After reading a post by Carl Elliott on this website in which Elliott discussed his upcoming presentation to an audience at a Pharmed-Out conference, I went to the Pharmed-Out Web site and ordered the tapes of their annual conference. Pharmed-Out is an organization at Georgetown Medical School of professors and students who are demanding that the training that future doctors receive reflect valid conclusions based on research untainted by the self-interest of purveyors of devices and pharmaceutical companies.
In the present climate, the truth proves elusive. Almost all clinical studies of various drugs are designed and funded by the pharmaceutical companies. Only the studies which support efficacy of a drug are published while the more numerous negative studies are rarely acknowledged. While companies are supposed to register the studies they are conducting so that planned timing of study endpoints are public knowledge, these requirements are often ignored.
Thus, when drug efficacy is lacking at the planned evaluation time point, companies scan the data for a time point when the drug seems efficacious. Then the company capitalizes on chance variation and publishes the positive finding. Drug companies pay “Key Opinion Leaders” to put their names on such questionable reports, and to provide continuing medical education for the practicing physicians.
The end result is that even when physicians want to provide the best of care, they are limited by corruption of the sources from which they derive their information. This point is effectively documented by Ben Goldacre. In a Ted Talk, Goldacre related his attempt to garner accurate information about a particular antidepressant and his later realization that he had been duped.
Marcia Angell, editor of the New England Journal of Medicine for twenty years, and her husband, Arnold Relman, have written extensively about the unhealthy relationship between pharmaceutical companies, purveyors of devises, medical education and the FDA. Of late, the story of corruption in medicine is receiving more focused attention. Recently, articles on the influence of the pharmaceutical companies on how doctors are informed appeared in the Washington Post (see Peter Worisky, November 24, 2012) and Scientific American (Charles Seife December 2012,).
The 2012 documentary, Escape Fire, also talks about bad medicine (this can be documented for statins–see books by Stephen Sinatra and Duane Graveline) and Democracy Now’s U-tube interview with Steven Nissan on Escape Fire, focused on over-treatment. Several recent books (Overdiagnosed by researcher and physician H. Gilbert Welch et al. and Seeking Sickness by Alan Cassels M.D.) have questioned the value of screening for various diseases which ends up doing very little to effect end points, results in sometimes harmful treatments, and costs lots of money.
Otis Brawley, the chief medical director of the American Cancer Society, in his 2012 book How We Do Harm: A Doctor Breaks Rank about Being Sick In America, discusses the widespread use of a medication that was supposed to reduce fatigue in patients undergoing cancer treatment. Although there was evidence that the drug increased red blood cell production, fatigue reduction had not been established. Despite the lack of evidence for reducing fatigue, the drug was widely used.
Later evidence emerged that the drug promoted tumor growth. In addition to stories about bad drugs and overtreatment, some have articulated the mechanisms enabling the current state of affairs. For an inside look at the power structure in medical schools, Doug Bremner, an Emory Psychiatrist, in The Goose that Laid the Golden Egg, discusses the pressure coming from the Emory medical school in response to his study documenting the suicidal-ideation-inducing effect of Accutane, a drug used to treat acne.
In the coming weeks, congress will be focused on reducing the national debt. There is a lot of talk about cutting entitlements, which include Medicare and Medicaid. We do have the world’s most expensive health care system, although we are not even close to being a nation with the best health. With the recognition that medications taken as directed are a leading cause of death (see 2000 JAMA by Barbara Starfield), one would think that someone would be asking the obvious questions.
To his credit, Republican Senator Charles Grassley has been a strong advocate for reducing pharmaceutical company influence at the FDA, for investigating ghost writing of articles in medical journals, and eliminating the use of strong medications for foster children.
Perhaps corruption in medicine can be one of the few issues on which Republicans and Democrats can agree. But, just as Dick Durbin said about the banks’ influence over congress, perhaps the pharmaceutical companies own the place. So, demanding integrity from the system will require a sea-change. Will the people demand it? Only if they know they are being mistreated by segments of the medical community they’ve always trusted.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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Thanks for this post, Jill. It is not a defense of psychiatry to point out that there are problems throughout medicine. I sometimes find, however, that commentators on this site believe that the rest of medicine is immune from the problems of psychiatry.
We have an expensive health care system but we do not have good outcomes. If we elminated treatments that are in effective and in many cases harmful, we could provide quality care and control costs.
