“Psychiatric Drugs: An Assault on the Human Condition”
Source: Street Spirit
Bob Whitaker is the author of Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.
Investigative reporter Robert Whitaker, author of the groundbreaking book Mad In America, isnow pursuing a fascinating line of research into how the mammothpsychiatric drug industry is endangering the American public bycovering up the untold cases of suffering, anguish and disease causedby the most widely prescribed antidepressants and antipsychoticmedications.
Whitaker exposes the massive lies andcover-ups that have corrupted the Food and Drug Administration’s drugreview process, and co-opted research trials in order to spin theresults of drug tests and conceal the serious hazards and even deadlyside-effects of brand-name drugs like Prozac, Zoloft, Paxil and Zyprexa.
Thestory becomes even more frightening when we look at the aggressivetactics these giant drug companies have used to silence prominentcritics by defaming them in the press, and by using their money andpower to have widely respected scientists and eminent medicalresearchers fired for daring to point out the hazards and risks ofsuicide and premature death caused by these drugs.
Whitakerstarts by debunking the effectiveness of these massively hyped wonderdrugs — antidepressants like Prozac, Zoloft and Paxil, and the newatypical antipsychotic drugs like Zyprexa. His research shows how theyoften are barely more effective than placebos in treating mentaldisorder and depression, despite the glowing adulation they havereceived in the mainstream media.
But he goes on tomake the startling claim that these new psychiatric drugs have directlycontributed to an alarming new epidemic of drug-induced mental illness.The very drugs prescribed by physicians to stabilize mental disordersin fact are inducing pathological changes in brain chemistry andtriggering suicide, manic and psychotic episodes, convulsions,violence, diabetes, pancreatic failure, metabolic diseases, andpremature death.
Whitaker originally was a highly regarded medical reporter at the Albany Times Union and also wrote off and on for the Boston Globe. A series he co-wrote for the Boston Globeon harmful psychiatric research was a finalist for the Pulitzer Prizein 1998. When he began his investigative research into psychiatricissues, Whitaker was still a believer in the story of progress thatpsychiatry has been telling the public for decades.
Hesaid, “I absolutely believed the common wisdom that these antipsychoticdrugs actually had improved things and that they had totallyrevolutionized how we treated schizophrenia. People used to be lockedaway forever, and now maybe things weren’t great, but they were a lotbetter. It was a story of progress.”
That story ofprogress was fraudulent, as Whitaker soon found out when he gained newinsight from his research into torturous psychiatric practices such aselectroshock, lobotomy, insulin coma, and neuroleptic drugs.Psychiatrists told the public that these techniques “cured” psychosisor balanced the chemistry of the brain.
But, inreality, the common thread in all these different treatments was theattempt to suppress “mental illness” by deliberately damaging thehigher functions of the brain. The stunning truth is that, behindclosed doors, the psychiatric establishment itself labeled thesetreatments as “brain-damaging therapeutics.”
Thefirst generation of antipsychotic drugs created a drug-induced brainpathology by blocking the neurotransmitter dopamine and essentiallyshutting down many higher brain functions. In fact, when antipsychoticssuch as Thorazine and Haldol were first introduced, psychiatriststhemselves said that these neuroleptic drugs were virtuallyindistinguishable from a “chemical lobotomy.”
Inrecent years, the media have heralded the arrival of so-called designerdrugs like Prozac, Paxil and Zyprexa that are supposed to be superiorand have fewer side effects than the old tricyclic antidepressants andthe first antipsychotics. Millions of Americans have believed thisstory and have enriched drug companies like Eli Lilly by spendingbillions of dollars annually to purchase these new medications.
Whitaker’sresearch into the tragic cases of disease, suffering and early deathscaused by these drugs shows that millions of consumers have been misledby a massive campaign of lies, distortions, and bought-and-paid-fordrug trials. Eminent medical researchers who have tried to warn us ofthe perils of these drugs have been silenced, intimidated and defamed.In the process, the Food and Drug Administration has become the lapdogof the giant pharmaceutical industry, not its watchdog.
Street Spirit interviewedRobert Whitaker about this new “epidemic” of mental disorders, and howthe giant drug companies have profited from selling drugs that make ussicker.
Street Spirit: Your newline of research indicates that there has been an enormous rise in theincidence of mental illness in the United States, despite the seemingadvances in a new generation of psychiatric drugs. Why do you refer tothis increase as an epidemic?
