A Long and Troubled Relationship

Jeremy Wallace, MD
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I am writing this because I feel furious. Because I’ve had to sit through another dreadful presentation by a pharmaceutical representative telling half-truths and lies. No one but me questioned these. If you show a slide in which a depot injection reduces relapses, compared to an oral preparation, then know this – dopamine super-sensitivity caused by coming off the oral medication is real. It probably causes the sudden relapse, rather than any intrinsic disease. If this is used this to justify some economic analysis that a new – very expensive – injectable antipsychotic will save one’s healthcare organization money by reducing relapses and therefore expensive re-hospitalizations then, by the previous point, you’ve created a false economy.

And where in the analysis is the cost of all the excess morbidity and mortality caused by these drugs? Diabetes, a common side effect of most atypicals, for example, is estimated to cost the National Health Service in Britain £25,000 per minute. To me, a more truthful reading of this economic analysis is that depot injectables ensure the company a steadier income.

If one slide includes pictures of brain scans of people who don’t take their medication, progressively atrophying, until you are left with something looking suspiciously like Alzheimer’s disease, then I’m afraid it is lying. I wrote to the rep. asking for some source documents for these claims. He sent me the slide. The images are drawings not photographs. They depict four pictures of the two third ventricles in a sagittal plane (i.e. from back to front) which on the first are weirdly, abnormally small, like a pea; and by the fourth, have grown, comparatively, to the size of orange segments.  Like all advertising they are fictions that try to make an emotive appeal, rather than muddy the water with facts.

The references at the bottom of the slide, are to two papers by Lieberman J. A. (2001 and 2006). The flaws in Lieberman’s studies have been discussed by Joanna Moncrieff here http://joannamoncrieff.com/2013/12/13/antipsychotics-and-brain-shrinkage-an-update/. Lieberman’s studies have now been superseded by Nancy Andearson’s (2011, 2013) studies which, to my mind, conclusively show it is the drugs which cause the atrophy and not any disease process. There are other recent studies to back this up. Furthermore, by their own admission, in a systematic review for the BJPscyh (2006) Steen et al (Lieberman J.A was a joint author) state “average volumetric changes are close to the limit of detection by MRI methods”, meaning that you wouldn’t see it with a naked eye, let alone capture it on some crude drawing. I wonder if Jeffery Lieberman takes as much time and energy castigating the drug industry for misrepresenting his data, as he does about attacking anyone being critical of the heroic profession of psychiatry.

I started training as a psychiatrist around the time Prozac first came onto the market. I remember the advertising well. At least in Britain, the leaflets, put in front of me by the pharmaceutical rep., depicted a climber, a man, standing on top of tall, priapic rock. The words read: Leadership is not given, it is earned. I used to argue with the rep. saying, of course, in the case of Prozac, it has been given: You are all over the press; there are books written about Prozac, You have entered the public imagination; Prozac is a household name. I had little idea back then of how Lilly had manipulated and influenced all the above. There was no internet back then.

Thanks to the internet, and to people like Peter Gøtzsche, David Healy and Ben Goldacre, we now know what earning leadership actually means; John Virapen, the Lilly executive turned whistleblower, had bribed a doctor, acting as an independent expert for the Swedish drug agency, to get Prozac approved in Sweden, thereby, opening the gates to the rest of the world (Gøtzsche 2013). SSRIS have also, more recently, been shown to be no more effective than placebo (Kirsch et al 2008). The tall, slender rock begins to look suspiciously like a middle finger, stuck up at the world, as if to say, we can do what the hell we want, including, as it turns out,  killing a few people along the way (Healy 2012).

Throughout my training, the pharmaceutical industry were a constant presence. This included visits from pharmaceutical representatives, sponsored academic meetings, lunches of supermarket sandwiches brought to our team base, being taken out to dinner in the evening with other doctors and, even, once, a weekend conference in Barcelona. Sometimes the drug was barely mentioned. I confess to not giving it a second thought. How could this influence me? I thought. Besides, nearly all my fellow trainees went along with this. It was part of the culture of my training.

