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Tandon said he selected experts who are knowledgeable, respected leaders in their field, with a working knowledge of the medication guidelines process. Because most experts have ties to the pharmaceutical companies, Tandon said, conflicts of interest are inevitable.
"There are clear conflicts of interest," he said. "Everyone is biased. For someone to say, 'I'm not biased,' they are not truthful or they are not introspective."
Given that there is a divide in the academic world about atypicals, why not bring in someone from the other camp, maybe somebody from the CATIE study, someone who would challenge the existing medications model?
"You could go with extremes," Tandon said. "I didn't think that was the way to go," because the point of the process is to reach a consensus.
Atypicals are usually better, he said. "Were the benefits of atypical medications exaggerated? Absolutely. And was it the pharmaceutical companies doing that? Absolutely."
Still ... "By no means are the newer medications astoundingly better, but they are better. If I have a child, I'm not going to start them on a typical."
More than a dozen Florida mental health officials sat on the committee, many of them adamant that the newer drugs generally offer a better alternative to the older ones. They said they feared that if they put the older drugs alongside the newer ones as front-line options, HMOs might require them to go with the cheaper option.
To treat schizophrenia, the previous expert panel had made atypicals the first and second options. For the third option, doctors were left to decide whether to try a third atypical.
This time around, the group kept atypicals the first option. As a small nod to CATIE, the group voted on a recommendation that if that first atypical failed, a doctor should try either a second atypical or an older-class, typical drug.
Asked for a show of hands, all were raised in favor.
Part 2...
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