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James Brody
July 10th, 2005, 06:27 PM
Microsoft gained a reputation: "Release X.0" became a joke because earlier versions of Windows were sometimes buggy. Billy Gates used his customers as probers and testers for whatever he had to sell.
Squeezed between investors and lawyers and European competitors, pharmaceutical companies do the same thing: sales representatives give samples and pamphlets to networks of psychiatrists. After all, word-of-mouth, played by network rules, is more effective than magazine ads. Build an alliance with one well-established physician and others will follow. (See Barabasi, "Linked," for more examples.)
The manufacturers also hedge their gambles:
1) They follow exploratory strategies (Gerhardt & Kirschner, 1997) That is, find something that works and make some minor changes to it. Histamine, for example, was not only an early sedative but also the parent of chlorpromazine (Baldessarini, ) and a dozen similar molecules that helped psychotics to be more accepting of their psychoses and less obnoxious when applying them on the rest of us.
2) There is a tremendous overlap in medication outcomes. That is, either lithium or some half-dozen anticonvulsants prevent extreme mood swings in lively minds. According to Baldessarini (author of more than 800 papers on antipsychotic medications), "adding lithium to an antidepressant is a powerful move." And "Haldol (an antipsychotic) shoots a lot of manics out of the sky." Another example: the benzodiazepines (Ativan, Valium, or Ambien) relieve anxiety and induce sleep for many individuals. But so will an anti-itch called Benadryl!
Psychiatrists now give novel medicines that scare the general practitioner and patients get bumped over when the gp or his nurse practitioner have no luck with last year's potions. General practitioners often, however, renew recipes created by psychiatrists and with little guilt. (Oddity: psychiatrists are the lowest-paid speciality and least-liked: many of them do "medication checks" that can be take from 3 minutes to an hour. Patients complain that the former number is more frequent than the latter: either way, the fee is the same.
Evolution continues...

References:
Brody, J. (2001) Evolutionary recasting: ADHD, mania and its variants. Journal of Affective Disorders. 65: 197-215.
Brody, J. (2004) Bipolar disorder: self-interested networks, cycling, and their management. In M. Brown (Ed.) Progress in Bipolar Disorder Research. Hauppage, NY: Nova Science Biomedical Series, pp. 33-64.
Raff, Rudolf (1996) The Shape of Life. Chicago, IL: University of Chicago Press.

Copyright 2005, James Brody, all rights reserved.