Thanks for reading the post. I continue to be amazed at what doctors are pushing. A microbiologist friend of mine has Sjogrens. She was told that she has osteopenia. I told her to hold on and I’ll look it up. I then find review articles discussing the dissolving of the jaws should bone be exposed (which is highly likely in my friend’s case because her mouth is often full of lesions), as well as the fact that bisphosphonate work because they inhibit osteoclasts. So, bone repair cannot take place. Effectively, the osteoblasts are putting down new concrete on a structure with fissures. Terrible idea really. (I wonder if Sally Fields knows she should not be dancing around.) Then, I go to my yearly physical yesterday. I’m handed an electronic check-in gadget, with the introductory statement “paper, is so 20th century”. I respond to the obligatory questions about the status of my insurance. Then comes the advertisement for Abilify. I query my doctor on his knowledge of atypicals. (To his credit, he’s against the stuff.) He tells me that the check in gadgets come for free and he has no knowledge of what’s on them. Maybe trusting your doctor is also “so 20th century”.
Any condition that is ubiquitous and chronic is targeted by the drug companies. It seems that almost all of my patients are on proton pump inhibitors (prescribed by the PCP). I am all for reducing the pain and suffering from heartburn but is it really that common?
That stroy of direct to consumer advertsing in the doctor’s office should not surprise me anymore but I admit that it does. Just this week, I got an inquiry from someone in our human resrource department. A very nice nurse came to offer to teach our staff (not medical staff)about helping people stay well after discharge from the hospital. The training was free and she was even going to bring lunch! I read the e-mail and at the very bottom it mentioned she was supported by a pharmaceutical company!!
There is no free lunch!!
Psychiatry never had a soul to lose in the first place.
It’s not just doctors. I have a nurse practitioner. I raalized that I can’t trust her when it comes to medicines when she thought that 18,000 mg of Effexor XR would only make a person sleep. Wrong! you’ll sleep alright; and never wake up! From that day forward the only thing I’ve allowed her to perscribe for me is my blood pressure medicine and then we had to have a long discussion about which one I was willing to take and all the ones that I wasn’t going to consider.
Some of the things that doctors tell people are so off the wall that I can’t believe anyone falls for it, but people do. A friend of mine was put on an antidepressant AND an antipsychotic by a doctor because “the antipsychotic would jump start the antidepressant amd make it start working faster!” My mouth fell open when my friend shared this with me and he firmly believed what the doctor said!
A young man that I dealt with at work told me he was schizophrenic. I asked him how he knew he was schizophrenic. He said a psychiatrist told him he was. I asked him how the psychiatrist knew this and he said that the psychiatrist told him he was schizophrenic because he was so intelligent that his brain made an overabundance of dopamine and too much dopamine created schizophrenia!
I never cease to be amazed at what I hear from ALL branches of medicine these days!
Psychiatry and other branches of medicine should never be compared. Surely there is corruption of clinical trials not to do with psychiatric drugs. However, no other branch of medicine is able to involuntarily force those drugs onto people. Also, no other branch of medicine has targeted and drugged millions of children with drugs that cause irreversible brain damage.
Although I’m not sure we should ever call the brain injury from psychiatric drugs “irreversable.”
The brain holds enormous potential for regeneration – neuroplasticity. There has been some good research in this area… and it is very promising, hopeful.
Neuroplasticity is an area where “more research is needed.”
oops, typo – irreversible
A few months ago I tried to find a tactful way to tell my family doctor’s NP that my blood pressure medication was causing me worrisome side effects. I mentioned side effects to her, and then said “You know, I’ve been reading on the internet that. . . ”
“Yes,” she interrupted tartly. “That’s the problem!”
Looks like the real problem is that patients are just getting too damn smart these days. Back in the good old days, this would never have happened.
“If you want something done right, you have to do it yourself. This especially includes your health care.” – Andrew Saul, Ph.D., Editor of the Journal of Orthomolecular Medicine
More on his website (including nutritional information for “severe mental illness”) –
Use the search engine on his site.
I’m also into food. Check out Bharat Aggarwall, biochemist who works on cancer. Also see what Charles Serhan has to say about omega-3s. Really exciting stories.
While all of medicine is overly influenced by commercial interests, only psychiatry is so thoroughly contaminated, from diagnoses to treatments to denial of adverse effects.
(I would agree that the patient has to play defense and do a lot of research before accepting any recommendation for any drug or treatment.)
littrell, I posted this question to you elsewhere. perhaps you can explain this to me. I’ve been looking for clarification everywhere.
Can you tell me how grieving, for example, becomes depression after a couple of weeks? What is the model based on the inflammation theory you espouse?
Further, is it possible the inflammation theory has arisen to fill the vacuum of the discredited “chemical imbalance” theory, to provide a justification for the prescription of psychiatric drugs on the grounds of improving physical health?
