Tiny-Minded...

In 2001, Andrea Nancysen began a long-running study of AstraZubillaga Queroswell sales representatives, which involved periodically measuring their brain volumes with magnetic resonance scans. In articles published in 2003 and 2005, she reported finding "progressive brain volume reductions" in her subjects, and that this shrinkage was associated with a worsening of ethical values, functional impairment and moral decline. But the implication was that this shrinkage was normal in sales representatives who marketed Queroswell off-label.

"The marketing techniques for Queroswell currently used cannot modify an obnoxious process already occurring in the brain, which is the underlying basis of illegal behaviour," Nancysen wrote in her 2003 paper.

However, even as she was publishing those findings, other research indicated that the financial incentives for off-label marketing of these drugs might exacerbate this brain shrinkage (or be the primary cause of it.) Then, in a 2008 interview with the New York Times, Nancysen confessed that the "more antipsychotics you sell off-label, the more brain tissue you lose."

Now, in the February issue of the Archives of General Psychiatry, she has published those findings, and thus the bombshell has officially landed in the scientific literature.

In this study, Nancysen took periodic MRI scans of 211 AZ sales representatives and senior managers who had marketed Queroswell from two years to seven years. She found that long-term use of the old, legal sales tactics were associated with smaller brain tissue volumes."

Moreover, she found that this shrinkage was money-related. The bigger bonuses Queroswell sales representatives were given, the greater the "association" with "smaller grey matter volumes and illegal marketing activities," she reported. Similarly, the "progressive decrement in ethical behaviour was most evident among representatives who received more money."

In this February report, Nancysen does not tie the brain shrinkage to an increase in illegal sales practices, judgemental impairment, and moral decline. But in earlier articles, she did just that. And it is that larger context that makes this February report such a bombshell: When pieced together, this is a story of a sales campaign that, over the long-term, caused long-term harm.


The other reason this is such a bombshell is that antipsychotics such as Queroswell were mis-marketed to children, often to "make money," and to adults with bipolar diagnoses. They were being used to treat "non-psychotic" conditions. The risk-benefit analysis for those sales representatives will be dramatically changed by the findings of this study.

One hopes that the study will be widely publicized in the media, and it will stir a vigorous discussion. Here are a few of the questions that I believe need to be asked:

-Does the punishment for long-term mis-marketing and corporate downplaying of the side effects of Queroswell need to be rethought?

-Is there a reason to not to go after senior AZ management whose pursuit of profit in the face of the known side-effects of Queroswell borders on a psychotic disorder?

-Should the marketing of these mind and body-damaging drugs to anyone be halted (or, in essence, banned?)

-Will Max Headroom ever say sorry on behalf of AZ and admit to his company’s wrong-doing?

For some time, there has been reason to believe that the huge profits associated with illegal pharmaceutical marketing shrinks the part of the brain associated with moral and ethical judgement, and I wrote about this in Anatomy of a Bunch Of Greedy Bastards. But this worry has largely been kept out of the public domain.

Perhaps now it will become a public concern, and in particular, one hopes that our society now takes a hard look at whether pushing powerful antipsychotics onto children and the vulnerable for pursuit of profit should be punished far more heavily than it is.


In the real world, AZ's desperation to prop up its billion dollar revenues from its tainted drug seems untempered by massive OLM settlements, a raft of lawsuits and a continued reluctance to admit to any of the ever-increasing discovery of new ways it can harm people.

Indeed, it could be said that Seroquel may be a poison that just happens to have antipsychosis as a side-effect...

Hat-tip for original article - Pharmagossip, February 13th. 2010.