Meet the Doctor Big Pharma Can’t Shut Up
By Tamara Straus
May 30, 2013
For the last 33 years, David Healy, an Irish psychiatrist and professor at Cardiff University School of Medicine in Wales, has written heavily researched university press books and academic journal articles on various aspects of psychopharmaceuticals. His output includes 20 books, 150 peer-reviewed papers and 200 other published works. He is not only well-pedigreed, with degrees and fellowships from Dublin, Galway and Cambridge medical schools, he is a widely recognized expert in both the history and the science of neurochemistry and psychopharmacology.
Yet Healy says his output and reputation have had little to no effect — both on the pharmaceutical industry he argues buries relevant information about prescription drug harms, and on the psychiatric and medical professions he claims are being “eclipsed” by drug companies. “It’s been clear to me that writing books or articles banging on the risks and hazards of drugs is just going to increase the sale of drugs,” said Healy, who speaks calmly, dresses mostly in black and looks a bit like Rod Serling.
Rather than write another university publication, Healy has taken his frustration to the street. In November, he launched a nonprofit website called Rxisk.org with a group of like-minded and highly credentialed international colleagues. The site aggregates FDA data about prescription drug side effects and urges patients to submit a detailed report on their own pharmaceutical drug reactions.
Healy is not the first psychiatrist to express boiling frustration with the pharmaceutical industry or to pen dire warnings about drug-based healthcare. He is joined by people like American psychiatrist Peter Breggin, who has written several books critical of “biological psychiatry,” and Irving Kirsch, who directs the Program in Placebo Studies at Harvard Medical School/Beth Israel Deaconess Medical School and is best known for The Emperor’s New Drugs: Exploding the Antidepressant Myth. Healy is the author of such dire sounding titles as Pharmageddon and Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.
For years, it was fairly easy for people in the pharmaceutical and medical industries to label Healy, Kirsch and Breggin as alarmists. But two summers ago, one of the most prominent members of U.S. medical establishment, Marcia Angell, former editor-in-chief of New England Journal of Medicine, published an article damning the over-prescription of psychoactive drugs. In two essays in the June 23, 2011 and July 14, 2011 New York Review of Books, Angell backed arguments by the university clinician Kirsh, the mental heath journalist Robert Whitaker, and Boston psychiatrist Daniel Carlat that there is something extremely suspicious about the following trends: the number of people treated for depression has tripled since the launch of Prozac® in 1987; 10 percent of Americans over age six are taking antidepressants; and 30 antipsychotics like Risperdal, Zyprexa and Seroquel are replacing cholesterol-lowering agents as the top-selling class of drugs in the U.S., largely because they are being prescribed to children.Angell’s articles should have been a bomb on the medical establishment. She wrote:
“The industry-sponsored studies usually cited to support psychoactive drugs—and they are the ones that are selectively published—tend to be short-term, designed to favor the drug, and show benefits so small that they are unlikely to outweigh the long-term harms. … Both the pharmaceutical industry and the psychiatry profession have strong financial interests in convincing the public that drug treatment is safe and the most effective treatment for mental illnesses, and they also have an interest in expanding the definitions of mental illness.”But like Healy, Angell’s warnings have fallen on deaf ears. Recent data indicates that U.S. prescription drug use is growing. The September 2012 Consumer Reports National Research Center report found that among the 46 percent of American adults taking prescription drugs, a fourth of those ages 18 to 39 regularly take two prescription drugs, indicating that multiple drug use is no longer confined to older Americans. Congressional testimony in 2012 by the American Society of Interventional Pain Physicians revealed that Americans consume 80 percent of opiate painkillers produced in the world. And a January 2011 report from Stanford University Medical School warned that antispychotics are now regularly being prescribed to treat conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia.