I became an NHS consultant around the time new rules for engagement between the pharmaceutical industry and clinicians came into play. Despite this, I can now look back and see, just how hard they tried to hit on me: Increasing the visits; invites to academic meetings; invites for training opportunities to become a better public speaker; and e-mails asking if I knew who the key opinion leaders in my area were. I confess to feeling a little insecure about not knowing who they were, as if it was important. Now I know it isn’t. In fact, the phrase ‘key opinion leader’ should probably come with a health warning.

I have previously written about an experience of coming to my senses, regarding the state of psychiatry, after reading a Peter Breggin book. In the wake of that experience, having read widely and thought much, I am increasingly aware of the inherent problems in the current system, in which the pharmaceutical industry and economics are driving forces.

These days I notice the heavy presence of the pharmaceutical industry at nearly every academic-focused doctors’ meeting, peddling their potions with a cheesy smile and a plate of sandwiches. At the biannual Finnish psychiatry meeting, a whole floor is given over to a pharmaceutical trade fair. Each company offering a bowl of free sweets to the circulating psychiatrists, who, to my mind are like infantilized, modern day Hansel and Gretels. It’s not a bad analogy. Most of my colleagues are either, in denial, or blissfully unaware, of the influence this cozy relationship has on the way they practice.

Unless I am to be an island unto myself, I cannot avoid the pharmaceutical industry altogether. To remain connected and keep up with Continuing Professional Development (CPD), I have to attend some meetings. I have learned to buy my own coffee and refuse any promotional literature, or the ubiquitous office stationary on offer. I realize that, if accepted, I promote their wares through a process of subtle product placement. Likewise, when I moved to my new office about a year ago I cleansed it of all drug logos including the patient information leaflets, kindly sponsored by the pharmaceutical industry. Theirs’, I feel, is a very self-promotional, one-dimensional discourse of mental illness and disordered neurotransmitters, surrendering easily to the beneficial effects of medication.

At first, in meetings, I didn’t ask any questions or make comments, more due to self-consciousness about my terrible Finnish. But I took note of the material being presented, the mode of presentation, the slickness of delivery. I remember a video being shown of a long-acting depot antipsychotic molecule dissolving like a slow-motion, exploding death star. It seemed high on gimmickry but curiously devoid of science.

In another presentation a line graph showed the efficacy of low-dose quetiepine (in the guise of an antidepressant adjunct) verses placebo. What seemed remarkable is how the shape of the graph for both drug and placebo were similar, but for quetiepine the response was a couple of points ‘better’ than the placebo on a standard measure like the HAMDS. Fundamental questions — such as; how significant is this clinically? Or; aren’t we witnessing a clear example of exaggerated placebo response? Or even; do you have any data about what happened beyond the incredibly short study time? — Didn’t get asked. To any doctors out there unconvinced by what I am saying, a modicum of critical reading can help make sense of some this stuff.

These days, with a little more fluency in Finnish, I ask the questions. I frequently ask if they have any data on how easy is it to stop taking these drugs, which leads to flat denial or some fuddled nonsense. I sometimes do a quick search with my smart phone, for further information on the drug in question. In a presentation about injectable paliperidone, I found out that at least 30 people had died in Japan 1 month after being given the drug. The pharmaceutical rep’s face looked not unlike Snow-white’s step-mother’s face on finding her nemesis still alive when I asked her to comment on this.

Psychiatry and the pharmaceutical industry are deeply entwined. As Joanna Moncrieff (2013) would have it, the history of psychopharmacology, is the history of modern psychiatry. The profession has been lead down what Moncrieff argues is a blind alley of self-deception and denial. On the one hand, the disease model is readily exploited by the drug industry to further their economic interests; on the other, psychiatry has so embraced this model that psychological, social and alternative interventions are seen as secondary or adjunctive to the medications. Whereas, I am sure many here would agree that the best we can expect of medication is providing some temporary symptom relief.