Robert Whitaker: Evenpeople like the psychiatrist E. Fuller Torrey wrote a book recently inwhich he said it looks like we’re having an epidemic of mental illness.When the National Institute of Mental Health publishes its figures onthe incidence of mental illness, you see these rising numbers ofmentally ill people. Some recent reports even say that 20 percent ofAmericans now are mentally ill.
So what I wanted to dowas two-fold. I wanted to look into exactly how dramatic is thisincrease in mental illness, and particularly severe mental illness.Part of this rise in the number of people said to be mentally ill isjust definitional. We draw a big wide boundary today and we throw allsorts of people into that category of mentally ill. So children who arenot sitting neatly enough in their school rooms are said to haveattention deficit hyperactivity disorder (ADHD), and we created a newdisorder called social anxiety disorder.
SS: Sowhat used to be called simply shyness or anxiety in relating to peopleis now labeled a mental disorder and you supposedly need anantidepressant like Paxil for social anxiety disorder.
RW: Exactly. And you need a stimulant like Ritalin for ADHD.
SS: Thisincreases psychiatry’s clients, but doesn’t it also increase the numberof people that giant pharmaceutical companies can sell theirpsychiatric drugs to?
RW: Absolutely.So part of what we’re seeing is nothing more than the creation of alarger market for drugs. If you think about it, as long as we draw asbig a circle as possible, and expand the boundaries of mental illness,psychiatry can have more clients and sell more drugs. So there’s abuilt-in economic incentive to define mental illness in as broad termsas possible, and to find ordinary, distressing emotions or behaviorsthat some people may not like and label them as mental illness.
SS: Yourresearch also shows that there is a real increase in people who have asevere mental disorder. Now, this seems counterintuitive, but is ittrue that you believe much of this increase is caused by the overuse ofsome of the new generations of psychiatric drugs?
RW: Yes,exactly. I looked at the number of the so-called severely disabledmentally ill — people who aren’t working or who are somehowdysfunctional because of mental illness. So I wanted to chart throughhistory the percentage of the population who are considered thedisabled mentally ill.
Now, by 1903, we see thatroughly 1 out of every 500 people in the United States is hospitalizedfor mental illness. By 1955, at the start of the modern era ofpsychiatric drugs, roughly one out of every 300 people was disabled bymental illness. Now, let’s go to 1987, the end of the first generationof antipsychotic drugs; and from 1987 forward we get the modernpsychiatric drugs. From 1955 to 1987, during this first era ofpsychiatric drugs — the antipsychotic drugs Thorazine and Haldol andthe tricyclic antidepressants (such as Elavil and Anafranil) — we sawthe number of disabled mentally ill increase four-fold, to the pointwhere roughly one out of every 75 persons are deemed disabled mentallyill.
Now, there was a shift in how we cared for thedisabled mentally ill between 1955 and 1987. In 1955, we werehospitalizing them. Then, by 1987, we had gone through social change,and we were now placing people in shelters, nursing homes, and somesort of community care, and gave them either SSI or SSDI payments formental disability. In 1987, we started getting these supposedly better,second-generation psychiatric drugs like Prozac and the other selectiveserotonin re-uptake inhibitor (SSRI) antidepressants. Shortly afterthat, we get the new, atypical antipsychotic drugs like Zyprexa(olanzapine), Clozaril and Risperdal.
What’s happenedsince 1987? Well, the disability rate has continued to increase untilit’s now one in every 50 Americans. Think about that: One in every 50Americans disabled by mental illness today. And it’s still increasing.The number of mentally disabled people in the United States has beenincreasing at the rate of 150,000 people per year since 1987. That’s anincrease every day over the last 17 years of 410 people per day newlydisabled by mental illness.
SS: Sothat leads to the obvious question. If psychiatry has introduced theseso-called wonder drugs like Prozac and Zoloft and Zyprexa, why is theincidence of mental illness going up dramatically?
RW: That’sexactly it. This is a scientific question. We have a form of care wherewe’re using these drugs in an ever more expansive manner, andsupposedly we have better drugs and they’re the cornerstone of ourcare, so we should see decreasing disability rates. That’s what yourexpectation would be.
