GPs were trained with Pharmaceutical Company-Funded “Early Psychosis” Training Pack—Now they prescribe 72% of all antipsychotics
An extraordinary 79% of 2-16 year olds taking antipsychotics in 2009/10 were prescribed risperidone, a drug at the centre of multi-billion dollar lawsuits in the US and capable of causing irreversible damage to the nervous system and life-threatening diabetes. The number of children taking antipsychotics overall increased 69% between 2007/08 (5,727) and 2009/10 (9,683), 759 of them in 2010 aged 6 or under. The Citizens Committee on Human Rights (CCHR) said an investigation is needed into the potential conflicts of interest between pharmaceutical companies and psychiatrists writing treatment guidelines and the influence of these on prescription trends.
Concerns have escalated with federal government plans for GPs to screen 3-year-olds for highly subjective mental disorders when already this group has been heavily marketed to by the pharmaceutical-psychiatric consortium and prescribe 72% of antipsychotics, 86% of antidepressants and 94% of sedative-hypnotics.1 CCHR says Medicine Australia’s proposed Code of Conduct disclosing conflicts of interest with doctors and consumer groups is a whitewash, needing federal legislation similar to that in the US which names all doctors receiving more than $100 from pharmaceutical companies. CCHR national executive director Shelley Wilkins says the pharmaceutical-psychiatric industry needs to disclose any funding of psychiatric training manuals, treatment guidelines, and research.
Conflicts of Interest Hidden in Australia
A Texas lawsuit brought earlier this year by the state Attorney General against risperidone (Risperdal) manufacturer, Janssen-Cilag/Johnson & Johnson revealed the company had paid psychiatrists to develop treatment guidelines to boost sales and gave kickbacks to officials to ensure risperidone became a “preferred” drug on government medicine lists. http://www.pharmalot.com/2012/01/jj-pays-158m-to-settle-risperdal-lawsuit-in-texas/
In 1998 in Australia, Janssen-Cilag sponsored the development of a Resource Kit for General Practitioners aimed at integrating GPs into outpatient services for young people who were given psychiatric treatment for early psychosis.
A leading Australian researcher, Richard Gosden, Ph.D. said in the late 90s Janssen also provided an “unrestricted” grant to produce an “Early Psychosis Training Pack” for mental health workers. The principal authors were Prof. Patrick McGorry, Director, and Jane Edwards, Assistant Director of the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, which had also received Janssen funds to conduct research on risperidone. https://sites.google.com/site/richardgosden/ehss; https://sites.google.com/site/richardgosden/phd
The treatment algorithm in the Training Pack and subsequent Early Psychosis Treatment Guidelines is similar to that exposed in the recent Texas case against Janssen, which was developed by psychiatrists funded by Janssen around the same time as the Australian training pack and early psychosis guidelines were produced.
David J. Rothman, Ph.D., Professor of Social Medicine at the Columbia College of Physicians & Surgeons, Columbia University provided expert evidence for the Texas State prosecution of Janssen, detailing from the company’s records and emails the marketing strategies the company used to increase sales. http://media2.kxan.com/PDF/Daniel_Rothman_Expert_Report_300dpi.pdf
Rothman exposed how the company’s phrase “unrestricted educational grant” was misleading, aimed really at expanding Risperdal’s market. Treatment guidelines were turned into a powerful marketing tool, he said.2 Medical education and research were “thinly disguised marketing activities” and “funding of these activities created conflicts of interest that subverted scientific objectivity and professional medical integrity.”3 Psychiatrists were paid to develop treatment guidelines with a $65,000 bonus for completing on time. Government officials were given kickbacks to make Risperdal a preferred drug in insurance rebates.
Like the US Schizophrenia Guidelines, the Australian Early Psychosis Training Pack, Australian Clinical Guidelines for Early Psychosis and The Diagnosis and Management of Psychosis: A Booklet for General Practitioners, recommended risperidone, quetiapine and olanzapine as treatment for early psychosis/first episode psychosis.
