Foreign Correspondents

The invitation from the London Review of Books to review Ben Goldacre’s Bad Pharma™ reads: “We were unsure, at first, what a review could add that isn’t already in the book – scrappy summaries and bits of praise are not for us. The book is of sufficient importance that the main thing is to get someone who knows what they’re talking about to present the material confidently... frame the discussion”. My head said it was inconceivable that the LRB wouldn’t take a review, even if it was at odds with the invitation to praise Bad Pharma. But my gut told me the inconceivable was about to take flesh.

It’s funny how things turn out. I would never have anticipated becoming interested in the way in which psychological treatment is provided to people. A benign comment by a manager at the beginning of my clinical psychology career, however, piqued my interest and things have never been the same since.

In Paris today we have a lot of people mouthing words that come easily: "Je Suis Charlie." For anyone who wants to be Charlie, who wants to get to know what modern politics is all about, by feeling it in your marrow, try reporting an adverse event on treatment to your doctor. Outside your doctor’s surgery/clinic/ consultation room you can believe you are operating in a democracy. Inside the room you may be treated with courtesy and apparent friendliness but you are being treated in an arrangement set in place to police addicts. This is not a domain in which ideals of Liberty, Equality or Fraternity are welcome.

In 1956, Lou Lasagna was on his way to being the most famous doctor in the United States; an advocate for controlled clinical trials of both the safety and effectiveness of medication, as well as for a revision to the Hippocratic Oath to include a holistic and compassionate approach to medicine. Then, caught in the nexus of reason, regulation, and the pharmaceutical machine, his star fell.

The idea of spending more time as a bureaucrat in the US Embassy in Iceland did not appeal to me. I longed for the freedom that academics have. While pursuing that dream I stumbled into the world of international media, “chemical imbalance”, book publishing and a greedy professor of psychiatry which was a prelude to my second annus horribilis.

I quit taking Prozac using a step-down method. Started in Sept. 2011 and finally off in January 2012. I experienced severe loss of balance early on, which progressed into full-blown ataxia & parasthesia. Have had extensive blood-testing & MRIs of brain & cervical spine, all negative! I have to believe this is a result of coming off Prozac, although most sites say the withdrawal side effects don't last this long.

There used to be a wonderful cartoon series called 101 Uses for a Dead Cat, which led me 25 years ago to give a talk at a British Association for Psychopharmacology meeting entitled 101 Uses for a Dead Psychiatrist. That was back in the days when Psychopharmacology meetings were places of debate and the British Journal of Psychiatry was guaranteed to have something of real interest in every issue.

From 1951, a system designed for heroin and cocaine addicts – prescription-only status – was applied to all new drugs. Why? These were after all the first truly effective drugs in medicine. But the ability to do good came with a likelihood of doing harm. There was a trade-off to be made between risks and benefits. The new complex trade-offs could not be put on to the label of a drug or even captured in a forty page package insert. They needed to be individual to each person.

Disclosure is an insufficient strategy for mitigating bias because bias does not result from the concealment of financial ties but from their effects. Even worse, social psychologists have demonstrated that when individuals disclose a competing interest, they give even more biased advice.

The norm in science is that there is free access to the data underpinning experiments. If free access is denied; it’s not science. In the case of branded pharmaceuticals, we do not even know what trials have been done. What is put in the public domain is not data. The selected highlights of a football game and the comments of the pundits afterwards don't change the score. The selected highlights of pharma studies and the comments of pundits routinely change the score.

In the 40 years since I was wrongly - and catastrophically - "diagnosed" and "treated," I've seen one after another announcement of supposed "progress" in the "science" of understanding and treating "mental illness" come and go — first trumpeted, then with nary a mention, failing to hold their ground and falling away to the mists of time along with the people and the lives they'd ruined. People will continue to suffer and die if the public do not wake up and have the courage to act as a caring community, and stop regarding human problems as "diseases" to be "cured," rather than as challenges that we share.

This is a study of psychiatry. It is a study of an area officially a branch of medicine and overwhelmingly seen as legitimate, benign, progressive, and effective. But what if society had it wrong? What if this were not legitimate medicine? Dare we imagine a world where helping is not professionalized, where caring is not commodified. Where, in the spirit of community, we go about the business of life together?