Instead, from 1987 until thepresent, we saw an increase in the number of mentally disabled peoplefrom 3.3 million people to 5.7 million people in the United States. Inthat time, our spending on psychiatric drugs increased to an amazingdegree. Combined spending on antipsychotic drugs and antidepressantsjumped from around $500 million in 1986 to nearly $20 billion in 2004.So we raise the question: Is the use of these drugs somehow actuallyfueling this increase in the number of the disabled mentally ill?
Whenyou look at the research literature, you find a clear pattern ofoutcomes with all these drugs — you see it with the antipsychotics,the antidepressants, the anti-anxiety drugs and the stimulants likeRitalin used to treat ADHD. All these drugs may curb a target symptomslightly more effectively than a placebo does for a short period oftime, say six weeks. An antidepressant may ameliorate the symptoms ofdepression better than a placebo over the short term.
Whatyou find with every class of these psychiatric drugs is a worsening ofthe target symptom of depression or psychosis or anxiety over the longterm, compared to placebo-treated patients. So even on the targetsymptoms, there’s greater chronicity and greater severity of symptoms.And you see a fairly significant percentage of patients where new andmore severe psychiatric symptoms are triggered by the drug itself.
SS: New psychiatric symptoms created by the very drugs people are told will help them recover?
RW:Absolutely. The most obvious case is with the antidepressants. Acertain percentage of people placed on the SSRIs because they have someform of depression will suffer either a manic or psychotic attack –drug-induced. This is well recognized. So now, instead of just dealingwith depression, they’re dealing with mania or psychotic symptoms. Andonce they have a drug-induced manic episode, what happens? They go toan emergency room, and at that point they’re newly diagnosed. They’renow said to be bipolar and they’re given an antipsychotic to go alongwith the antidepressant; and, at that point, they’re moving down thepath to chronic disability.
SS: Modernpsychiatry claims that these psychiatric drugs correct pathologicalbrain chemistry. Is there any evidence to back up their claim thatabnormal brain chemistry is the culprit in schizophrenia and depression?
RW: Thisis the key thing everyone needs to understand. It really is the answerthat unlocks this mystery of why the drugs would have this long-termproblematic effect. Start with schizophrenia. They hypothesize thatthese drugs work by correcting an imbalance of the neurotransmitterdopamine in the brain.
The theory was that peoplewith schizophrenia had overactive dopamine systems; and these drugs, byblocking dopamine in the brain, fixed that chemical imbalance.Therefore, you get the metaphor that they’re like insulin is fordiabetes; they’re fixing an abnormality. With the antidepressants, thetheory was that people with depression had too low levels of serotonin;the drugs upped the levels of serotonin in the brain and thereforethey’re balancing the brain chemistry.
First of all,those theories never arose from investigations into what was actuallyhappening to people. Rather, they would find out that antipsychoticsblocked dopamine and so they theorized that people had overactivedopamine systems. Same with the antidepressants. They found thatantidepressants upped the levels of serotonin; therefore, theytheorized that people with depression must have low levels of serotonin.
Buthere is the thing that one wishes all of America would know and wishespsychiatry would come clean on: They’ve never been able to find thatpeople with schizophrenia have overactive dopamine systems. They’venever been able to find that people with depression have underactiveserotonin systems. They’ve never found consistently that any of thesedisorders are associated with any chemical imbalance in the brain. Thestory that people with mental disorders have known chemical imbalances– that’s a lie. We don’t know that at all. It’s just something thatthey say to help sell the drugs and help sell the biological model ofmental disorders.
But the kicker is this. We do know,in fact, that these drugs perturb how these chemical messengers work inthe brain. The real paradigm is: People diagnosed with mental disordershave no known problem with their neurotransmitter systems; and thesedrugs perturb the normal function of neurotransmitters.
SS: So rather than fixing a chemical imbalance, these widely prescribed drugs distort the brain chemistry and make it pathological.
RW:Absolutely. Stephen Hyman, a well-known neuroscientist and the formerdirector of the National Institute of Mental Health, wrote a paper in1996 that looked at how psychiatric drugs affect the brain. He wrotethat all these drugs create perturbations in neurotransmitterfunctions. And he notes that the brain, in response to this drug fromthe outside, alters its normal functions and goes through a series ofcompensatory adaptations.
