Rob: Yeah. Now, one thing you said that really struck me is that because though the narrative, the story that has been repeatedly told and marketed, doctors feel an obligation to prescribe these medications; they may even feel they are at risk of being sued for malpractice if they don't -- is that the case and can you talk a little bit about that more?
RW: Yeah, this is part of the trap we're in a society now....is yes. So what happens again here is that the guys that are being paid by the drug companies, right, to be speakers, advisers, and consultants at these leading academic medical schools, are also the same people that, in essence, set forth standards of care in psychiatric textbooks, in psychiatric journals, etcetera. So they start saying is the standard of care is to do this, well it's to medicate with this drug. And if that doesn't work, it's to medicate to add with this other drug -- and they, in essence, develop protocols that never involve weaning people off, but just in essence if this drug doesn't work...try a second drug and/or try two drugs together, or three drugs together...so the people setting the standard of care, which other doctors are expected to follow and which HMOs and insurance companies reimburse for, are in essence the psychiatrists who are paid by -- not in essence, are the same people being paid by the drug companies to act...to promote these drugs. That's the extraordinary thing going on, and therefore if you are a doctor, if you're a psychiatrist and you, say, don't give somebody a drug, and that person then has a bad outcome, you sometimes can be liable for a lawsuit. But if you follow the standard of care and you give a person a drug and the person has a terrible outcome, you're home free...you were just following the standard of care. So this is in fact a very, very big problem and it is a barrier to reform.
And one of...this sort of stems back from a case -- I think it goes all the way back to the late 70s, maybe early 80s -- where someone was at Chestnut Lodge, a care facility in the northeast, depressed, and they didn't treat him with an antidepressant. Well eventually he was treated with an antidepressant...this particular patient did better on the antidepressant...so then he sued the lodge, the attending psychiatrist, for not giving him the antidepressant right away. And this became a case that made doctors afraid of not following that immediate standard of care of when to medicate and medicating very quickly, etcetera. So yes, this is a big problem.
Rob: There's a kind of knee jerk reaction to medicate.
RW: In essence, yeah, to protect themselves. Now you can use inform consent principles with your patients to...if you laid out all the risks and benefits to your patients and then let the patient make this decision in some ways, you can now avoid that legal liability, but there are some real risks there if you don't give them that...if you don't, sort of, run through that process.
Rob: This is the Rob Kall Bottom Up/Future Health Radio Show. I'm speaking with Robert Whitaker, the author of Anatomy of an Epidemic. This is 1360 AM, Washington Township. We're sponsored by futurehealth.org and opednews.com.
Robert, in your book you say that, to quote "the literature is hopelessly poisoned." Then you go on to say "the story of research in selective serotonin reuptake inhibitor use in childhood depression is one of confusion, manipulation, and institutional failure." Actually you're quoting [Inaudible 0:47:54] in a 2004 editorial.
RW: Right, I mean...go ahead.
Rob: The history here, you know, this just goes on that this is not an accident. Now I want to take a step now and talk about...you have a chapter on the rise of an ideology...
RW: Right.
Rob: ...that gives us a bit of the history of the politics and the economics of this. Could you talk about that?
RW: Yeah, I think this is important to try to understand how we as a society ended up where we are today, where we have embraced this extraordinary paradigm of care and where we've embraced pathalogizing so many kids, etcetera. What happened was this -- in the 1970s, there was an explosion of this therapist industry, and by that I mean social workers began providing counseling services, psychologists, there were other therapists offering alternative therapies, whatever they might be, and so there was a lot of competition in the marketplace for people who were, sort of, feeling emotional distress of some kind and wanted help, alright. And psychiatrists found themselves -- psychiatry as a profession -- found themselves in competition with all these newly...new groups of therapists. And you'll see in the psychiatric literature saying -- Uh oh, we're now in a fight for our survival and we have to figure out how to compete in this new marketplace. And what they basically decided as a profession, they said -- well what is...what gives us our benefit? What is our competitive advantage over all these other therapists? And what psychiatrists as a profession said is that we're doctors and we can prescribe medications, okay. So we need to tell a story, in essence, if we're going to revive psychiatry -- and by the way, there was a sense that psychiatry was fighting for its survival; the percentage of doctors choosing psychiatry as a specialty was very low; there was a survey why was that so...it was because it was seen that psychiatric therapies were very low in efficacy -- so psychiatry in the 70s was fighting for its survival in the marketplace and as a profession that would attract young psychiatrists as well -- and they made a decision to say we're going to find a refuge in the white coat. We will wrap ourselves in the white coat of physicanhood so to speak, and we will tell a story, in essence, of that our disorders are brain disorders are just like other disorders and infectious medicine, and that our drugs are specific treatments for those brain disorders. In other words, we will make our prescribing powers valuable in the marketplace.
