more about media biases than it did about the study.
On September 22, 2005, a landmark study on antipsychotic drugs, funded by the National Institute of Mental Health (NIMH), was published in the New England Journal of Medicine. Known as CATIE, short for the Clinical Antipsychotic Trials of Intervention Effectiveness, the study compared the effectiveness and side effects of five medications, including one older medication, that are used to treat schizophrenia.
“The study, which included more than 1,400 people, supplies important new information that will help doctors and patients choose the most appropriate medication according to the patients’ individual needs,” said the NIMH news release on CATIE.
Principal Investigator of the study, Jeffrey Lieberman, M.D., Chair of the Department of Psychiatry at Columbia University’s College of Physicians and Surgeons and director of the New York State Psychiatric Institute, said in Psychiatric News, “The Phase I findings indicate that ‘all these medications work, but they also have substantial limitations.’”
The general news media coverage of the study framed the issues far differently than the study scientists intended. A scan of the articles in various mainstream publications recalls the blind men describing the elephant. Each blind man only touches one part of the animal, and so each describes a wildly different creature. Similarly, the articles on the study gave no picture of the whole.
They reported selectively on narrow aspects of the results, deluging the public with conflicting interpretations. Some articles said the drugs worked; some said they didn’t; some articles attacked the efficacy and cost of the newer, “atypical” antipsychotics, praising an older, less expensive “typical” antipsychotic as effective.
“Schizophrenia Drugs Work Poorly, Study Suggests,” reported the Boston Globe, while an AP story in The Philadelphia Inquirer had as its headline, “Older, Cheaper Schizophrenia Drug Fares Well in Major Study.”
The headline in the Chicago Tribune characterized a lot of the coverage that focused on costs: “New Schizophrenia Drugs Test No Better Than The Old: Billions Wasted On More Expensive Medication, Unusual Study Finds.” A New York Times editorial warned, “The nation is wasting billions of dollars on heavily marketed drugs …” Much of the coverage followed this same pattern, strongly implying that healthcare policy makers would be smart to go with a cheaper, older antipsychotic drug.
Many professionals in the mental healthcare community, professional organizations and consumer advocacy groups were quick to respond, expressing worry and even anger over what they saw as distortions of the CATIE findings.
“The National Council believes that the national media has been reporting on the results of CATIE in a misleading light, indicating that the newer antipsychotics are no better than older cheaper ones,” wrote Linda Rosenberg, president and chief executive of the National Council for Community Behavioral Healthcare (NCCBH), in Mental Health Weekly. “What the study does,” she continued, “is present a body of evidence for clinicians to consider in prescribing the most appropriate drug for each patient.”
“Misleading press coverage of an ongoing national Institute of Mental Health study comparing schizophrenia drugs could lead to new regulations that would make it harder for Medicaid and Medicare patients to get the medications they need…,” wrote John Reichard in CQ Health Beat, a federal policy Web site owned by the Congressional Quarterly.
The focus on drug costs without including any larger perspective was particularly distorting, like the blind man who holds the elephant’s trunk declaring an elephant to be like a snake. “When figuring drug costs, you have to pit those costs against the far higher costs of going to the hospital,” said Jerry Maguire, M.D., a CATIE investigator and advisor to this publication (he also has research grants through Lilly, Pfizer, Novartis and a grant application with Wyeth).
“The average cost of a psychiatric in-hospital stay is anywhere from $500 to $1,000 a day, depending on where you are,” Dr. Maguire continued. “If hospitalization costs drive schizophrenia treatments, then the drugs that are the most effective are those that keep people out of the hospital the longest, as some of the newer, and, yes, more expensive ones do, which makes them the most cost-effective. This important fact is in the CATIE study, yet didn’t appear in any of the coverage.”
The National Alliance on Mental Illness (NAMI), reinforced that point in a letter to The New York Times signed by NAMI’s executive director, Michael J. Fitzpatrick: “Although old- and new-generation medications were found comparably effective, the NIH study noted that the newer schizophrenia drugs appear more efficacious in reducing the negative symptoms like lack of emotion, interest and expression. That is an impact that makes a difference in the level of recovery for many Americans.”
NAMI’s Web site goes further: “The results of Phase I of the CATIE study do not justify the conclusion that there are no differences in the way individuals with schizophrenia respond to the older antipsychotic medications and the newer atypical antipsychotic medications.”
Also disturbing to the mental health community was the fact that not one article interviewed a consumer, the customer for the products. “It’s hard to imagine a reporter writing about different arthritis medications without including an interview with a patient who has arthritis,” Dr. Maguire said. “The most disadvantaged group in our country, people with severe mental illnesses, could, because of cultural bias and skewed reporting, be forbidden from getting the option they may need if price were the only criterion.”
And there were serious sins of omission in most of the mainstream coverage. As the articles discussed efficacy and costs, they usually paid scant attention to the larger framework for treatment well-known to consumers and their caregivers--namely, that drugs, even when they work well to stop psychotic episodes, are never the full story about recovery. Successful drug therapy has to be supported by carefully administered programs of community support in the form of housing, jobs, social interaction with friends and family.
“Drugs are only part of the reintegration story, an important part,” said Ralph Aquila, M.D., executive director of the Center for Reintegration and executive editor of this publication. “But by focusing national attention only on drugs the nation loses sight of the other ingredients necessary for reintegration.
“Americans are left without any information on community support, an exclusion with important implications for public policy. We know that these newer medications may not show their full potential when you don’t factor in “wraparound” services. When you do bring in those other pieces, you start to see greater efficacy in the drugs.”
“If this were about a physical medical condition, there would be more of an uproar,” Dr. Aquila continued. “But because it’s about mental illness, there’s unfortunately a lot of tolerance for bad treatment by the media.”
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