In other words, it tries toadapt to the fact that an antipsychotic drug is blocking normaldopamine functions. Or in the case of antidepressants, it tries tocompensate for the fact that you’re blocking a normal reuptake ofserotonin. The way it does this is to adapt in the opposite way. So, ifyou’re blocking dopamine in the brain, the brain tries to put out moredopamine and it actually increases the number of dopamine receptors. Soa person placed on antipsychotic drugs will end up with an abnormallyhigh number of dopamine receptors in the brain.
If yougive someone an antidepressant, and that tries to keep serotonin levelstoo high in the brain, it does exactly the opposite. It stops producingas much serotonin as it normally does and it reduces the number ofserotonin receptors in the brain. So someone who is on anantidepressant, after a time ends up with an abnormally low level ofserotonin receptors in the brain. And here’s what Hyman concluded aboutthis: After these changes happened, the patient’s brain is functioningin a way that is “qualitatively as well as quantitatively differentfrom the normal state.” So what Stephen Hyman, former head of the NIMH,has done is present a paradigm for how these drugs affect the brainthat shows that they’re inducing a pathological state.
SS: Sothe paradox is there’s no evidence for modern psychiatry’s claim thatthere is any pathological biochemical imbalance in the brain thatcauses mental illness, but if you treat people with these new wonderdrugs, that is what creates a pathological imbalance?
RW: Yes,these drugs disrupt normal brain chemistry. That’s the real paradoxhere. And the real tragedy is, that even as we peddle these drugs aschemical balancers, chemical fixers, in truth we’re doing precisely theopposite. We’re taking a brain that has no known abnormal brainchemistry, and by placing people on the drugs, we’re perturbing thatnormal chemistry. Here’s how Barry Jacobs, a Princeton neuroscientist,describes what happens to a person given an SSRI antidepressant. “Thesedrugs,” he said, “alter the level of synaptic transmission beyond thephysiologic range achieved under normal environmental biologicalconditions. Thus, any behavioral or physiologic change produced underthese conditions might more appropriately be considered pathologicrather than reflective of the normal biological role of serotonin.”
SS: Oneof the SSRI antidepressants that’s widely believed to be a wonder drugis Prozac. Yet your research found that the Food and DrugAdministration (FDA) received more adverse reports about Prozac thanany other drug. What sort of ill effects were people reporting?
RW:First of all, with Prozac and the SSRIs that followed, their level ofefficacy was always of a very minor sort. In all the clinical trials ofthe antidepressants, roughly 41 percent of the patients got better inthe short term versus 31 percent of the patients on placebo. Now justone other caveat on that. If you use an active placebo in these trials– an active placebo causes a physiologic change with no benefit, likea dry mouth — any difference in outcome between the antidepressant andplacebo virtually disappears.
SS: Weren’t the early drug tests of Prozac so unpromising that they had to manipulate test results to get FDA approval at all?
RW:What happened with Prozac is a fascinating story. Right from thebeginning, they noticed only very marginal efficacy over placebo; andthey noticed that they had some problems with suicide. There wereincreased suicidal responses compared to placebo. In other words, thedrugs was agitating people and making people suicidal who hadn’t beensuicidal before. They were getting manic responses in people who hadn’tbeen manic before. They were getting psychotic episodes in people whohadn’t been psychotic before. So you were seeing these very problematicside effects even at the same time that you were seeing very modestefficacy, if any, over placebo in ameliorating depression.
Basically,what Eli Lilly (Prozac’s manufacturer) had to do was cover up thepsychosis, cover up the mania; and, in that manner, it was able to getthese drugs approved. One FDA reviewer even warned that Prozac appearedto be a dangerous drug, but it was approved anyway.
We’reseemingly finding all this out only now: “Oh, Prozac can cause suicidalimpulses and all these SSRIs may increase the risk of suicide.” Thepoint is, that wasn’t anything new. That data was there from the veryfirst trial. You had people in Germany saying, “I think this is adangerous drug.”
SS: Even back in the late 1980s, they already knew?
RW: Beforethe late 1980s — in the early ’80s, before Prozac gets approved.Basically what Eli Lilly had to do was cover up that risk of mania andpsychosis, cover up that some people were becoming suicidal becausethey were getting this nervous agitation from Prozac. That’s the onlyway it got approved.
