Mass psychosis in the US - Opinion - Al Jazeera English

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Mass psychosis in the US

How Big Pharma got Americans hooked on anti-psychotic drugs.

Ridgewayâ  Last Modified: 12 Jul 2011 06:20



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Drug companies like Pfizer are accused of pressuring doctors into

over-prescribing medications to patients in order to increase profits

[GALLO/GETTY]

Has America become a nation of psychotics? You would certainly think so, based

on the explosion in the use of antipsychotic medications. In 2008, with over $14

billion in sales, antipsychotics became the single top-selling therapeutic class

of prescription drugs in the United States, surpassing drugs used to treat high

cholesterol and acid reflux.

Once upon a time, antipsychotics were reserved for a relatively small number of

patients with hard-core psychiatric diagnoses - primarily schizophrenia and

bipolar disorder - to treat such symptoms as delusions, hallucinations, or

formal thought disorder. Today, it seems, everyone is taking antipsychotics.

Parents are told that their unruly kids are in fact bipolar, and in need of

anti-psychotics, while old people with dementia are dosed, in large numbers,

with drugs once reserved largely for schizophrenics. Americans with symptoms

ranging from chronic depression to anxiety to insomnia are now being prescribed

anti-psychotics at rates that seem to indicate a national mass psychosis.

It is anything but a coincidence that the explosion in antipsychotic use

coincides with the pharmaceutical industry's development of a new class of

medications known as " atypical antipsychotics. " Beginning with Zyprexa,

Risperdal, and Seroquel in the 1990s, followed by Abilify in the early 2000s,

these drugs were touted as being more effective than older antipsychotics like

Haldol and Thorazine. More importantly, they lacked the most noxious side

effects of the older drugs - in particular, the tremors and other motor control

problems.

The atypical anti-psychotics were the bright new stars in the pharmaceutical

industry's roster of psychotropic drugs - costly, patented medications that made

people feel and behave better without any shaking or drooling. Sales grew

steadily, until by 2009 Seroquel and Abilify numbered fifth and sixth in annual

drug sales, and prescriptions written for the top three atypical antipsychotics

totaled more than 20 million.  Suddenly, antipsychotics weren't just for

psychotics any more.

Not just for psychotics anymore

By now, just about everyone knows how the drug industry works to influence the

minds of American doctors, plying them with gifts, junkets, ego-tripping awards,

and research funding in exchange for endorsing or prescribing the latest and

most lucrative drugs. " Psychiatrists are particularly targeted by Big Pharma

because psychiatric diagnoses are very subjective, " says Dr. e

Fugh-Berman, whose PharmedOut project tracks the industry's influence on

American medicine, and who last month hosted a conference on the subject at

town. A shrink can't give you a blood test or an MRI to figure out

precisely what's wrong with you. So it's often a case of diagnosis by

prescription. (If you feel better after you take an anti-depressant, it's

assumed that you were depressed.) As the researchers in one study of the drug

industry's influence put it, " the lack of biological tests for mental disorders

renders psychiatry especially vulnerable to industry influence. " For this

reason, they argue, it's particularly important that the guidelines for

diagnosing and treating mental illness be compiled " on the basis of an objective

review of the scientific evidence " - and not on whether the doctors writing them

got a big grant from Merck or own stock in AstraZeneca.

Marcia Angell, former editor of the New England Journal of Medicine and a

leading critic of the Big Pharma, puts it more bluntly: " Psychiatrists are in

the pocket of industry. " Angell has pointed out that most of the Diagnostic and

Statistical Manual of Mental Disorders (DSM), the bible of mental health

clinicians, have ties to the drug industry. Likewise, a 2009 study showed that

18 out of 20 of the shrinks who wrote the American Psychiatric Association's

most recent clinical guidelines for treating depression, bipolar disorders, and

schizophrenia had financial ties to drug companies.

In a recent article in The New York Review of Books, Angell deconstructs what

she calls an apparent " raging epidemic of mental illness " among Americans. The

use of psychoactive drugs—including both antidepressants and

antipsychotics—has exploded, and if the new drugs are so effective, Angell

points out, we should " expect the prevalence of mental illness to be declining,

not rising. " Instead, " the tally of those who are so disabled by mental

disorders that they qualify for Supplemental Security Income (SSI) or Social

Security Disability Insurance (SSDI) increased nearly two and a half times

between 1987 and 2007 - from one in 184 Americans to one in seventy-six. For

children, the rise is even more startling - a thirty-five-fold increase in the

same two decades. Mental illness is now the leading cause of disability in

children. " Under the tutelage of Big Pharma, we are " simply expanding the

criteria for mental illness so that nearly everyone has one. " Fugh-Berman

agrees: In the age of aggressive drug marketing, she says, " Psychiatric

diagnoses have expanded to include many perfectly normal people. "

Cost benefit analysis

What's especially troubling about the over-prescription of the new

antipsychotics is its prevalence among the very young and the very old -

vulnerable groups who often do not make their own choices when it comes to what

medications they take. Investigations into antipsychotic use suggests that their

purpose, in these cases, may be to subdue and tranquilize rather than to treat

any genuine psychosis.

