Wednesday, October 2, 2013
The Rise of the Psychopharmaceutical Industry 1987-2010
by Mary Beth Ackerly,MD. Robert Whitaker’s brilliant book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America asks a simple question.Why , if psychiatric drug treatments are so efficacious, has the number of people on disability for mental illness more than tripled in the last 25 years? Most doctors and researchers answered this question by stating that the numbers have increased simply because we are diagnosing more people with mental illness. In response to this stereotyped dismissal of his data, Robert began to do more research on the efficacy of known psychiatric treatments. And then, while poring through the psychiatric scientific literature on treatment effectiveness for the last fifty years he found an even darker question beginning to emerge. “Is it possible that psychiatric drugs are actually making people much worse?” Could it be that far from “fixing broken brains” the drugs being offered actually are worsening, and even causing, the very illnesses they claim to heal? 1987 can be considered ground zero for the new era of psychopharmacology. Prozac had just been introduced and was being widely advertised to the psychiatric profession, as well as to the general public, as a new safer antidepressant. Many people became aware that a chemical imbalance of serotonin might be causing their depression, and begged for the drugs. In one notable Newsweek article a woman stated that in case of nuclear war it would be the first thing she grabbed for. As a young psychiatric resident I was proudly confident that the treatment of psychiatric illness was being revolutionized and that we could all look forward to a world where severe depression, anxiety and mania no longer crippled and ruined human lives. WRONG!! It should be apparent to many that despite the incredible profiteering of the pharmaceutical industry off of psychiatric illness that depression and anxiety are still rampant in this country. If psychiatric medications worked the way the are supposed to, and they way the drug companies and psychiatric industry tells us they do, why are so many people still severely depressed and anxious. At the start of the psychopharmacological “revolution” when it became popular to blame all illness on “imbalanced brain chemistry” the percentage of bipolar patients who could return to work was 85 percent. Now it is less than thirty percent. Certainly the introduction of the SSRI’s (selective serotonin reuptake inhibitors) revolutionized the profitability of the pharmaceutical industry. In 1987 about half a billion dollars were spent on psychiatric medications, by 2010 the figure is closer to 40 billion!!! So if the number of adults diagnosed as mentally disabled has tripled its not because they weren’t exposed to the medication. Actually in children the disability figures are far more frightening. In 1987 there were less than 20,000 severely mentally disabled children, now there are almost 600,000. That is a 30 fold increase. Part of that is due to the diagnosis of autism, while more is due to the even newer diagnosis of bipolar disorder in children which has increased 40 fold in the last 10 years! Most frightening are the numbers of children under six receiving SSI which have tripled over the last ten years to more than 65,000. UNDER SIX!!! How can this possibly be . Were psychiatrists twenty years ago oblivious to the plight of these severely disabled children. I can assure you, from my experience that is not true. Rather it seems that drug companies have discovered another very profitable market in young children and are busy pushing their drugs, in particular the atypical antipsychotics, onto children with the newly diagnosed pediatric bipolar disorder. However our leading psychiatrist assure us these drugs are safe and they are paid amply by the drug companies to certify this safety. How can anyone possibly predict the longterm impact of a major tranquilizer, used to subdue agitated and psychotic adults, on a five-year old brain ? Those studies have not been done. From these sobering statistics the author then goes on to answer the following questions about longterm results with psychiatric medicines. Does antidepressant usage make it more likely that you will become disabled. Are bipolar patients better off than they were 40 years ago? When the National Institute of Health studies the long-term outcome of children treated for ADHD did they find stimulants provided any benefit. And most startlingly of all, to anyone who has been indoctrinated in the current medical thinking that psychiatric patients are always better off on medications, he asks an unthinkable question – are recovery rates for schizophrenics better with or without medication? In addition Robert Whitaker chronicles the stories of many of the people who have been diagnosed and treated for depression and bipolar disorder and treated with many different types of psychiatric medication. In fact although some parts of the book where he examines scientific evidence may seem a bit heavy going her more than makes up for that by interweaving the stories of many psychiatric patients whom he has personally interviewed. My favorite was the story of a young women named Kate diagnosed with schizophrenia. Years on meds had left her partially disabled unable to work or have a relationship. After 10 years she began to decrease her meds and is now married and working a full-time job. She has not had a relapse. She feels her time on antipsychotic medication kept her from learning skills on how to deal with emotions, emotions which she felt were completely numbed by psych meds. She says of herself now – I am a completely different person. This story leads into one of the most interesting parts of the book for me. It seems that if you are schizophrenic and living in India or Nigeria you chances of a good outcome are far higher than if you live in the US where everyone is medicated. The fact seems astonishing, and World Health Organization repeated the study, but found the same thing – that living in an undeveloped country where meds are scarce but patients are cared for by the community assures a much better prognosis for schizophrenia. However Whitaker also quotes several studies done in the US from the late seventies that also showed similar results, that young adults suffering a first episode of schizophrenia who were not medicated showed significantly better outcomes in terms of subsequent relapse. Later in the book he details the current treatment of schizophrenia in an experimental clinic where drugs are rarely prescribed. Again the findings are similar that patients there have much better long-term outcomes than other Finnish schizophrenics who are routinely medicated. I admit to being somewhat naïve as a young doctor. Even in the 80’s there were always people demonstrating at APA conventions against the “brain killing and mind numbing effects of drugs”. I, like many of my colleagues, dismissed them as either angry ex patients or Scientologists. I thought that the fact that drugs companies paid psychiatric professors to do their research was not a big deal. Again WRONG! The last chapters of Anatomy of Epidemic tallies up the enormous profits the drug companies, and certain psychiatrists, have made off the reinvention of psychiatry as biological psychopharmacology. He details how the growth of the Diagnostic and Statistical Manual from DSM 2 to DSM 4 has fueled the growth of diagnosing more and more Americans as having a psychiatric illness which requires pharmacological treatment and suggests that this was a necessary preparation for “building the market” for the drug companies wares. Now most scientists would absolutely bristle at the suggestion that their passion to finally make psychiatry a real science was actually a ploy to help the drug companies remarkably expand their profits. Yet there is no doubt that the expansion of the definitions of psychiatric illness, which now has one in every eight Americans taking a psychotropic medication , has been exceeding profitable. Drug company sales of psychotropic medication went from about half a billion in 1987 to over 40 billion dollars in 2008. Atypical antipsychotics, once reserved for the most severely ill patients, are now the top revenue producer for drugs companies, helped by the psychiatric professions willingness to prescribe them to even two-year olds. Dr. Biederman, the psychiatrist most associated with leading the way to using antipsychotics for children by popularizing pediatric bipolar illness, personally received 1.6 million dollars from 2000 to 2007, as well as procuring another 2 million for a pediatric pathology department at Mass Gen hospital. He is a designated KOL by the drug companies, which means a Key Opinion Leader. That means what he writes and says is usually followed by other psychiatrists. In a recent deposition he was asked his rank at Harvard Medical School. Full professor he replied. What’s above that asked the attorney. GOD, replied Dr. Biederman. Truly that is a response worthy of a KOL. This is not the book of a disgruntled patient who is angry at the system. It is the carefully researched and documented expose of a multibillion dollar industry that affects the lives of a least a quarter of the population. It is also an engrossing read, and an accurate depiction of the lives of people who are afflicted with these illnesses. I would recommend it to anyone who has ever used, or had a family member use, psychiatric services or been given psychiatric medication.