There were various ways they didthe cover-up. One was just to simply remove reports of psychosis fromsome of the data. They also went back and recoded some of the trialresults. Let’s say someone had a manic episode or a psychotic episode;instead of putting that down, they would just put down a return ofdepression, and that sort of thing. So there was a basic need to hidethese risks right from the beginning, and that’s what was done.
SoProzac gets approved in 1987, and it’s launched in this amazing PRcampaign. The pill itself is featured on the cover of severalmagazines! It’s like the Pill of the Year [laughs]. And it’s said to beso much safer: a wonder drug. We have doctors saying, “Oh, the realproblem with this drug is that we can now create whatever personalitywe want. We’re just so skilled with these drugs that if you want to behappy all the time, take your pill!”
That wascomplete nonsense. The drugs were barely better than placebo atalleviating depressive symptoms over the short term. You had all theseproblems; yet we were touting these drugs, saying, “Oh, the powers ofpsychiatry are such that we can give you the mind you want — adesigner personality!” It was absolutely obscene. Meanwhile, whichdrug, after being launched, quickly became the most complained aboutdrug in America? Prozac!
SS: What were the level of complaints when Prozac hit the market?
RW:In this county, we have Medwatch, a reporting system in which we reportadverse events about psychiatric drugs to the FDA. By the way, the FDAtries to keep these adverse reports from the public. So, instead of theFDA making these easily available to the public. so you can know aboutthe dangers of the drugs, it’s very hard to get these reports.
Withinone decade, there were 39,000 adverse reports about Prozac that weresent to Medwatch. The number of adverse events sent to Medwatch isthought to represent only one percent of the actual number of suchevents. So, if we get 39,000 adverse event reports about Prozac, thenumber of people who have actually suffered such problems is estimatedto be 100 times as many, or roughly four million people. This makesProzac the most complained about drug in America, by far. There weremore adverse event reports received about Prozac in its first two yearson the market than had been reported on the leading tricyclicantidepressant in 20 years.
Remember, Prozac ispitched to the American public as this wonderfully safe drug, and yetwhat are people complaining about? Mania, psychotic depression,nervousness, anxiety, agitation, hostility, hallucinations, memoryloss, tremors, impotence, convulsions, insomnia, nausea, suicidalimpulses. It’s a wide range of serious symptoms.
Andhere’s the kicker. It wasn’t just Prozac. Once we got the other SSRIson the market, like Zoloft and Paxil, by 1994, four SSRIantidepressants were among the top 20 most complained about drugs onthe FDA’s Medwatch list. In other words, every one of these drugsbrought to market started triggering this range of adverse events. Andthese were not minor things. When you talk about mania, hallucinations,psychotic depression, these are serious adverse events.
Prozacwas pitched to the American public as a wonder drug. It was featured onthe covers of magazines as so safe, and as a sign of our wonderfulability to effect the brain just as we want it. In truth, the reportswere showing it could trigger a lot of dangerous events, includingsuicide and psychosis.
The FDA was being warned aboutthis. They were getting a flood of adverse event reports, and thepublic was never told about this for the longest period of time. Ittook a decade for the FDA to begin to acknowledge the increasedsuicides and the violence it can trigger in some people. It just showshow the FDA betrayed the American people. This is a classic example.They betrayed their responsibility to act as a watchdog for theAmerican people. Instead they acted as an agency that covered up harmand risk with these drugs.
SS: Inlight of the FDA’s failure to warn us about Prozac, what about theirrecent negligence on the issue of the risk of suicide in children givenantidepressants like Paxil? Weren’t England’s mental health officialsfar better than their American counterparts in the FDA in warning aboutthe dangers of suicidal attempts when antidepressants are given toyouth?
RW: Yes. The children’sstory is unbelievably tragic. It’s also a really sordid story. Let’s goback a little to see what happened to children and antidepressants.Prozac comes to market in 1987. By the early 1990s, the pharmaceuticalcompanies making these drugs are saying, “How do we expand the marketfor antidepressants?” Because that’s what drug companies do — theywant to get to an ever-larger number of people. They saw they had anuntapped market in kids. So let’s start peddling the drugs to kids. Andthey were successful. Since 1990, the use of antidepressants in kidswent up something like seven-fold. They began prescribing themwilly-nilly.
Now, whenever they did pediatric trials ofantidepressants, they found that the drugs were no more effective onthe target symptom of depression than placebo. This happened again andagain in the pediatric drug trials of antidepressants. So, what thattells you is there is no real therapeutic rationale for the drugsbecause in this population of kids, the drugs don’t even curb thetarget symptoms over the short term any better than placebo; and yetthey were causing all sorts of adverse events.
