diagnostic skills…

Posted on Sunday 29 January 2012

I don’t know Dr. David Healy [before that became cool!…] except from a few things on the Internet [like his trial testimony] and reading his book, Let Them Eat Prozac [Amazon 2004]. That book followed The Antidepressant Era [Amazon 1999] and The Creation of Psychopharmacology [Amazon 2002]. There have been many others, but these are the central precursors to his newest book which I am now reading, Pharmageddon [Amazon 2012]. No, this will not be a book review, there will be plenty of those coming in the near future, but here’s the publisher’s blurb:
    This searing indictment, David Healy’s most comprehensive and forceful argument against the pharmaceuticalization of medicine, tackles problems in health care that are leading to a growing number of deaths and disabilities. Healy, who was the first to draw attention to the now well-publicized suicide-inducing side effects of many anti-depressants, attributes our current state of affairs to three key factors: product rather than process patents on drugs, the classification of certain drugs as prescription-only, and industry-controlled drug trials. These developments have tied the survival of pharmaceutical companies to the development of blockbuster drugs, so that they must overhype benefits and deny real hazards. Healy further explains why these trends have basically ended the possibility of universal health care in the United States and elsewhere around the world. He concludes with suggestions for reform of our currently corrupted evidence-based medical system.
I listed his earlier books because just looking at the titles, you can see a progression in his thought. He started with the unpopular observation that some patients taking Prozac develop suicidal thinking. It’s not particularly common, but once you’ve seen it, it doesn’t matter that it’s not so common – it’s dramatic enough to sear itself into your mind [if you’re lucky enough to see it as I was, rather than simply hear that your patient committed suicide]. Dr. Healy’s open discussion of the topic resulted in his being villified and lost him a job opportunity early on [before that became cool!…]. As he delved further into the organized resistance against the truth of this simple, observable phenomenon, he’s been lead into the murky world of the megalithic Pharmaceutical Industry and its interconnections with organized medicine – at first in his own fields of psychiatry and psychopharmacology. But with this book, I can already see after a couple of chapters that he’s moving well outside the borders of psychiatry and psychopharmacology into a world of Big PHARMA and healthcare in general.

I might have thought that such an expansion in focus would bother me, being something of a newcomer to thinking editorially about medicine – still catching up with the back story that has increasingly pervaded psychiatry during my almost forty years in the specialty. But I was in the world of mainstream medicine in another specialty [Internal Medicine] long enough to have formed a medical identity, so I can see that the problem is everywhere, not just psychiatry. To paraphrase Janis Joplin, "My friends all take Statins, I must make amends." Every time somebody mentions their Lipitor, I wince, but say nothing. I know that outside of those unfortunate people afflicted with familial hyperlipdemia, the drugs mainly cause expensive urine. But if I say that, I feel like an outlaw or a disease denier. Even though I trained in an era when effective drugs were first available for hypertension and I know that they save the lives of many people with a certified disease we call hypertension, most of my friends are on antihypertensives to treat trivial elevations in blood pressure probably due to the "white coat syndrome" or the stiff pipes that people my age seem to develop along the way, but again I don’t say anything. It’s not well received [or effective]. And when people ask me about some drug they’ve seen advertised on television, if my wife is not nearby, I say, "It says ‘ask your doctor,’ not ask any doctor!" If she’s around, she laughs and interrupts saying, "He screams at those ads! Please don’t ask him."

All of which is to say that Pharmageddon is not about psychiatry or psychopharmacology, it’s about dramatic changes in the whole culture of medical care that have occurred largely in our lifetimes, a change that is simply a disaster [as his title suggests]. So far, for me, it’s a sad book because it’s about something that has been of central importance in my own life, my profession and identity, and some very large forces that have been at work totally out of my control or even my awareness. But it’s the good kind of sadness because already I can see that Healy’s gone to the trouble to parse out those larger forces at work and is extrapolating them into a predictable future that need to be diverted. He actually uses the analogy of climate change as seen from the perspective of someone hopping in the car to drive to the store, one that has already occurred to me thinking about this conundrum sitting on my porch.

Medicine is an unusual "market," a captive audience of sorts. And it is sustained by the biggest fear of all – the fear of death. So it’s really not a fair market, or a free market – in my mind, it’s not really a market at all. It’s something else, or at least it should be something else. This book is about that and a lot more. He’s going beyond just decrying the visible pieces that are obviously dysfunctional to characterize the underlying disease. Dr. Healy is not a gadfly as he has been called, or a martyr, or even a hero. He’s a doctor, and he’s written a book that proves his diagnostic skills. Back to reading…
    January 29, 2012 | 10:57 PM

    You might know this already, but Dr Healy now has a blog http://davidhealy.org/blog

    Joel Hassman, MD
    January 30, 2012 | 9:29 AM

    Thanks for the referral, Stephany. By the way, in this physician’s opinion, psychiatry started sliding down into that pit of despair when the profession so meekly and cluelessly allowed managed care to dictate what we could do as professionals.

    What was the line I heard yesterday while watching Jurassic Park III, by the Sam Neill character? Oh yeah, something like this, “a lot of terrible things happened with people who started out with nothing but good intentions.”

    Sort of like what I have come to experience in my life, “no good deed goes unpunished.” Still think we as a profession should have gone on strike back in the 90’s when managed care started to go out of control. Yeah, all those “qualified” substitutes would have just stepped right in and saved the day. NOT!

    January 30, 2012 | 10:49 AM

    I scream at those ads, too, Mickey. You are not alone.

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