Anyway in 1980, with that sort of -- and by the way the sale of psychiatric drugs was going down in the 1970s so that was part of the change -- so in 1980, psychiatry basically launched this new ideology and that was with the publication of DSM-III, which is the Diagnostic and Statistical Manual; and what the claim that was made is this is a new scientific document, that psychiatric diagnoses prior to this time were vague and unreliable, and they really reflected, sort of, Freudian roots and Freudian notions about neurosis -- and what psychiatry said is now we have a scientific text -- we have these disorders neatly defined, as if they're quantifiable, and these are diseases and we have drugs to treat those diseases...and as they did this, the American Psychiatric Association basically mounted a press...public relations campaign. They formed a press to help tell this story -- the APA Press was founded in 1980, they began doing workshops, training psychiatrists around the country, dealing with the press, newspaper reporters, magazine reporters, television reporters -- telling them how to tell this medical model story (by the way, many of those workshops were funded by the drug companies) -- so it was a story of an organization, a trade organization, that was having difficulties fighting for its survival, not doing well in the marketplace, and coming up with an ideology -- a medical model -- that exalted their place in society; and then also as a trade organization, training itself to sell that story to the public, and doing so in conjunction with pharmaceutical companies which began funding these promotional efforts. So yes, there was a rise of an ideology -- the ideology was the medical model, and you can see how effective it was. They started holding annual, sort of, meetings...even, sort of, press conferences; they started telling about these great advances that were being made in this uncovering of biological causes of psychiatry. And next thing you know...there's a series by John Franklin at the Baltimore Sun that tells about these great advances that we're making; secrets of mental disorders are being discovered -- and it was all nonsense...it was all PR...it was all like selling a product...it was not founded in science.
And then of course what happens is when they get Prozac -- that's a new drug that comes to market in 1987 -- and they really go to town there, in terms of working with the...psychiatry worked with both the NIMH and pharmaceutical companies to start funding something called the DART campaign -- I think that's the right acronym -- in which they would send literature to doctors' offices around the country saying we now know that depression is a brain disease caused by chemical imbalance and people need to get tested, and we have these wonderful new drugs like insulin for diabetes. So we had this very well-oiled, well-financed promotional campaign that was based on selling the drugs but not based on science. So that's the story of the ideological rise and it resulted in an increasing spending on psychiatric medications from around 800 million in 1987 to more than 40 billion dollars today. So you sort of have to...from just a capitalistic point of view, you sort of have to clap and say 'well done.'
Rob: You think there's any chance that this can be turned around with $40 billion in sales? It's hard to imagine lobbyists allowing it to happen...you've got these small state senators from Idaho and Montana, what have you, who basically sell out and block anything from getting done -- I just wonder...is this something that America can save itself from or are we stuck with this...? Well, answer that first.
RW: Yeah, that's a good question. In some ways I think there is a backlash forming. One, there's a backlash forming because it's...everyday it seems like we're hearing new news about how these psychiatric medications were falsely marketed. You'll have state attorney generals suing the drug companies. We here one company after another agreeing to pay a billion dollar settlement for having lied about their drugs and falsely marketed their drugs. So that is making the public quite skeptical about this whole story -- that's number one.
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