1 Boring Old Man

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 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.