I’ve looked at the studies and it seems to me they are all confounded by the possibility of subclinical or co-existing physical illness. People who feel lousy (from inflammation) might complain of symptoms (feeling low, fatigue) that may be misdiagnosed as “depression” and mistreated with psychiatric drugs.
Throwing psychiatric drug prescriptions at unrecognized physical problems happens all the time, particularly for middle-aged women. Could this not be so common it would contaminate any studies on “depressed” people, finding inflammation not related to the “depression” but to the physical ailment?
The research grounding for the inflammation theory seems to me to be motivated by a need to keep the bio in biopsychiatry rather than an interest in patient health.
So what is the continuum from grief, a normal emotional reaction, to “depression”? The theoretical underpinnings for the DSM-5 entry holds the symptoms of the two conditions to be identical.
Of course, this issue requires a long explanation. Please see my article published in Frontiers of Psychology which is an open access journal. The case for psychological stressors resulting in systemic inflammation has been validated in animal work. Researchers shock the animal and then examine brain inflammation and peripheral inflammation. You see both inflammation in periphery and brain. Also, it is known that exposure to psychological stressors will cause leaky gut. (The autonomic nervous system controls the leakiness.) Given a leaky gut, there are more pathogens in the blood stream. Thus inflammation occurs. With regard to this point of view justifying more drug treatment, antidepressants are anti-inflammatory short term. However, long term they are inflammatory (see documentation, there’s a lot of it, in Frontiers article). Thus, antidepressants are not a good idea. What is a good idea are dietary interventions that are anti-inflammatory: omega-threes (fish oil), curcurmin in turmeric, folate, B-12, N-acetylcysteine. Exercise and meditation also good. In the future I’ll be writing more on these issues. There is an entire literature (see J.R. Hibbeln) on omega-threes being good for schizophrenia, ADHD, post-partum depression, major depression. The people at NIMH know about this. Why aren’t they working on better delivery systems? You can’t get a patent for omega-3s?
sorry I missed your question. In the future, if I’m not responsive, feel free to use my school e-mail [email protected]
Case in point: Leaky gut. Is “depression” (universally poorly defined) a cause or consequence of leaky gut? Is the inflammation a result of leaky gut or emotional stress?
Is leaky gut due to emotional stress or eating too much junk?
For many people, bad habits or unhealthy lifestyle lead to physical conditions that may cause them to feel sub-par emotionally.
Given evolution’s investment in negative emotions, wouldn’t you say organisms are stocked with them for a good reason? Don’t they indicate a situation that should be escaped?
If, for example, people stay in distressing situations until they get sick, wouldn’t that be a cultural pattern rather than a biological imperative?
I strongly question the inflammation theory of “depression.” First of all, it depends on what you call “depression.” (Anthropomorphizing animal models — what could be the fallacy in that?) Second, cause and effect are not at all clear.
The theoretical setup smells fishy to me, and more of the same ol’ propaganda from biopsychiatry empire-builders.
I think the thinking is that when someone is stressed by being in a field of battle or losing a loved one, then the sympathetic nervous system is activated which will alter the connections between the cells lining the gut.
I think, as do you, one should set up life for enjoyment and less stress. However, some people volunteer for stress, e.g., med students. There is a study where Ron Glaser showed that giving med students omega-3s enabled them to experinece less stress during exams.
I think that the dismissal of all things physiological before one is familiar with data on the immune system and neuroscience creates the danger of being a “flat earther”. I have no argument with all behavior, normal and abnormal having a physical base. (My problem is then about the, then what part.) However, I am not selling this point of view. As they say in AA, “take what you can use and leave the rest.”
You make some good points.
There is some good science in areas such as absorption difficulties (leaky gut) and nutrient deficiency and their links to “mental illness.”
I’m not interested in getting rid of a ‘one-size-fits-all’ model of psychopharmacology only to replace it with a one-size-fits-all model of talk therapy. I know some folks who’ve had all the talk therapy they can tolerate and are no more functional than they were years before. Sure, it works for some, but not everone. Such is the case with all of this stuff. All of it.
This seems like such a no-brainer, yet many folks are convinced there is *never* an underlying physical condition involved. Not ever.
I’m hardly a “new ager”… but I don’t ignore the obvious things in life. One is this simple fact: The body and mind are connected. Emotions can cause decline in physical health; underlying physical conditions can play havoc on emotional health. It’s not rocket science (and thankfully, not brain sugery).
oops, “Dr. Littrell” (not Littrell).