Dr. Gosden stated: “In the end one may propose the working hypothesis argued presently, that early psychosis research and intervention programs are driven by funding and lobbying from the pharmaceutical companies that have recently launched atypical neuroleptics [antipsychotics] onto the market.” https://sites.google.com/site/richardgosden/ehss; https://sites.google.com/site/richardgosden/phd
Antipsychotic Drug Use Soaring
The elderly are also a target for antipsychotic prescriptions. According to PBS 2009/10 figures, of the 87,911 elderly aged 72 and over taking antipsychotics, 48% (42,478) were prescribed risperidone, 24% olanzapine and 11.6% quetiapine. [See Janssen/Johnson and Johnson marketing off label to treat the elderly in the U.S. http://americanfraud.blogspot.com/2012/01/marketing-risperdal-part-iii-marketing.html
PBS expenditure on antipsychotics has soared 3,700% since 1992/93. Expenditure on just three brand-name antipsychotics Risperdal (risperidone), Zyprexa (olanzapine) and Seroquel (quetiapine) year-ending 30 June 2011 reached $343,121,352; total costs with co-payments were $362,728,613.4 Between April 2010 and March 2011, Janssen in Australia spent over $1 million on 563 events attended by psychiatrists, representing 36% of all their sponsored medical events.
The manufacturers of Risperdal, Zyprexa and Seroquel have paid almost $4.5 billion in fines and penalties over illegal marketing of and covering up serious adverse effects of their antipsychotics in the US Janssen-Cilag has been fined over $1.9 billion since 2010. http://www.nytimes.com/2012/04/12/business/drug-giant-is-fined-1-2-billion-in-arkansas.html
Parallel Between US and Australian Conflicts Regarding Risperidone: Big Pharma Tactics
David J. Rothman, Ph.D. wrote an 86 page expert statement regarding Janssen/J& J’s egregious marketing strategies to increase sales, subverting scientific objectivity and buying off psychiatric researchers and government officials. In part:
- “In promoting its drug, Risperdal, in its oral and injectable forms, J&J exerted improper influence over potential payors and prescribers. Activities that it funded in medical education, research, and publication were, in fact, thinly disguised marketing activities. J&J’s funding of these activities created conflicts of interest that subverted scientific objectivity and professional medical integrity. J&J dispensed gifts, honoraria, speaking fees and meeting attendance payments to win favors from payors and prescribers; these activities represented a deliberate effort by J&J to influence payors and prescribers to favor Risperdal.” [Pages 12-13]
- “J&J’s use of the phrase ‘unrestricted educational grant’ to describe its funding was misleading…In official terminology, these were general guidelines [Schizophrenia Treatment Guidelines] supported by an unrestricted grant. In fact, to J&J, this was a venture to help Risperdal expand its market…J&J turned the guidelines into a powerful marketing tool.” [Pages 16-17]
- They picked “those who made purchasing and reimbursement decisions—that they should use the Guidelines to justify making Risperdal the drug of choice.” [Page 17]
- J&J provided an ‘unrestricted’ grant of $450,000 among the three schools (and psychiatrists) to develop treatment guidelines. “It further agreed to a $65,000 bonus incentive payment if the team was timely with its product. The team met the requirement, requested the additional payment, and received it.” [Page 14-15]
- “The guideline team promised wide distribution of its product.” [Page 15]
- The costs for these various activities included $250,000 for “educational conferences;” and dissemination of publications at $177,659. (Anderson Exhibit, 2244, 2245). J&J agreed to them. So all told, J&J paid at least $942,659 on the production and marketing” of the guidelines. [Page 16]
- One J&J employee, Rob Kraner, explained J&J’s approach to colleagues: ‘One of the reasons Janssen committed substantial funding was to develop treatment guidelines/algorithms for schizophrenia that positioned atypicals as the first line agents (at the time atypicals were usually positioned after conventionals) and test it in a real world setting. The rationale was to develop this approach in Texas, find out the most effective way to roll it out, and then other states could replicate [it] with minimal investment.’ (Italics added) [Page 18].
- “The strategy was set forth early in the history of Risperdal. Already in September 1992, a consulting firm (STATE AND FEDERAL ASSOCIATES) gave J&J a blueprint that between 60 and 80 percent of schizophrenia medications were paid for by state mental health and Medicaid programs, and should be the prime target for promotional activity…It particularly advised J&J to identify state mental health officials because they would be essential to Risperdal’s marketing success, including marketing in Texas.” [Page 13]
- Funding Patient Front Groups: “So too, the firm urged J&J to work with such patient advocacy groups as the National Alliance on Mental Illness (NAMI) to expand mental health insurance benefits and thus gain more of a market for Risperdal. Indeed, it recommended that J&J enlist support from NAMI to accompany the product launch.” [Page 13]
- Another PR firm “GTFH Public Relations” emphasized that J&J should be convening Expert Task Force Meetings: ‘Formulate position and draft guidelines for consensus use’; ‘Personalized invitational campaign to maximize participation.’ Finally, it counseled J&J to ‘Form exclusive partnership with growing advocacy groups,’ citing NAMI as one case in point. J&J should help establish chapters and co-sponsor educational programs on patient issues.” [Page 13-14]5
Like the US Schizophrenia Guidelines, between the Australian Early Psychosis Training Pack, Australian Clinical Guidelines for Early Psychosis (including updated 2010 version) and The Diagnosis and Management of Psychosis: A Booklet for General Practitioners, the atypical antipsychotics risperidone, quetiapine and olanzapine are recommended as treatment for early psychosis/first episode psychosis.