According to a Feb. 7, 2013 report from Drugs.com, the No. 1 best-selling U.S. drug [in dollar volume] is an atypical antipsychotic for schizophrenia treatment called Abilify. Sales for the last quarter of 2012 soared to $1.5 billion, because Abilify is widely prescribed off-label—i.e., not for schizophrenia in adults, but, for example, for irritability in children. Although Bristol-Myers Squibb, the maker of Abilify, was fined $515 million in September 2007 for recommending off-label uses of Abilify, doctors are still doling out the drug. Why?…
Top Five Drugs by Sales, Q4 2012 Drug Name Sales
Abilify $1,478,301 5.20% Nexium $1,441,472 1.45% Crestor $1,275,483 2.41% Cymbalta $1,227,484 5.97% Humira $1,206,377 4.70%
As I read the Alternet article, I got stuck on the opening line, "For the last 33 years, David Healy, an Irish psychiatrist and professor…" The calculator in my head felt a jolt since 2013 – 33 = 1980. In 1980, there was no Prozac® or SSRI in existence. I thought it was probably just some fuzzy math but I looked up Dr. Healy and found the quote that started this post ["In 1990, Healy became a Senior Lecturer in Psychological…"] which made more sense. 1990 was when he took his faculty position, some 3 years after Prozac® was approved. That would make it "For the last 23 years, David Healy, an Irish psychiatrist and professor…" That would mean that Healy’s focus on the pharmaceutical industry started at the very beginning of his academic career and has persisted to the present. But being the follow-your-nose type, I pulled down his 2004 book, Let Them Eat Prozac, and ended up rereading Chapter I – Take One [which is available on the Internet here as a Google Book preview]. If you haven’t read it, it is still more than worth the time. This is the terse PubMed version of the report Dr. Healy read back then [in 1990] reinforcing his own experiences with his cases:
Emergence of intense suicidal preoccupation during fluoxetine treatment
by Teicher MH, Glod C, and Cole JO
American Journal of Psychiatry. 1990 147:207-210.
Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment. This state persisted for as little as 3 days to as long as 3 months after discontinuation of fluoxetine. None of these patients had ever experienced a similar state during treatment with any other psychotropic drug.
Around that time, I had left-or-been-sent-away-or-both from an academic position as a dinosaur and was in practice. In 1991, I read two documents pertinent to this topic. The first was a Time Magazine article that blamed the concern about suicidality and Prozac® on Scientology [covered by Dr. Healy here], and the exceedingly thick résumé of our new Chairman of Psychiatry at Emory, Dr. Charlie Nemeroff. At the time, I knew nothing about Scientology, or Prozac®, or Dr. Healy, or Dr. Nemeroff. I sure didn’t know that in that year, Dr. Nemeroff was testifying for Eli Lilly in an FDA hearing on this very topic that Prozac® was absolutely safe [see an anatomy of a deceit 6…]:
September 20, 1991
I would suggest to you that I have as little confidence in these anecdotal reports as I do in the anecdotal report of Teicher, and that, in fact, there is no substitute for controlled prospective double-blind clinical trials…
In conclusion, there is simply no scientific evidence whatsoever, no placebo-controlled double-blind study that has established a cause-and-effect relationship between antidepressant pharmacotherapy of any class and suicidal acts or ideation. As Drs. Potter and Fawcett have suggested, limiting the availability of antidepressants could have a very profound adverse effect in terms of increasing the morbidity and, in fact, mortality associated with untreated depression.
Dr. Charles Nemeroff,
Professor and Chair, Department of Psychiatry,
Emory University, Atlanta Georgia
What is this post about with all of its old stories? It was so refreshing to me to read Dr. Healy’s case reports in Let Them Eat Prozac, Dr. Teicher’s case reports in the full text of Emergence of intense suicidal preoccupation during fluoxetine treatment, the case reports on the Rxisk site, and the case reports on the blog Dr. Healy started. And it was so infuriating to read Dr. Nemeroff’s pronouncement "I would suggest to you that I have as little confidence in these anecdotal reports as I do in the anecdotal report of Teicher, and that, in fact, there is no substitute for controlled prospective double-blind clinical trials…" It was the spirit of that quote that lead me to leave my job at Emory so long ago, a job I really loved. Back then, I had no idea that the depersonified clinical trial would replace the case focus that brought me to psychiatry in the first place. I thought it was just what was happening in the department I was leaving.
I’m not opposed to clinical trials per se. What I oppose is that they became the sine qua non of truth rather than ancillary information. And I am beyond outraged that they became such a regular conduit for manipulation and obscuring the truth as time went on. It was through those very depersonified and deified clinical trials that psychiatry handed over the reins to the Managed Care bean counters, the Pharmaceutical Companies, and the Dr. Nemeroffs in academia.