STAT+: How a depression test devised by a Zoloft marketer became a crutch for a failing mental health system

In an overstretched health care system warped by business interests, a depression survey has become a crutch — used in place of, rather than as a gateway to, thoughtful care.

A bedrock of the U.S. mental health system — a nine-item questionnaire used to spot depression — began not with a doctor, but with a marketing man. Howard Kroplick, now 73 years old and living on Long Island, is obsessed with antique racing cars and, in his storied career in the pharmaceutical industry, crucially urged Pfizer to avoid the word “impotence” when promoting Viagra.

More than two decades ago, he had the brainstorm to give primary care doctors a simple form to help them identify depressed patients. His key client, Pfizer, had recently released Zoloft, one of a new generation of antidepressants called SSRIs. Although the drug was safe enough to be prescribed by primary care doctors, most were uncomfortable treating mental illness, meaning these patients were going untreated and Pfizer was missing a huge potential market. Kroplick, speaking for the first time publicly about how he came up with the idea, told STAT he pitched the concept to both its scientific creators and to Pfizer, which funded their work: “It wouldn’t have happened if it wasn’t for me,” he said.

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