Has the pharmaceutical industry become the Pied Piper of Hamelin--ridding us of lethal diseases only to turn around and "take" our children?
Would a physician from the 1950s "have identified the frenzy to treat bipolar disorders in infants that developed in twenty-first-century American as a mania?"
In his latest book, Mania: A Short History of Bipolar Disorder (the John Hopkins University Press) David Healy, author of Let Them Eat Prozac, looks at the historic roots of our current "medicalized distress" in which half the population is said to suffer a mental illness at some point in life and babies are diagnosed in utero as bipolar.
Bipolar disorder, once called manic depression, has been embroiled in controversy from its first descriptions in Paris in the 1850s. The pharmaceutical companies and academics behind its current popularity as a "catch-all" disease say it dates back to the ancient Greeks.
But David Healy, professor of psychiatry and the director of the North Wales Department of Psychological Medicine at Cardiff University, is not so sure.
References to the frenzied behavior of mental patients found in Hippocrates' Epidemics books 1 and III, Plato's Phaedrus and other early writings almost certainly referred to infective states and not what we mean by bipolar disorder infective disorders with high fevers, hysteria, postpartum manias, catalepsies and melancholies developing into manias, he writes.
Even if the disorder existed before direct-to-consumer television advertising beamed its warning signs into living rooms, it was rare says Healy. Between 1875 and 1924 only 123 patients from North West Wales were admitted to the asylum in North Wales with what we would today call bipolar disorder from a population of a quarter of a million or 12,500,000 person years.
The discovery of lithium in 1817--so plentiful and inexpensive it was added to soft drinks and beer until 1929--and its value in treating bipolar disorder in the late 1950s, changed the course of psychopharmacology says Healy.
Lithium not only introduced the concept of a drug that could act as a mood stabilizer-- offering actual prophylaxis against a mental disease--it introduced the concept of a randomized controlled trial (RCT) in which a drug's effectiveness is tested against placebo.
RCTs, part of what is called evidence-based medicine, are designed to refute a null hypothesis, says Healy, so that a successful outcome literally means "it is not right to say a treatment has no effect."
But RCTs were developed to forestall irrational medical exuberance and "cast doubt on clinical enthusiasms about new treatments," he argues, not to demonstrate "treatment effects of dubious significance," the inverse use for which the pharmaceutical industry has "commandeered" RCTs.
Medical case reports, now dismissed as anecdotal, have been edged out by RCTs in journals and as drug evaluation tools even though chlorpromazine (Thorazine), imipramine (the first tricyclic) and even Viagra resulted from case report vignettes, says Healy.
Moreover the suicidal and akathisia side effects that blemished the antidepressant Prozac were revealed --but ignored--in case reports of the antihypertensive drug, reserpine.
Randomized controlled trials ironically amount to "a more problematic anecdotalism," writes Healy by "garlanding" the experience of one drug responder "over the ninefold larger pool of other responders or nonresponders" with the claim it will "generalize to others given the treatment in a way that was never claimed with traditional medical case reports."
The data manipulation potential of RCTs is so great, charges Healy, it allowed GlaxoSmithKline to promote Paxil for child and adolescent "depression"--it sold 900,000 prescriptions in 2002--despite conclusive data the drug did not work in children as was actually harmful.
David Healy, author of The Antidepressant Era and the Creation of Psychopharmacology, was an early critic of the pharmaceutical industry's one-size-fits-all marketing of antidepressant Prozac and its selective serotonin reuptake inhibitor (SSRI) cousins.
I have dealt with personal mental illness for the majority of my life and have, likewise, been a reluctant (but desperate) patient who has voluntarily and involuntarily (known as 'chemical restraint' and 'monitored dose administration') taken nearly every single drug in the psychiatric bag of tricks in order to find relief from symptoms of my disease -all to little or no avail. Sometimes to an end result of a very serious nature...
It's simply disgusting how big Pharma is allowed to market these drugs like M&M's... even more repulsive are the physicians who take incentives and dispense these drugs to anyone who self-diagnosed themselves or their children after seeing the latest commercial and are determined to shop until they get what they want.
Scarier still, the court system (even without expert advice) may set conditions so that a person has no choice in the matter of what drugs are put into their bodies.
The most interesting facet of your article, to me, was the intial purpose of RCT's and how they have now been twisted into a sort of advocacy or support for big Pharma in the face of evidence to the contrary...
Thank you.
by
C.Bid (0 articles, 7 quicklinks, 7 diaries, 736 comments)
on Wednesday, August 20, 2008 at 9:42:28 AM
I have periodic episodes of romanticizing the past as the good old days (Delusional Denial of History and Times syndrome (or D.D.H.T.). Is BigPharma marketing a pill for that, too?
by
Robert Arend (5 articles, 17 quicklinks, 19 diaries, 183 comments)
on Wednesday, August 20, 2008 at 3:46:27 PM
Yes, Medical industry is in manic phase at the moment.
Maybe when the industry crashes, it can console itself with the fact that although it is vexed with bipolar disorder it has cured manic-depression.
by
vidiot (0 articles, 0 quicklinks, 0 diaries, 262 comments)
on Wednesday, August 20, 2008 at 3:53:30 PM
Absolutely Great Piece, M.R.
I thought this was the best synthesis of an emormously complicated subject I've ever read, when I saw the (same?) version in Dissident Voice. And I still do.
by (0 articles, 0 quicklinks, 0 diaries, 4 comments)
on Thursday, August 21, 2008 at 10:56:52 AM
4 comments
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