Foreign Correspondents

A little over a year ago, there was consternation in psychiatric circles as a French psychiatrist, Daniele Canarelli was found guilty after her patient hacked a man to death. She had not recogized the hazard he posed. Doctors didn’t like the implications they saw. In a series of lectures I have raised the question as to how long it might be before doctors would be found guilty for a suicide or homicide linked to an antidepressant, given that we have known that these drugs can cause suicide or homicide for over 50 years.

In recent weeks I have taken part in some very powerful meetings at my work place, the Family Care Foundation. By "powerful" I mean that they have been both moving and demanding, Many people who did not know about us before seeing Daniel Mackler´s movie, Healing Homes, have contacted the Family Care Foundation looking for a place where it is possible to get off pharmaceuticals, and to be supported. Even more importantly, they are longing for a place where they are met as a human being, amongst other human beings.

In 1972, prisoners at Holmesburg Prison in Philadelphia were paid $3 to have their eyes held open with clamps and hooks while Johnson & Johnson's baby shampoo was dropped into them. In 2011, mothers of newborns were arrested when their babies tested positive for exposure to cannabis, a false result caused by the use of Johnson & Johnson’s Head-to-Toe Foaming Baby Wash. Young men have undergone mastectomies to remove breasts grown as a result of Johnson & Johnson antipsychotics, which were used as a result of Johnson & Johnson's criminal promotion of its drugs for off-label purposes. And now, Johnson & Johnson has announced the removal of carcinogenic chemicals from their No More Tears baby shampoo.

This has got to stop. Around the world a million people die from suicide each year and the response internationally is to pour more funding and channel more people into psychiatric services. Three large studies have now found that the more we spend on mental health services the higher our suicide rates. In addition, a recent study has completely discredited claims that 90% of those who die from suicide are mentally ill at the time of their death. We need to use this evidence to stop the expansion of psychiatry as a suicide prevention measure.

Danish psychiatry has been besieged by scandals. Or perhaps it is better to say 'exposed', as many of the scandals - like massive overmedication, deaths etc. - have been an ongoing problem for years. 2014 has started off with a bang. Two deaths due to psychiatric drugs acknowledged as being the cause of death. This is the first time this has happened.

In an era of prescribing rights for psychologists will psychology become a more marketable, less tarnished version of psychiatry, a target for pharma marketing and a new distribution channel for psychotropic drugs?

Stephen Hawking believes there are an infinite number of universes and that alien life exists. Nobel Prize winning physicist Neils Bohr’s interpretation of quantum mechanics shows a cat can be alive and dead simultaneously until we fix it in one state through our observation of it. These are ideas that most people would struggle to see as credible science and yet recent literature reviews reveal that physicists are far more trusted than psychiatrists.

GSK has recently announced that it will cease paying doctors for promoting its drugs and sponsoring them to attend conferences and sever the link between pay for its sales representatives and the numbers of prescriptions physicians write. My reading of GSK’s annual report leaves me in no doubt that they are changing their business model because it is likely to increase their profitability – not because they are being forced to. There is a niche in the market for a pharmaceutical company to become the leader in ethical practice. It is not necessary for GSK to be ethical in reality but to create the perception of being so.

Drug profitability requires three parties to work together – drug companies to make the drugs, psychiatrists to prescribe them and consumers to take them. Too often, though, patients have failed to play nicely and do their bit. They have banged on about tiresome things like adverse reactions and alternative treatments, they have expressed foolish opposition to the very concept of pharmacotherapy and questioned its efficacy. They have become medication non-compliant and undermined the profits of the pharmaceutical industry and the authority of psychiatry. They have been bad and landed themselves on a lot of people’s naughty lists and made the World Health Organization very sad and worried.

In our last blog, we focused on the fact that nutrient supplementation has not only been accepted in the realm of physical health in the past, but it has actually been endorsed by reputable sources such as the Journal of the American Medical Association editors who published the Fairfield and Fletcher articles 11 years ago recommending that all adults take a multivitamin to reduce their risk of cardiovascular disease, cancer, and osteoporosis (note that this is completely inconsistent with very recent studies reported in the Annals of Internal Medicine --- but that’s just the way science works, using different nutrients and different methodologies, coming up with discrepant findings, until facts finally emerge).

Two pieces of research have been published over the last two years that should prompt a major reorientation of the treatment of schizophrenia and psychosis, and a fundamental reappraisal of the use of antipsychotic drugs in general. Put together, these studies suggest that the standard approach to treating serious mental health problems may cause more harm than good. Long-term treatment with antipsychotic drugs has adverse effects on the brain, and may impair rather than improve chances of recovery for some. Many people ask me how the psychiatric profession has responded to this data. Surely, they think, it must have stimulated a major debate within the profession, and some critical reflection about why it took so long to recognise these worrying effects? Sadly, this does not appear to be happening.

Before the early 1990’s the use of antipsychotic medications was largely reserved for adults with severe psychotic disorders; unpleasant involuntary movement disorders (extrapyramidal side-effects) and cardiovascular risks appear to have largely limited their use outside these disorders. The introduction and intense marketing of what seemed to be better tolerated and safer (now proven not to be), second generation atypical antipsychotics (AAPs) such as risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole from the mid 1990’s led to a rapid expansion of antipsychotic medication use for a wide variety of unlicensed conditions and in more diverse clinical populations.

In Salem Village in the winter of 1692, nine-year-old Betty Parris and her 11-year-old cousin Abigail Williams began exhibiting strange behavior.  A local doctor could find no physical evidence of any ailment. When other young women in the village started exhibiting similar behaviours, Sarah Good, a homeless begger, Sarah Osborne, a woman who rarely attended church, Tituba, a slave from a minority ethnic group, and Dorothy Good, a four-year-old child, were accused of bewitching the girls. They were interrogated and sent to jail.