Carl Elliott reports in Mother magazine: " Once bipolar disorder could be

treated with atypicals, rates of diagnoses rose dramatically, especially in

children. According to a recent Columbia University study, the number of

children and adolescents treated for bipolar disorder rose 40-fold between 1994

and 2003. " And according to another study, " one in five children who visited a

psychiatrist came away with a prescription for an antipsychotic drug. "

A remarkable series published in the Palm Beach Post in May true revealed that

the state of  Florida's juvenile justice department has literally been pouring

these drugs into juvenile facilities, " routinely " doling them out " for reasons

that never were approved by federal regulators. " The numbers are staggering: " In

2007, for example, the Department of Juvenile Justice bought more than twice as

much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081

tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in

state-operated jails and homes for children…That's enough to hand out 446

pills a day, seven days a week, for two years in a row, to kids in jails and

programs that can hold no more than 2,300 boys and girls on a given day. "

Further, the paper discovered that " One in three of the psychiatrists who have

contracted with the state Department of Juvenile Justice in the past five years

has taken speaker fees or gifts from companies that make antipsychotic

medications. "

In addition to expanding the diagnoses of serious mental illness, drug companies

have encouraged doctors to prescribe atypical anti-psychotics for a host of

off-label uses. In one particularly notorious episode, the drugmaker Eli Lilly

pushed Zyprexa on the caregivers of old people with Alzheimer's and other forms

of dementia, as well as agitation, anxiety, and insomnia. In selling to nursing

home doctors, sales reps reportedly used the slogan " five at five " —meaning

that five milligrams of Zyprexa at 5 pm would sedate their more difficult

charges. The practice persisted even after FDA had warned Lilly that the drug

was not approved for such uses, and that it could lead to obesity and even

diabetes in elderly patients.

In a video interview conducted in 2006, Sharham Ahari, who sold Zyprexa for two

years at the beginning of the decade, described to me how the sales people would

wangle the doctors into prescribing it. At the time, he recalled, his doctor

clients were giving him a lot of grief over patients who were " flipping out "

over the weight gain associated with the drug, along with the diabetes. " We were

instructed to downplay side effects and focus on the efficacy of drug…to

recommend the patient drink a glass a water before taking a pill before the 

meal and then after the meal in hopes the stomach would expand " and provide an

easy way out of this obstacle to increased sales. When docs complained, he

recalled, " I told them, ‘Our drug is state of the art. What's more important?

You want them to get better or do you want them to stay the same--a thin

psychotic patient or a fat stable patient.' "

For the drug companies, Shahrman says, the decision to continue pushing the drug

despite side effects is matter of cost benefit analysis: Whether you will make

more money by continuing to market the drug for off-label use, and perhaps

defending against lawsuits, than you would otherwise. In the case of Zyprexa, in

January 2009, Lilly settled a lawsuit brought by with the US Justice Department,

agreeing to pay $1.4 billion, including " a criminal fine of $515 million, the

largest ever in a health care case, and the largest criminal fine for an

individual corporation ever imposed in a United States criminal prosecution of

any kind,''the Department of Justice said in announcing the settlement. " But

Lilly's sale of Zyprexa in that year alone were over $1.8 billion.

Turning people into zombies

As it turns out, the atypical antipsychotics may not even be the best choice for

people with genuine, undisputed psychosis.

A growing number of health professionals have come to think these drugs are not

really as effective as older less expensive medicines which they have replaced,

that they themselves produce side effects that cause other sorts of diseases

such as diabetes and plunge the patient deeper into the gloomy world of serious

mental disorder. Along with stories of success comes reports of people turned

into virtual zombies.

Elliott reports in Mother : " After another large analysis in The Lancet

found that most atypicals actually performed worse than older drugs, two senior

British psychiatrists penned a damning editorial that ran in the same issue. Dr.

Tyrer, the editor of the British Journal of Psychiatry, and Dr. Tim

Kendall of the Royal College of Psychiatrists wrote: " The spurious invention of

the atypicals can now be regarded as invention only, cleverly manipulated by the

drug industry for marketing purposes and only now being exposed. "

Bottom line:Stop Big Pharma and the parasitic shrink community from wantonly

pushing these pills across the population.

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