Worryingly, challenging this hubris can sometimes have disastrous consequences. David Healy has talked about the persecution of heretics in his blog-posts on MIA. In Finland last summer a psychologist, Aku Kopakkala, lost his job for appearing on a current affairs television program about SSRIs. In the program, Kopakkala is very measured in the way he discusses the possible negative effects of SSRIs, for example saying that they may lead to chronicity of depression and are notoriously difficult to stop. He questions the wisdom of their widespread use in Finnish society.

His employer, a private health care organization called Mehiläinen, stated the reason for his dismissal was that the position of his employment had been stated in the program and that Mehiläinen’s employees had been instructed not to publicly criticize the national treatment guidelines for depression.

What this incident demonstrated about the state of public debate and freedom of speech in Finland is somewhat concerning. It seems inconceivable that anyone should lose their job for questioning the use of SSRIs and backing up his arguments with well-validated science. But would it surprise you if I told you, that the Vice President of working life services at Mehiläinen had previously been managing director at Pfizer Finland? From the side lines it looks suspiciously like an attempt to silence a critical voice rather than a fair dismissal.

Moreover, Käypähoito, who publish the national care guidelines, state on their web page: That the guidelines are meant to be objective and based on scientific research evidence; that the body of scientific evidence increases daily; that treatment practices should be evaluated continually in light of the latest scientific knowledge; and the goal of Käypähoito is to encourage a critical and constructive debate about treatment guidelines. Ideally, care guidelines exist to protect the public, which is why openness to scrutiny, as well as impartiality (lack of conflicts of interest), are important values to try and uphold.

Following this incident there was a public outcry. A support Aku Koakkala, campaign was started on facebook, which had grown to 10,000 likes within a few weeks. People started talking more about the role of medication in the treatment of depression. People were able to openly discuss, sometimes for the first time in a public forum, their horror stories of SSRIs. Others talked about how they had been helped by medication. There was openness and debate. These are the signs of a healthy state.

Subsequently, there have been meetings with peers and survivors who are keen to set up medication reduction groups. Aku Kopakkala has been central in helping to steer these groups forward. He’s been busy writing a blog, as well as starting to write a book about his experiences. He is also standing as the Green candidate in the Helsinki area, for parliamentary elections this year. One of the central themes of his campaign is addressing the over-medicalization of Finnish life, especially within mental health.

One of the strangest responses to all of this came from within psychiatry. Two prominent psychiatrists wrote articles, one in a newspaper and another in a medical journal, suggesting that only medical professionals should be able to critically appraise the medication; certainly not a psychologist. One even wrote that scientific arguments should not be presented at all in public.

To me this indicates a tenuous grip on what post-modernity is all about, as well as violating a basic rule of civil discourse; arguments should never be ad hominem — i.e; questioning the credentials of the person discussing the science — but rather ad rem, i.e; addressing the data, evidence, and arguments being presented. Moreover, in my experience, psychologists generally have better training in research methodology than doctors do. And, of course, anyone should be able to appraise medication, especially the patients, as they embody – literally – the experience of the drugs’ effects.

Finally, to tie it in with how I started, doctors are badly placed to appraise the science around medications. They are the very group to which, drugs are marketed. They are the ones who read the ghost-written journal articles. It is their continuing medical education that is largely funded by pharmaceutical companies.  It is they who, in the interests of overcoming their cognitive dissonance, overlook the myriad conflicts of interest they are confronted with in daily clinical life.

Most ridiculously, if you can’t bear a psychologist talking about medication, why do you entertain and put up with pharmaceutical representatives on a regular basis? Many of them don’t even have a science degree, let alone clinical experience. Why is our profession so beholden to the drug industry? Do we just follow the money? Or are there more noble values that we should be manifesting? I certainly think so.

* * * * *

References:

Andreasen, N.C, et al. Progressive Brain Change in Schizophrenia: a Prospective Longitudinal Study of First Episode Schizophrenia. Biol. Psychiatry 2001 Oct 1;70 (7): 672-9.

Andreasen, N.C, et al. Relapse Duration, Treatment Intensity and Brain Tissue Loss in Schizophrenia, a Longitudinal MRI Study. Am. J. Psychiatry 2013 Jun 1;170(6): 609-15

Gøtzsche, P. Deadly Medicine and Organised Crime: How Big Pharma has Corrupted Health Care. 2013 Radcliffe Publishing, London & New York.

