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
[$000]% Change
[previous quarter]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[2]: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, 1991I 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.
Re: Blaming concern about suicidality and Prozac on scientology in 1991.
Unfortunately, it’s still taking place today…
Mainstream doctors, websites… quick to point to scientology as the source of any discomfort… Quick to prescribe drugs for patients for same condition.
Whatever happened to “not so quick?”
Has it just become “too uncomfortable?”
Duane
and then we have the neuro$ience of freewill:
http://books.google.com/books?id=5w64WC_-jbMC&pg=PA76&lpg=PP1
It was in 1991 that I was told by a psychiatrist on the day we met that she wanted to put me on an anti-depressant so I “would get more out of counseling.” Prior to that, no one had suggested that medication at all. I hadn’t even described symptoms of “depression.” I was suffering from PTSD (concurrent with Gulf War I) and the national bloodlust; was being hard on myself for not having been over it yet, and was mourning the lost time and interuption. She didn’t want to talk about what I was paying her to listen to, she wanted to talk about my childhood. While I was drugged. I saw her twice then quit.
Psychiatrists and psychologists had truly helped me overcome a lot, including my childhood; but once they went bio, pain became a thing to drug away rather than a clue that you need to take your hand of the proverbial stove or wear a mitt, so to speak.
The fact that the industry named a drug “SOMA” was what I consider evidence that the people at the top of the industry did, indeed, have a dystopian vision for humanity.
I have been practicing 20 years, reading at blogs for about 3 plus now, and yet the tone of most who are critical of psychiatry, even psychiatrists themselves, just want to point the finger of blame solely at us as a whole.
I don’t get it. I have yet to read a colleague or commenter say or write something about the patients who as a whole, NOT 100% MIND YOU that some critics quickly accuse me of saying in my retorts, but most just come in and demand, not even want to debate of late, they need ‘the right medication” after 5, 10, sometimes more than 15 trials all failed to have a significant impact on symptom reduction. And the frank annoyance, if not florid dismissal of my recommendation they either return, or for a sizeable portion START psychotherapy.
I just want to know if these same patients argue with their somatic doctors when they come in for treatment of their hypertension, diabetes, autoimmune disorders like MS or Lupus, hell, even with people who fracture a bone in a limb, do they argue about the need for physical therapy after the cast comes off?!
And the therapists who increasingly are quick to send patients to doctors, whether it be psychiatrists or PCPs/other nonpsychiatrists, simply because either the patient pushes for it at visit one, or the patient is not the “cherry pick” the therapist thought they were getting for an easy 6 visit managed care approval.
The problems of mental health care are not just by psychiatrists, and the sheer disingenuous dialogue I read and hear daily is stupid. And you know why psychiatrists as a whole are so easy to attack? Because someone in residency irresponsibly told residents that providers can’t defend themselves, that speaking back to people who just want to blame “will defeat the premise to the treatment process”.
Really? In 2013 at least?? Is Psychiatry undergoing the most ludicrous Jesus Christ complex ever seen by a profession???
Hey, you hate psychiatry and want to rant how the profession is the detriment to society, feel free to come to my site and the most recent post is your venue, as long as you agree to the terms to the ranting allowed. I am more than ready to read what everyone who hates my profession has to say to legitimize this crucifixion need.
How many solutions will be offered will be interesting to read.
John Grohol at http://psychcentral.com/blog/ has 2 posts in the past 2 days about his experience at the national conference on mental health 2013. As I wrote in reply to the Obama opening speech, it is a dog and pony show until proven otherwise. Politicians are not invested in mental health.
And those who claim otherwise are either completely out of touch with reality, or are so partisan in supporting a party public image first, they will just practice the usual incompetent defense mechanisms ad nauseum until they succumb to anoxia.
Silence is death, and the pervasive silence by those who CLAIM to really care and want to redirect psychiatry and mental health care in general is just ridiculous to witness. And everyone is guilty as contributing. Brutal honesty? Look in the mirror first and say you have done everything in your power to make a difference.
If that is true, then at least you know you have the right to complain.
Oh, and when you attack me next, just remember to ask why I have left a good number of positions for not tolerating the status woe attitude that is pandemic among many places who offer mental health care. And filed complaints within institutions and with state agencies. And why I speak out in meetings and conferences and just get either blank stares or organizational playbook rebuttals.
First impact for change? Make the APA irrelevant by ending your membership. Yes, there will still be physicians as members, but, over 90% of remaining members will be either retired, entrenched academicians who don’t do any regular clinical care, and the brainwashed who will do only what the organization tells them to do.
And as a group, they will be seen as irrelevant by the majority providers who do the care and think for what benefits the patients first and foremost. But, can people tolerate sacrifice? Historically for this country as a whole, forget just doctors for a minute, people are timid, self serving, and just looking for a handout.
Which completes the circle I started here with in this comment!
Let me help you with this, Dr. Hassman, because you appeared to have missed it:
Psychiatrists and psychologists had truly helped me overcome a lot, including my childhood; but once they went bio, pain became a thing to drug away rather than a clue that you need to take your hand of the proverbial stove or wear a mitt, so to speak.