- As Richard Gosden highlights: “In Australia, EPPIC’s preventive treatment centre for young people, PACE (Personal Assessment and Crisis Evaluation Clinic), also receives drug company funding from Janssen-Cilag. This may have paid off handsomely for the company. The EPPIC researchers have established a leadership role in early psychosis research and treatment in Australia…It may not be coincidental that a half page of the Clinical Guidelines is dedicated to dosage recommendations for using risperidone in first-episode psychosis. The Clinical Guidelines do not extend these dosage recommendations to include other schizophrenia drugs and the recommendations for risperidone give the appearance of an official endorsement of the drug.” https://sites.google.com/site/richardgosden/ehss
- In 1996, Prof. Mc Gorry was provided an “unrestricted research grant for his investigator-initiated study” from Janssen-Cilag to study risperidone as an intervention for early psychosis/ultra-high risk of psychosis and designed for the EPPIC program at the PACE clinic. The results published in the Archive Gen Psych Oct 2002.6
- 1996-98: The first International Conference on Early Psychosis was held in Melbourne in 1996, hosted by EPPIC and leading to the formation of the IEPA
- (International Early Psychosis Association) in 1997. The organisation incorporated in August 1998 in Victoria.7
- January 1997: Prof. McGorry and Jane Edwards published the EARLY PSYCHOSIS TRAINING PACK with 10 modules.8 The pack was produced by a UK PR firm, Gardiner-Caldwell, in conjunction with EPPIC (Early Psychosis Prevention and Intervention Centre) under an educational grant provided by Janssen and Organon. In Module 4 of the pack, “Acute Treatment,” it recommends new antipsychotics a treatment of first-psychotic episode.9 The algorithm recommends “Low dose risperidone or haloperidol” for 8 weeks, while emphasising the newer antipsychotics (risperidone) were more effective, with less side effects. It also provides “dosing guidelines for risperidone in first-episode patients.”10
- 1998: Drug company involvement was particularly evident in the organisation of the Second National Conference on Early Psychosis – “Realising the Potential” – hosted by EPPIC at Hobart Tasmania in early September 1998. The conference was principally sponsored by Pfizer, with additional sponsorship coming from Janssen-Cilag, Eli Lilly and Novartis (manufacturer of clozapine). [Gosden 1999]
- 1998: The Australian Early Psychosis Treatment Guidelines were produced that provides a dosage chart for prescribing risperidone for first-episode psychosis. Risperidone and olanzapine are recommended.11
- 1998: A further indication of the influence gained by Janssen-Cilag through sponsoring EPPIC initiatives was in a Resource Kit for General Practitioners, which were assembled to integrate general practitioners into the ongoing out-patient services for young people who were given psychiatric treatment for early psychosis. It was an 18-month schedule during which responsibility for the patient’s supervision is progressively transferred from psychiatric specialists to a local GP. There was a prominently displayed banner across the cover bearing the Janssen-Cilag name and logo.12
- 2002: Orygen, which still receives funding from Janssen, AstraZeneca, Eli Lilly and produced an Early Diagnosis and Management of Psychosis: A Booklet for General Practitioners, which recommends a medication-free period of 2 days when early or first psychosis is identified, then start antipsychotics slowly. The manual states: Since the early 1990s a number of newer atypical antipsychotics have become available. Drugs in this category include: risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel) and clozapine (Clozaril) for treatment of first episode psychosis. A treatment algorithm is provided.13
- 2010, October: The Australian Early Psychosis Treatment Guidelines produced by Orygen Youth Health and edited by McGorry and others recommended risperidone, olanzapine, quetiapine and three other atypical antipsychotics.
To reiterate Dr. Gosden: “In the end one may propose the working hypothesis argued presently, that early psychosis research and intervention programs are driven by funding and lobbying from the pharmaceutical companies that have recently launched atypical neuroleptics onto the market.”