Healy, D. Pharmageddon, University of California Press, 2013.

Kirsch, I. et al. Initial Severity and Antidepressant Benefits: a Meta-analysis of Data Submitted to the Food and Drug Administration. 2008, PLoS Med 5: e45–e45.

Lieberman J. A, et al. Longitudinal Study of Brain Morphology in First Episode Schizophrenia. Biological Psychiatry, 2001, 49, 487-499.

Moncrieff J. The Myth of Chemical Cure. Palgrave McMillan, 2013.

Steen R. G, et al. Systematic Review and Meta-analysis of Magnetic Resonance Imaging Studies. British Journal of Psychiatry (2006), 1 8 8 , 510 -518

37 COMMENTS

  1. Thanks for an engaging read. I like the point about keeping the facts in focus in discussing these things, not the qualifications of the persons talking.

    Reading the Andreasen articles (2001, 2013) I get the impression, that there are different interpretations of them regarding the possible negative effects of antipsychotic medication on brain volume. Apparently they conclude that medication causes atrophy but so does relapse/psychosis, and therefore medication should be used at lowest possible dose but possibly for life?

    Can anybody point me to posts, sites, articles that tries to give an overview/a good discussion of the different ways of understanding these data – and what implications the different views have for treatment?

    Best
    Jonathan

  2. Dr. Wallace – Your radical conversion after reading Breggin’s expose’ still shows you taking off like a rocket with the work on your perspective that you share here. Let’s qualify the point about ad hominem by following up it’s relation to credentialism more widely, too. I’m sure it crosses your mind, in writing your articles, besides inspiring openness and courage among your colleagues, to lift the very general and profound blanket condemnation of the voice of mental patients in treatment as well as survivors who already have taken heart. I see your interests in how treatment might prove to work–at long last–more therapeutically from the patient’s perspective to reflect the attitude by which I chose to remain labelled and compartmentalized within the service mazes here in the U.S. for the first fifteen years of coping with my dysfunction in the recommended way. My careproviders never had my faith in their rituals and beliefs, though. They just proved everything Szasz said about narrowness of mind and self-styled liberals acting out and calling it healthy and kind.

    Since my childhood involved me with heavily intertwined give and take between the public and parochial school systems, and I understood this tertiary influence early on, Szasz was easier for me to read when he developed metaphors and analogies for sacred symbols, priestly relations, heresy, and such things in explaining institutional corruption by analogy. I hope that you will keep an eye open for why various colleagues of yours could not open up to Szasz, Breggin, Foucault, who just suddenly make themselves look alive now that all of Bob Whitaker’s books format data for them. I know why in general, but how could they stand & how did they stand looking at the collateral damage and taking their jolly time charting it as progress?

  3. Its always nice to hear from a sober doctor who understands science and embraces ethics in practice. Perhaps the best solution to the rampant corruption to the psychiatric profession would be not to just publish the payments from pharmaceutical companies to doctors but to outlaw the bribes altogether.

  4. just want to say thank you, dr wallace, for your sense and clarity and good in a sea of denial at best and destruction at worst.

    my husband’s ( and mine, and the kids) life has been wrecked by these drugs and the criminals who fed them to him. there was NOTHING wrong with him before. now, there is no part of our lives untouched.

    please, please, for my family, and all the others, keep up the good work. you are on the inside. you command respect. when i try to speak the truth about the psychotropic drugs i am labelled the nut.

    strength to you as you go forward.

    erin

  5. Dear Dr Wallace,
    Thank you very much for expressing your anger so skillfully.

    There is such a thing as dopamine supersensitivity syndrome, I’ve had it: I was happy to refuse medication in the beginning, but when I tried to come off it some years later, I nearly went mad in the process.

    I did come off it eventually though, through careful taper.
    But I did end up with new anxiety and misery type problems that I never had before.

    Crisis is frightening, but its an emotional type of thing that eventually runs out of steam, isn’t it? I think the main problems are the problems behind a crisis.