That “work” and personal responsibility you appear to think most of your patients don’t have in them— I wanted to do it, I’d done it before, and I wanted help. But after ’91, because I couldn’t afford talk therapy, my only option seemed to be 15 minute checks and rotating cocktails. Before leaving the V.A., my psychiatrist apologized to me for letting those cocktails get out of hand. I told him that I recognized that there was little he could do in the system, understood why he wasn’t gruntled, and there were no hard feelings.
The point of this blog is to a large degree about being critical of a lot of what’s going on with bio-bio-bio-psychiatry. I don’t think any of the people who comment here are the thoughtless, lazy, harpies who take no responsibility for their lives that you appear to think that the lion’s share of your patients are.
Joel,
The Vatican is going to be holding a session this month that will expose the dangers of psychiatric drugs for children, youth and mothers.
IMO, this will open up Pandora’s Box regarding the myths, the dangers… as well as hope with non-drug options.
It looks as though the days of blaming all of this on scientology may be coming to a close. Soon, you’ll have to blame the Holy See for exposing the facts, the truth. –
http://www.fiamc.org/uncategorized/study-meeting-the-child-as-a-patient/
Duane
An interesting line-up, Joel.
Bob Whitaker, Joanna Moncrieff, Irving Kirsch, Jaakko Seikkula, et al…
IMHO, with 1.2 billion Catholics in the world, this opening round at Vatican (several years in the making) should have been called:
‘Anti-psychiatry’ goes mainstream
Duane
Also the systemic effect of all those chains of hospitals would have considerable clout on multiple levels.
a-non,
amen
glad the agenda will impact on all in need.
The agenda of the current stakeholders already impacts those in need.
http://mentalillnesspolicy.org/
The agenda of the current stakeholders is to gain more human $ubjects:
” Human subject is defined in 45 CFR 46.102(f) as follows:
Human subject means a living individual about whom an investigator (whether professional or student) conducting research obtains
1. (1) data through intervention or interaction with the individual, or
2. identifiable private information.
Intervention includes both physical procedures by which data are gathered (for example, venipuncture) and manipulations of the subject or the subject’s environment that are performed for research purposes. Interaction includes communication or interpersonal contact between investigator and subject. Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a medical record). Private information must be individually identifiable (i.e., the identity of the subject is or may readily be ascertained by the investigator or associated with the information) in order for obtaining the information to constitute research involving human subjects.
Institution is defined in 45 CFR 46.102(b) as any public or private entity or agency (including federal, state, and other agencies).
For purposes of this document, an institution’s employees or agents refers to individuals who: (1) act on behalf of the institution; (2) exercise institutional authority or responsibility; or (3) perform institutionally designated activities. “Employees and agents” can include staff, students, contractors, and volunteers, among others, regardless of whether the individual is receiving compensation.”
http://www.hhs.gov/ohrp/policy/engage08.html
Consider this: “Researchers asked more than a thousand Californians if they would tell their primary care doctor about symptoms of depression. Almost half the people said they had their reasons for keeping the symptoms secret. The No. 1 reason: 23 percent said they feared that they would be prescribed antidepressants.”
http://www.npr.org/blogs/health/2011/09/13/140439308/fear-of-antidepressants-leads-people-to-shun-treatment
These days, if you haven’t been on these drugs yourself, at least you know three or four people who have. Most likely your fears have very little to do with Nature-Boy-or-Girl philosophy, and more to do with how mom, Uncle Ralph or your old friend from high school have fared on Big Meds.
Joel, I don’t doubt you’ve had patients who demand you keep up the hunt for the Right Drug, even after taking a dozen drugs that were useless or worse. I’ve met those people. I almost became one. But it takes a lot of systematic “education” (read demoralization) to get to that point. Overwhelmingly, people today hear the message coming from shrinks as one of hopelessness — far more than in the days before the Bio-Bio-Bio model. And no wonder. People with depression — depression! — are told they will never work again and shouldn’t try, that they have an illness comparable to chronic schizophrenia, and that they will need to be on neuroleptics for life. Once you take in that message, it’s more or less all over.
… “an illness comparable to chronic schizophrenia” … said innocently, without malign intent, by Johanna, demonstrates the enormous stigma and prejudices of the very word – extremely harmful to those so labelled. The mental diagnosis are constructs – laden to the hilt with generations of ignorance, fear, prejudice, discrimination, marginalization, used by vested interestes. No wonder many are chosing suicide.
a-non:
Thank you for more eyeopening links. I looked into the mental illness policy org, and found neutral-looking advice from the family-industrial NAMI, funded by Big Pharma, and the not-at-all-neutral E.Fuller Torrey, with his own yearn to spin. The governmetal link tells us that research is activities yielding generalized knowledge.
No one – not shrinks either – wants to be seen as a generalized specimen, to be treated as something less than human, less than his/her self, concrete, alive, the particular human being with the human rights of all and everyone.
Cambridge University Press last year published the first textbook I know of, “Mental Health and Human Rights: Vision, Praxis and Courage”, by M. Dudley, D. Silove, F. Gale. 2012.
Universal Human Rights can curtail , and hopefully, some day, end the abuses, if we will. Three days ago Norway ratified UN CRPD, though with major reservations, that we shall have to overcome. But that major, first hurdle is behind us.