CLASS ACTION LAWSUITS
Individual or Class Action lawsuits may be the only way for Australians to learn the truth about all adverse drug events and potential collusion between pharmaceutical companies and psychiatrists conducting industry-funded studies and/or writing treatment guidelines that could influence prescription sales in the country.
Associate Professor Ian Kerridge, head of the Centre for Values, Ethics and Law in Medicine at the University of Sydney says class actions may deter companies tempted not to fully disclose their product’s risks. And court action could have a political impact.14
QUESTIONS OF THE FEDERAL MINISTER FOR MENTAL HEALTH
Mental Health Minister Mark Butler does not appear to monitor conflicts of interest within the mental health system. An investigation should be conducted into whether pharmaceutical company-funding of antipsychotic research and treatment guidelines or potential influence over government preference of prescription psychiatric drugs.
QUESTIONS OF THE MINISTER FOR MENTAL HEALTH
- How does the Minister account for the 69% increase in 2-16 year olds prescribed antipsychotics between 2007/08 and 2009/10?
- How does the Minister account for the fact that of 2-16 year olds taking antipsychotics in 2009/10 (9,683) 79% were prescribed risperidone, a drug which is the subject of lawsuits in the U.S. against one of its manufacturers, Janssen-Cilag?
- What statistics are collected annually on number of children/teens prescribed antipsychotics, antidepressants and psychostimulants through federally-funded youth mental health programs, such as headspace and Orygen Youth Mental Health?
- If statistics in (3) are not collected, what will the Minister do to obtain such information and make it publicly accessible and accountable?
- What investigation(s) have been initiated or will be initiated to determine what, if any, conflicts of interest may be influencing government treatment guidelines for psychosis, schizophrenia and depression in children, youths and the elderly?
- How does the Minister explain the over-representation of risperidone use in the elderly [of all elderly aged 72 and above in 2009/10 taking antipsychotics (87,911), 48% were taking risperidone (42,478), 24% were taking Zyprexa (21,099), and 11% Seroquel (10,203)]?
- Is the Minister aware of the recent lawsuits in the U.S. against Janssen-Cilag, the maker of Risperdal (risperidone) resulting in $1.9 billion in fines and settlements over misleading promotion and concealing adverse effects risperidone? Does the government have guidelines or any policy that makes Risperdal (risperidone), Seroquel (quetiapine) or Zyprexa (olanzapine) “preferred” drugs to be prescribed in mental health facilities?
- Does the Minister intend implementing a regulation/law where any government-subsidised healthcare facility, organisation, and or researcher and doctor must disclose complete past and present pharmaceutical company or medical device financial support or affiliation?
- Can the Minister provide a current breakdown of the number of Australians prescribed antipsychotics, antidepressants and psychostimulants, by age, gender, state and by itemized drug in these classes?
CHILDREN AND YOUTH
Based on PBS figures, there’s been a 69% increase in 2-15/16 year olds prescribed antipsychotics between 2007/08 (5,727) and 2009/10 (9,683).
Of the total number of 2-16 year olds taking antipsychotics in 2009/10 (9,683) 79% were prescribed risperidone, towering over quietapine at 9% and alonazapine at 7%.
NSW tops the list of 2-16 years old on antipsychotics, representing nearly a third (3,448) of the nationwide consumption of them in this age group. Queensland ranks second (2,777) and Victoria third (1,881).
Of all elderly aged 72 and above in 2009/10, 48% were taking risperidone, 24% were taking olanzapine, and 11% quietapine.
In 2007/08, the number of elderly prescribed risperidone at age 80 was 1,688 and soared an inexplicable 1,433% (to 25,893) among those aged 81 and older.
Federal reporting of these statistics changed in subsequent years, showing aged groups broken down more generally to 72-76 and 77 plus. Even then, in 2009/10, 5,220 72-76 year olds were taking risperidone, increasing 613% in the age group 77 plus (37,258).
Olanzapine was taken by 4,915 elderly aged 72-76 in 2009/10 and 16,184 aged 77 and over.
Quetiapine was taken by 2,577 elderly aged 72-76 in 2009/10 and 7,629 aged 77 and over.