    I know in my own case, that I needed to straighten my head and this is why I’ve remained well (it was nothing to do with brain “illness”).

    Thanks again for speaking out.

    • I agree with others, thank you Dr. Wallace, for your honest assessment of what is going on within the psycho / pharmaceutical industries. I’m very grateful for the ethical psychiatrists who are standing up against the mainstream; I know it takes a very strong person to do this. Thank you.

      I also agree with Fiachra, that drug withdrawal induced super sensitivity manic psychosis does occur, but I know there are quite a few articles now being written about this neuroleptic withdrawal problem, so I would imagine you are aware of it. And the fact that it should not be called a return of symptoms, thus proof of any so called mental illness.

      I would also like to mention, however, that some people do NOT benefit in the short run on neuroleptics either. And my research has found the proof that the neuroleptics can, indeed, cause the schizophrenia symptoms. From drugs. com:

      “neuroleptics … disopyramide … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      Personally, as a grown adult, I was made psychotic for the first time ever on a child’s dose (.5 mg) of Risperdal (in conjunction with 50 mg of Voltaren, and since both the Voltaren and disopyramide are both sodium channel blockers, this may be relevant, I’m not certain).

      But I have extreme concern that since the symptoms of schizophrenia and the central symptoms of neuroleptic induced anticholinergic intoxication syndrome are almost identical. It is possible that the most common cause of schizophrenia today may actually be psychiatrists misdiagnosing the central symptoms of neuroleptic induced anticholinergic intoxication syndrome as either bipolar or schizophrenia.

      I’d love to see research into this concern, especially given John Read’s research showing evidence between the correlation of adverse childhood experiences / child abuse and schizophrenia. Personally, I had concerns of child abuse called “psychosis,” and I have concerns it’s possible the most common cause of schizophrenia is doctors misdiagnosing symptoms of child abuse as psychosis, and then creating the symptoms of schizophrenia with their neuroleptics.

  6. Breggin is a good start. Whitaker adds clarity and accuracy. As was mentioned in an earlier comment, Szasz is important. Until psychiatrists (or would be psychiatrists) read Szasz, they are in the dark concerning the profession. Peter Gøtzsche, David Healy, Ben Goldacre and others are doing good work to expose medical mendacity, but even these great contributions only scratch the surface of what Szasz understood many decades ago. The psychopharmaceutical industrial complex is only successful insofar as it is able to exploit “patients” (or potential “patients”) through the pseudo-scientific confabulations of psychiatry and the power of the therapeutic state. Even if the evil of pharmaceutical companies were extirpated from the face of the earth, the sadistic seeds of psychiatry would remain to infect the ground. Until psychiatry is uprooted and its lies eliminated, the innocent will continue to suffer. Perhaps the question is “Why do people who are as good and as smart as Szasz even enter the field of psychiatry?”

    • I have the same question. I never thought that I could be a physician. I have considered studying law, but the thought of becoming a cop, a psychiatrist or a soldier never occurred to me, except maybe as a guerrilla fighter or a soldier in the Spanish Civil War. Before I was blind sided by psychiatry, if one had asked me my opinion, I would have stated that the two sides were in an intractable opposition to one another, and it is obvious that one should be rooting for the underdog-the patient.

  7. I remember my old psychiatrist’s office was over flowing with pharmaceutical brand name items: pens, clocks, note pads, paper weights. Every time I went to see my pdoc in the afternoon the remains of a pharmaceutical meal was still evident in the lounge room and pharmacy reps in the hall ways dragging their blue suitcases full of free drug samples. If my psychiatrist decided to change my psych drugs (he changed them constantly) he’d fill a a paper bag with free samples. Took me a long time to realize he did not know what he was doing and was throwing drugs at me haphazardly not caring about the consequences.

    Today I am psych drug free and feeling better than I ever did when heavily drugged.