Forexample, in one trial, 75 percent of youth treated with antidepressantssuffered an adverse event of some kind. In one study by the Universityof Pittsburgh, 23 percent of children treated with an SSRI developedmania or manic-like symptoms; an additional 19 percent developeddrug-induced hostility. The clinical results were telling you that youdidn’t get any benefit on depression; and you could cause all sorts ofreal problems in kids — mania, hostility, psychosis, and you may evenstir suicide. In other words, don’t use these drugs, right? It wasabsolutely covered up.
SS: How was it covered up?
RW: Wehad psychiatrists — some of those obviously getting money from thedrug companies — saying the kids are under-treated and they’re at riskof suicide and how could we possibly treat kids without these pills andwhat a tragedy it would be if we couldn’t use these antidepressants.
Finally,a prominent researcher in England, David Healy, started doing his ownresearch on the ability of these drugs to stir suicide. He also managedto get access to some of the trial results and he blew the whistle. Hefirst blew the whistle in England and he presented this data to thereview authorities there. And they saw that it looks like these drugsare increasing the risk of suicide and there are really no signs ofbenefits on the target symptoms of depression. So they began to movethere to warn doctors not to prescribe these drugs to youth.
Whathappens in the United States? Well, it’s only after there’s a lot ofpressure put on the FDA that they even hold a hearing. The FDA sort ofdownplays the risk of these drugs. They’re slow to even put black boxwarnings on them. Why? Aren’t kids lives worth protecting? If we knowthat we have a scientifically shown risk that these drugs increasesuicide, shouldn’t you at least warn about it? But the FDA was evendigging in its heels about putting that black box warning on the drugs.
SS: IfProzac is the nation’s most complained about drug, if Paxil is shown tobe a suicide risk for youth, how do these antidepressants continue tohave a reputation as near-magic cures for depression? And why did theFDA failed to warn us about Paxil and Prozac for such a long time?
RW: There’sa couple reasons for that. The FDA’s funding changed in the 1990s. Anact was passed in which a lot of the FDA’s funding came from the drugindustry: the PDUFA Act, or Prescription Drug User Fee Act. Basically,when drug companies applied for FDA approval they had to pay a fee.Those fees became what is funding a large portion of the FDA’s reviewof drug applications.
So all of a sudden, the fundingis coming from the drug industry; it’s no longer coming from thepeople. As that act comes up for renewal, basically the drug lobbyistsare telling the FDA that their job is no longer to be criticallyanalyzing drugs, but to approve drugs quickly. And that was part ofNewt Gingrich’s thing: Your job is to get these drugs to market. Startpartnering with the drug industry and facilitating drug development. Welost this idea that the FDA had a watchdog role.
Also,in a human way, a lot of people who work for the FDA leave there andend up going to work for the drug companies. The old joke is that theFDA is sort of like a showcase for a future job in the drug industry.You go there, you work awhile, then you go off into the drug industry.Well, if that’s the progression that people make, in essence they’remaking good old boy network connections, so they’re not going to be soharsh on the drug companies. So, that’s what really happened in the1990s. The FDA was given new marching orders. The orders were:”Facilitate getting drugs to market. Don’t be too critical. And, infact, if you want to keep your funding, which was coming now from thedrug industry, make sure you take these lessons to heart.”
SS: Sothe giant pharmaceutical companies have a vast amount of power to cookthe results of drug tests and make researchers and even the FDA itselfbow to their will?
RW: The FDA, inessence, was kneecapped in the early 1990s, and we really saw it withthe psychiatric drugs. The FDA became a lapdog for the pharmaceuticalindustry, not a watchdog.
It’s only now that this has become common knowledge. We have Marcia Angell, the former editor of the New England Journal of Medicine, writea book in which she says that the FDA became a lapdog. It’s basicallynow well recognized that you had this decline and fall. As the editorof the New England Journal of Medicine, the most prestigiousmedical journal we have, Marcia Angell is someone who was at the veryheart of American medicine, and she concluded that the FDA let down theAmerican people. And she lost her job at the New England Journal of Medicine for starting to criticize pharmaceutical companies.