RISK OF DEATH
The Australian Therapeutic Goods Administration clearly warns of the increased risk of strokes and death in elderly dementia patients, seizures, major weight gain, onset of diabetes and potentially fatal high blood sugar.15
The FDA also warns that the death rate in the elderly taking antipsychotics is nearly double (1.6 – 1.7 times) that in those taking placebo.16 The Australian National Prescriber Service (NPS) reports an increased death rate was found in an analysis of placebo-controlled trials of aripiprazole, olanzapine, quetiapine and risperidone in dementia patients, mostly due to cardiovascular events (e.g. heart failure, sudden death) or infections (e.g. pneumonia) One death was associated with antipsychotic use for every 100 patients treated over 10–12 weeks.17
A Canadian study found that 5.2% of the nursing homes residents studied died within a month of being given one of the newer classes of antipsychotic drugs, compared to 3.3% of residents who did not take the drugs who died within a month. Among community-dwelling patients, nearly 14% taking the drugs suffered a “serious health event” within 30 days, compared to about 4% not on the drugs.18
DEATHS ASSOCIATED WITH ANTIPSYCHOTICS
Based on Adverse Drug Reports to the TGA
|Up to 2007||Up To 2011 (includes earlier figure)|
|TOTAL||440||629 (22 suicides) – 43% increase|
|Clozapine –||248||433 (13 suicides) – 74% increase|
|Olanzapine||40||62 (2 suicides) – 5% increase|
|Risperdone –||27||38 (3 suicides) – 41% increase|
|Quetiapine –||10||27 (2 suicides) – 63% increase|
“Patients ages 30 to 74 who took atypical antipsychotics such as risperidone (sold as Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa) and clozapine (Clozaril) had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to a study funded by the US Department of Health & Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) in 2009. The risk of death increased with higher doses of the drugs taken. Especially among children and demented elderly patients for whom there is little evidence of the drugs’ efficacy, their use “should be reduced sharply.”19
NB: The total number of people PBS reports take clozapine is low: 894 in 2007/08, 952 in 2008/09 and 1003 in 2009/10, compared to olanzapine for the same period, 101,012; 105,337 and 104,407 respectively. That means the risk of death could be 87,000 or greater for those taking Clozapine.
The Medical Observer reported in February 2012 that Australia’s monitoring requirements for clozapine are some of the least stringent in the world and have not changed since
1992. The TGA noted that the rate of moderate leukopenia [decrease in white blood cells which places individuals at risk of infection] was “very significant” at 11.8 per 1,000 between weeks 19 to 52, and 6.1 per 1,000 after one year’s use. A psychiatrist and member of the RANZCP complained to the TGA that the monitoring requirements were “unnecessarily onerous.”20
The expenditure on Clozapine increased steadily over the 2004-05 – 2008-09 period—from $30.1 to $39.4 million.21
In Australia, obtaining statistics on psychiatric drug usage, especially by age group and drug is a lengthy and costly affair—upwards of $4,000 per request.
Medicare has informed those seeking such statistics that they now must provide a detailed explanation for wanting the information and how it will be used. This is information that should be provided annually in health care statistics as a matter of transparency.
TOTAL ANTIPSYCHOTIC DRUG USAGE AUSTRALIA WIDE
See near bottom of this page for statistics references.
14% increase from 2007/08 – 2009/10
MAIN ANTIPSYCHOTICS CONSUMED
|Olanzapine (Patent drug Zyprexa by Eli Lilly)||101,012|
|Risperidone (Patent drug Risperdal by Janssen- Cilag)||89,955|
|Quetiapine (Patent drug, Seroquel) Astra Zeneca)||52,782|
|Haloperidol, older antipsychotic||25,399|
|Aripiprazole (Abilify–Bristol-Myers Squibb)||14,257|
NUMBER OF AUSTRALIANS TAKING ANTIPSYCHOTICS – BY AGE GROUPS
Aged 2 – 16
|2009/10:||9,683 – 69% increase|