  8. Please dr. Wallace, take one of the famous (infamous) ferries to Sweden and share some of your knowledge to our psychiatrists too.
    The denial of ssri hypocrazy is possibly even worse here, not one known critic.
    Why not team up with Goetsche and spread some critical knowledge here.
    I know I desperately need it, my 15 years of Seroxat is not a pretty fairytale.
    //Ove

    • The patents of the so-called-atypical antipsychotics have run out, or are about to run out. They’ve been just waiting to market you these new injectable forms of the same drugs. Why? Because these forms have a new patent. Then the marketers of pharma, lay psychiatrists, etc, go out and spread the word that this is the way to treat the patients.

      • And there is official collusion for this wastage.

        In 2005 my prescription of mellaril 25mg per day was halted and I was offered Seroquel at 25mg per day. Mellaril being discontinued in the UK due to its potential for heart rhthym interference.

        Seroquel (a lethal heart rhthym interference drug) was maybe 50 times more expensive.

        • Exactly. I googled the receptor affinities of Mellaril (thioridazine), and for instance it binds strongly to antihistamine receptor H1, etc. It’s the same receptor that quetiapine binds strongly to. That effect gives the strong sedation, and possibly also part of the heart issues. Both Mellaril and Seroquel have strong sedating antihistamine activity on the same antihistamine receptors (H1, etc), and I can’t see any rational point to switch medications like what was done to you, Fiachra.

          If you want just the antihistamine sedation of H1, you can buy the the OTC (in USA, not in Finland) drug Benadryl which sedates persons just like Seroquel in low doses.

          • Hi Hermes
            Thanks for the information. Mellaril has a half life of 22 hours and at 25mg it also had a type of dopamine withdrawal effect (in 2005 I didn’t know this, all I knew was that if I didn’t take the drug I went on edge).

            Seroquel has a half life of 6hrs and at 25 mg is a lot stronger on sleeping, so I cut the Seroquel right down. But eventually I found out that Seroquel at 25mg has no dopamine effect, so by switching to Seroquel I had ‘weaned’ myself.

          • Fiachra: “Seroquel has a half life of 6hrs and at 25 mg is a lot stronger on sleeping, so I cut the Seroquel right down. But eventually I found out that Seroquel at 25mg has no dopamine effect, so by switching to Seroquel I had ‘weaned’ myself.”

            Yes, Seroquel at 25 mg is very sedating because it works very strongly on histamine H1 receptors. That effect is possible useful in getting sleep, etc. In the long term, it may also havoc one’s metabolism, etc.

          • Hermes
            At a small fraction of 25mg per day I was experiencing a type of straining on heartbeat effect, and I noticed when I woke in the morning my chest, ribcage area was reddish and the rest of my body was white. When I stopped the Seroquel completely these symptoms disappeared.
            My sleeping was then diminished but I got it back with more daytime exercise.

          • Fiachra:

            “At a small fraction of 25mg per day I was experiencing a type of straining on heartbeat effect, and I noticed when I woke in the morning my chest, ribcage area was reddish and the rest of my body was white. When I stopped the Seroquel completely these symptoms disappeared. My sleeping was then diminished but I got it back with more daytime exercise.”

            When I started quetiapine (same as Seroquel) at 25 mg, I started to get some weird heart issues just when going to bed. Just when I was falling asleep, I was awakened be some kind of heart shock. There also started to randomly appear some strong and large red spots around my body, meaning some type of issues with inflammation, immune systems and so on.

            It’s true that Seroquel at 25 mg does not really affect dopamine systems. At the same time, it’s a very strong antihistamine in H1 receptors, similar to Benadryl, in those doses.

          • Hi Hermes,
            I believe Seroquel is banned in the American military and has a black box warning (in America) as well, because of its dangers.

            The strange thing is that I did have occasional palpitations while on Mellaril, but not the scary straining on beats that I experienced on Seroquel.

            To me the prescribing policy looks like a rigged market; the way to make the money being with official assistance.

          • Fiachra said:

            “The strange thing is that I did have occasional palpitations while on Mellaril, but not the scary straining on beats that I experienced on Seroquel.”