Shewas the editor of the journal in the late 1990s and there was acorresponding doctor named Thomas Bodenheimer who decided to write anarticle about how you couldn’t even trust what was published in themedical journals anymore because of all the spinning of results.
So they did an investigation about how the pharmaceutical companies arefunding all the research and spinning the trial results, so you can nolonger really trust what you read in scientific journals. They pointedout that when they tried to get an expert to review the scientificliterature related to antidepressants, they basically couldn’t findsomeone who hadn’t taken money from the drug companies.
Now, the New England Journal of Medicine ispublished by the Massachusetts Medical Society which publishes a lot ofother journals, and they get a lot of pharmaceutical advertising. Sowhat happens after that article appears by Thomas Bodenheimer and anaccompanying editorial by Marcia Angell about the sorry state ofAmerican medicine because of this? They both lose their jobs! She’sgone and so is Thomas Bodenheimer. Think about this. We have theleading medical journal firing people, letting them go, because theydared to criticize the dishonest science and the dishonest process thatwas poisoning the scientific literature.
So we have theFDA that’s acting as lapdogs. You can’t trust the scientificliterature. All this shows how the American public was betrayed anddidn’t know about all the problems with these drugs and why it was keptfrom them. It has to do with money, prestige and old boy networks.
SS: Italso has to do with the silencing of critics. Eli Lilly uses the mediato trumpet Prozac’s benefits and gives perks to doctors to attendconferences to hear about its benefits, and buys off researchers. Butdon’t they also use their power and money to silence their critics?
RW: Anexample is Dr. Joseph Glenmullen, a psychiatrist who also works forHarvard University Health Services, and who wrote a book called ProzacBacklash to warn about the dangers of Prozac. He’s finding that thedrugs are being overused and cause severe side effects. He even raisesquestions about long-term memory problems with the drugs and cognitivedysfunction. Well, Eli Lilly then mounted a public relations campaignto try to discredit him. They sent out notices to the media questioninghis affiliation with Harvard Medical School, etc. It was all aboutsilencing the critics.
If you sing the tune that thedrug companies want, at the very top levels, you get paid a lot ofmoney to fly around and give presentations about the wonders of thedrugs. And those who come, and don’t ask any embarrassing questions,get the lobster dinners and maybe they get a little honorarium forattending this educational meeting. So if you want to be part of thisgravy train, you can. You sing the wonders of the drug, and you don’ttalk about their nasty side effects, and you can get a nice payment asone of their guest speakers, as one of their experts.
Butif you’re one of the ones saying, “What about the mania, what about thepsychosis?” — they do silence you. Look at what happened to DavidHealy. Healy is even the best example. David Healy has this sterlingreputation in England. He’s written several books on the history ofpsychopharmacology. He’s like the former Secretary of thePsychopharmacology Association over there. He gets offered a job at theUniversity of Toronto to head up their psychiatry department. So whilehe’s waiting to assume that position at the University of Toronto, hegoes to Toronto and delivers a talk on the elevated risk of suicidewith Prozac and some of the other SSRIs. By the time he’s back home,the job offer has been rescinded.
Now does Eli Lillydonate some money to the University of Toronto? Absolutely. So, toanswer your question, yes, Eli Lilly silences dissenters as well.
SS: Whatis the story behind the secret settlement between Eli Lilly and thesurvivors who sued the company after Joseph Wesbecker shot 20 coworkersafter being put on Prozac?
RW: Duringthis trial in which Eli Lilly was being sued, the judge was going toallow some very damaging evidence showing wrongdoing by Eli Lilly in aprevious instance. The judge said, “Go ahead and introduce this at thetrial.” But next thing you know, they don’t introduce this; and infact, all of a sudden, the plaintiffs no longer are presenting verydamaging evidence to make their case. So the judge wonders why they arenot presenting their best case anymore. He smells a rat. He suspectsEli Lilly has settled with the plaintiffs secretly and the deal isthat, as part of this settlement, the plaintiffs will go ahead with asham trial so that Eli Lilly will win the trial. Then Eli Lilly canclaim, “See our drug doesn’t cause people to become violent.”
And,indeed, that’s what happened. Eli Lilly felt it was going to lose thistrial. They went to the plaintiffs and said they would give them a lotof money. They agreed to go ahead and settle the case, but had theplaintiffs go ahead with the trial. That way Eli Lilly can publiclyclaim that they won the trial and Prozac doesn’t cause harm.