|2007/08:||1,694 (aged 7-10 – not possible to work out 7-11 for this year)|
Aged 12 – 16
|2007/08:||3,505 (aged 11-15 – not possible to work out 12-16 for this year)|
Aged 17 – 21
|2007/08:||3,642 (16-18 years only reported)|
Aged 72 – 77 Plus
|2007/08:||14,672 – 72-76|
|67,305 – 77 plus|
|(Age 80 – 3,987 – Age 81 plus – 52,303)|
|2008/09:||15,353 – 72-76|
|71,079 – 77 plus|
|2009/10:||15,869 – 72-76|
|72,042 – 77 plus|
7% increase in elderly on antipsychotics since 2007/08
STATES – ANTIPSYCHOTIC USE
|NSW||3,448||7,039||13% increase over 2008/09|
MAIN ANTIPSYCHOTICS PRESCRIBED CHILDREN & TEENS
|Total 2 -16||4,464 (2-15)||6,597||7,640|
|Total 2- 21||6,022||9,705||10,906|
|Ages 7-11||1,459 (7-10yrs)||2,654||3,147|
|Ages 12-16||2,580 (11-15 yrs)||3,384||3,818|
|Ages 17-21||1,558 (16-18 yrs)||3,108||3,266|
|Total 2 -16||245 (2-15)||660||908|
|Total 2- 21||1,196||3,816||4,994|
|Ages 2 -6||4||15|
|Ages 7-11||30 (7-10 yrs)||53||72|
|Ages 12-16||256 (11-15 yrs)||592||836|
|Ages 17-21||906 (16-18 yrs)||3,156||4,086|
|Total 2 -16||390 (2-15)||659||646|
|Total 2- 21||1,391||3,803||3,774|
|Ages 7-11||41 (7-10 yrs)||61||66|
|Ages 12-16||349 (11-15 yrs)||584||567|
|Ages 17-21||1,001 (16-18 yrs)||3,144||3,128|
ANTIPSYCHOTICS PRESCRIBED THE ELDERLY
|Ages 77 +||67,305||71,079||72,042|
|81,977||86,432||87,911 – 7% increase|
Of all elderly aged 72 and above in 2009/10, 48% were taking risperidone, 24% were taking olanzapine, and 11% quetiapine.
|Ages 77 +||31,870||35,927||37,258|
|Ages 77 +||16,380||16,674||16,184|
|Ages 77 +||5,196||6,320||7,626|
[See alerts re: antipsychotics] http://au.mediguard.org/alerts/alert/1329.html
Click here to see the TGA report for the number of deaths linked to …
Click here to see the numbers of deaths linked to risperidone
Click here to see the numbers of deaths linked to quetiapine
Click here to see the numbers of deaths linked to clozapine
Click here to see the numbers of deaths linked to olanzapine
- Mental health services in Australia, 2007-08, Australian Institute of Health and Welfare, Aug. 2010, p. 131.
- http://www.omsj.org/cases/2011/rothman-report-1-20.pdf, pp. 16-17
- http://www.omsj.org/cases/2011/rothman-report-1-20.pdf, p. 12-13
- “Expenditure and prescriptions twelve months to 30 June 2011,” Data and Modelling Section, Pharmaceutical Policy and Analysis Branch, PBS, p. 11.
- http://www.omsj.org/cases/2011/rothman-report-1-20.pdf, p. 18
- Randomised Control Trial http://www.meb.uni-bonn.de/psychiatrie/zebb/literatur/mcgorry.pdf
- Early Psychosis Training Pack, Module, 4, p. 6.
- Early Psychosis Training Pack, Module, 4, pp. 15-16.
- The Australian Early Psychosis Treatment Guidelines, pp. 28,30.
- Richard Gosden, Ph.D., Chapter 10, Schismatic Mind: Early Psychosis, pp. 298-299.
- Early Diagnosis and Management of Psychosis: A Booklet for General Practitioners, 2002, pp. 15,17,20.
- “See you in court,” SMH.com, 22 Nov. 2007, http://www.smh.com.au/news/national/see-you-in-court/2007/11/21/1195321867047.html
- ”Johnson & Johnson fined $1.1bn in Risperdal case”, Herald Sun, 12 April 2012.
- WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS, drugs.com, http://www.drugs.com/pro/seroquel.html
- NPS Prescribing Practice Review 37: “Role of antipsychotics in managing behavioural and psychological symptoms of dementia”, http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/role_of_antipsychotics_in_managing_behavioural_and_psychological_symptoms_of_dementia
- ”Antipsychotic drugs dangerous for the elderly”,Agedcarecrisis.com, 27 May 2008, http://www.agedcarecrisis.com/dementia/dementia-and-antipsychotics-medication-or-management/2773-antipsychotic-drugs-dangerous-for-the-elderly
- “Antipsychotics Increase Risks for Sudden Cardiac Death,” Pharmacology Corner, Jan 2009, http://pharmacologycorner.com/atypical-antipsychotics-and-sudden-cardiac-death-medical-media-coverage/
- ”Clozapine monitoring least stringent in Australia,” Medical Observer, 28 Feb 2012.
- Mental Health Services in Australia, 2007-08 (August 2010), Aust. Institute of Health and Welfare, Mental Health Series 12, p. 189.