            These drugs work on many different receptors besides dopamine and histamine. Adrenergic, serotonin, acetylcholine, etc. Each drug has a bit different profile on which receptors they affect on. One drug also has different relative effect on different receptors based on dosage. For instance, 25 mg of Seroquel has lots of histamine effect relative to effects on other receptors, while 600 mg has much more dopamine effect yet not that much more histamine effect than 25-100 mg of Seroquel.

            For instance, I with thioridazine there are effects that are different from those of quetipine. For instance, the action of these drugs on alpha adrenergic 1 and acetylcholine receptors probably are involved in cardiovascular related issues. Each of these drugs work on a similar set of receptors, but they vary on which receptors they prefer to activate.

          • Fiachra, here’s an article concerning QTc prolongation with neuroleptic drugs:

            QTc Prolongation and the Use of Antipsychotics: A Case Discussion

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419398/

            “Despite the documentation of prolonged QT intervals with all of the above-mentioned antipsychotics, significant evidence of TdP is linked only to use of thioridazine (and possibly other low-potency antipsychotics), droperidol, and haloperidol. Among antipsychotics, thioridazine is most closely associated with TdP. Other low-potency antipsychotic medications may also be associated with TdP; however, thioridazine, unlike the other low-potency antipsychotic medications, acts as a calcium-channel blocker, and it may be this property that leads to elevated rates of TdP.”

  9. It’s always good to see an MD challenging the status quo. More than one study has shown that doctors think they aren’t influenced by advertising (but others are) though their prescribing habits say differently. Even just using a pen with the drug’s name on it increases the number of prescriptions they write for that drug.

    Psychiatry has broken with psychology to the degree that there is a stunning lack of self-awareness among too many psychiatrists. Silly doctors, of course advertising and marketing works, otherwise, it wouldn’t be everywhere you turn and pharmaceutical companies wouldn’t be spending more on it than they do on R&D.

  10. Jeremy,
    I know we are allies but I wonder if you truly have to sit in on there presentations. I think we can expect nothing less than a promotional presentation when we are hearing about drugs from a sales person. I also understand the problem goes deeper since so many academic psychiatrists have conflicts of interest. There are places (at least in the US) where one can go to get somewhat less biased educational credits.

    • I don’t know it makes a difference, but unlike USA, in Finland pharma is not allowed to directly advertise prescription drugs to consumers. What they do instead is to advertise directly to doctors in their conferences, papers, advertisements and so on. Other technique they use is to publish for public some “official information sites” about schizophrenia and the best ways to treat it (currently of course atypical drugs or injection forms of these drugs). There are chief psychiatrists going around teaching other psychiatrists about the awesome effects of these new injection medications.

      • As an example of “promotional sites”, when I was an inpatient in a Helsinki psychiatric clinic, I noticed in the waiting room that there was a large promotional for this site in the waiting room for patients: http://www.skitsofreniainfo.fi. When you click it, yeah, it’s not direct promotion to patients, but it’s from Lundbeck Ab, makers of injectable neuroleptics. When you click the first link, it says in the end, quoting Heli Pilvilampi from Aurora hospital. I don’t have time to translate it myself, but you’ll get the idea with this Google translate:

        “Schizophrenia relapse fastest way to the situation in order to balance is usually achieved by modifying the person’s medication. Because relapse is often caused treatment interruption, Pilvilampi, the alternative is to practice therapy resumption of the old medication strengthening or replacement. In particular, long-term injections at this stage are recommended:” Pretty soon we will usually talk about these long-acting injections in favor – especially if the pre-drug therapy has been interrupted. Their advantage is the ease of use, efficiency and smooth effect on your body. ”

        Patients’ attitudes injections varies, but mainly they are perceived positively: “For some it’s just a matter of course, and a good thing, that once a month to get the injection, and that’s all. Of course, it also requires further staff motivation and merits emphasis. Family support is also changing the type of treatment is still very important, “Cloud Lake says.

  11. Why oh why do we not have more trained psychiatrists like Dr. Wallace? We can only hope others support his work and get off their lazy professional drug-company controlled arses to think like the scientists they are suppose to be and act in good conscience in treating their patients – not like the pathetic pharmeacutical-industry puppets they are now.

    Thank you Dr. Wallace for all your dedicated work and leadership.