One thing that amazes us is that even though information linking nutrition to physical health is quite advanced, and generally very prominent in the media as well as in public awareness, people seem to be surprised when told that nutrients are essential for brain function. It may be silly to remind everyone of this, but we need to begin with this simple fact: the brain is part of the body. But to add some heft to this point, let us also recall that the brain is the organ of the body with the greatest metabolic demands (the heart is second).

What distinguishes the pharmaceutical industry from the producers of other potentially harmful products, is the fact that, governments have passed legislation allowing detention of potential customers and forced administration of its product to consumers who do not wish to purchase it. Imagine if goverments passed laws allowing other industries to detain potential customers and force them to use their products.

A century ago Freud and Jung made us aware of the biases underpinning what patients say. Not everything should be accepted at face value. In particular claims of abuse may not be based on reality. We needed experts – analysts – they claimed, to tease out what is real from what is not. The Catholic Church was once intensely hostile to Freud, but when it came to child abuse adopting a Freudian approach was very convenient. But while Freud essentially denied that real abuse was taking place and got away with it in his life-time, the Catholic Church has learnt to its cost that many claims of abuse are real.

I really valued the massive Melbourne Hearing Voices conference last week. The theme of reconciliation between voice hearers and mental health workers was a powerful one. This emphasis on creating understanding conversations at the conference was encouraged with dialogues between people on specific subjects - medication, spirituality, psychological approaches to voices etc. - rather than keynotes. It seemed a move away from presentations of competing knowledges, toward a more dialogical conference; a respectful exchange of different viewpoints, feelings and values. When you have a range of views in a presentation it’s less easy to adopt a “good guys vs. bad guys” mentality; you start to see the complexities in more relief. The surprise for me was that I liked it.

In Belgium, patients with mental health problems mostly receive drug treatment despite the emphasis in international guidelines on the importance of psychological approaches. Currently one in ten Belgians takes antidepressants. That makes Belgium the European leader when it comes to antidepressant prescriptions and costs our country 300 million euros annually. This has been a glaring concern for our Minister of Health. From January 1, 2016, all psychologists and psychotherapists in Belgium will need to register in an official list. This should slash the number of unqualified therapists and help more Belgians stay off antidepressants.

Facing a sexual abuse lawsuit, the archdiocese of St Paul and Minneapolis made a big deal of putting an independent panel in place to investigate. They put the Reverend Reginald Whitt in charge of appointing the panel and receiving its reports on behalf of the archdiocese. Rev. Whitt told priests and deacons that the task force may review specific files to determine whether the policies of the archdiocese concerning clergy sexual misconduct were properly followed. But, he wrote, “Access to these files will be within my control, and limited only to what is necessary for the task force.” This sounds terribly like the approach Sir Andrew Witty is attempting to put in place for GSK, AbbVie and the rest of the branded pharmaceutical industry vis-a-vis abuses, including child abuse committed in their name. They are asserting their right to spin their version of what it is you put in your body even though this clashes fundamentally with your right to know what you are putting in your body.

In the face of concerns that large numbers of children were being incorrectly diagnosed with pediatric bipolar disorder, the DSM–V introduced Disruptive Mood Dysregulation Disorder (DMDD). In the scramble by drug companies to produce evidence that their drug should be prescribed to this new population of mentally ill children, the manufacturer of Risperidone paid to test their drug on a group of children. The study does not investigate whether treatment with Risperidone has any therapeutic benefit to the children, whether it cures or treats DMDD or ‘rage outbursts.’ It is quite open that Risperidone is being trialled for its efficacy as a chemical restraint.

In recent months the English pharmaceutical company GlaxoSmithKline (GSK) has assiduously portrayed itself as an advocate of transparency, and in support of access to clinical trial data. Well, in support of "Responsible Access." "Responsible" here essentially means that a researcher commits to the primacy of RCTs and statistical significance over an analysis of adverse events. It would not, for example, be responsible to claim that an SSRI causes suicide, a statin muscle damage or cognitive failure, or hypoglycemics cause hypoglycemia unless a trial has shown this to happen to a Statistically Significant extent – and they never do.

On the 7th of November, Robert Whitaker was here in Copenhagen to officially launch the Danish translation of his book, . While we were celebrating the day, in another part of Denmark, psychiatry was preparing its attack. A professor of psychiatry Poul Videbech, one of our finest, specializing in depression with a particular emphasis on electroshock, was busy writing a review. The title of his review is “The Boy Has No Clothes On” and as you can imagine with such a title, the review is hardly going to be favorable, indeed it smacks of condescending paternalism framing the well-worn scenario for establishing psychiatric supremacy.

On 25 October 2013, the World Health Organization issued a press release promoting guidelines produced by the Patient-Reported Outcomes Safety Event Reporting (PROSPER) Consortium. The consortium aimed to “to improve [drug] safety reporting by better incorporating the perspective of the patient” with the aim of the guidance produced “to ensure that the patient ‘voice’ and perspective feed appropriately into collection of safety data.” Rather than 'quietly protecting the health of every person on this planet, every day' it seems clear that WHO is quietly protecting the interests of pharmaceutical companies and their advisors on planet 'profit from patients', every day.

The World Health Organisation was established in 1945 to provide leadership on global health matters. According to its Director General Dr Margaret Chan, it...

GSK's continued failure to provide true transparency flies in the face of what the overwhelming majority of people signing consent forms probably intend - which is to make their data available for scrutiny by independent experts. If those who participate in trials thought some remote risk of a breach of privacy were being used to prevent disclosure of details that would save someone else's life - but threaten GSK's profits - most of us would likely be horrified.