SS: How did this even come out into the light of day?
RW: Wewould never have known about this except for two things. One, believeit or not, the judge, in essence, appealed the decision in his owncourt. He said, “I smell a rat.” And through that, he found out thatthere was this secret settlement and that it was a sham proceeding thatcontinued on. He said it was one of the worst violations of theintegrity of the legal process that he’d ever seen. And second, anEnglish journalist named John Cornwell wrote a book called Power to Harm: Mind, Medicine, and Murder on Trial.He wrote about this case, and yet in the United States, we got almostno news about this secret settlement and this whole perversion of thelegal process. It was an English journalist who was exposing this story.
Mypoint here is this: They silence people like Marcia Angell. Theypervert the scientific process. They pervert the legal process. Theypervert the FDA drug review process. It’s everywhere! And that’s how weas a society end up believing in these psychiatric drugs. You asked thequestion a while back, “Why do we still believe in Prozac?” One of thereasons is that the story about Prozac is, in effect, maintained. It’spublicly maintained because we do all this silencing along all theselines.
The other thing to remember is that some peopleon Prozac do feel better. That’s true. That shows up, just in the sameway that some people on placebos feel better. And those are the storiesthat get repeated: “Oh, I took Prozac and I’m feeling better.” It’sthat select group that does better that becomes the story that is toldout there, and the story that the public hears. So that’s why wecontinued to believe in the story of these wonder drugs that are verysafe in spite of all this messy stuff that gets covered up.
SS: Let’snow move from the antidepressants like Prozac to consider another newgroup of supposed wonder drugs — the new antipsychotic drugs. Youwrite that long-term use of antipsychotic drugs — both the originalneuroleptic drugs like Thorazine and Haldol and the newer atypicalslike Zyprexa and Risperdal — cause pathological changes in the brainthat can lead to a worsening of the symptoms of mental illness. Whatchanges in brain chemistry result from the antipsychotics, and how canthat lead to the most frightening prospect you describe — chronicmental illness that is locked in by these drugs?
RW: Thisis a line of research that goes across 40 years. This problem ofchronic illness shows up time and time again in the researchliterature. This biological mechanism is somewhat well understood now.The antipsychotics profoundly block dopamine receptors. They block70-90 percent of the dopamine receptors in the brain. In return, thebrain sprouts about 50 percent extra dopamine receptors. It tries tobecome extra sensitive.
So in essence you’ve created animbalance in the dopamine system in the brain. It’s almost like, on onehand, you’ve got the accelerator down — that’s the extra dopaminereceptors. And the drug is the brake trying to block this. But if yourelease that brake, if you abruptly go off the drugs, you now do have adopamine system that’s overactive. You have too many dopaminereceptors. And what happens? People that go abruptly off of the drug,do tend to have severe relapses.
SS: Sopeople that have been treated with these antipsychotic drugs have a fargreater tendency to relapse, and have new episodes of mental illness,as opposed to people who have had other kinds of non-drug therapies?
RW: Absolutely,and that was understood by 1979, that you were actually increasing theunderlying biological vulnerability to the psychosis. And by the way,we sort of understood that if you muck with the dopamine system, thatyou could cause some symptoms of psychosis with amphetamines. So if yougive someone amphetamines enough, they’re at increased risk ofpsychosis. This is well known. And what do amphetamines do? Theyrelease dopamine. So there is a biological reason why, if you’remucking up the dopamine system, you’re increasing the risk ofpsychosis. That’s in essence what these antipsychotic drugs do, theymuck up the dopamine system.
Here’s just one realpowerful study on this: Researchers with the University of Pittsburghin the 1990s took people newly diagnosed with schizophrenia, and theystarted taking MRI pictures of the brains of these people. So we get apicture of their brains at the moment of diagnosis, and then we preparepictures over the next 18 months to see how those brains change. Nowduring this 18 months, they are being prescribed antipsychoticmedications, and what did the researchers report? They reported that,over this 18-month period, the drugs caused an enlargement of the basalganglia, an area of the brain that uses dopamine. In other words, itcreates a visible change in morphology, a change in the size of an areaof the brain, and that’s abnormal. That’s number one. So we have anantipsychotic drug causing an abnormality in the brain.
Nowhere’s the kicker. They found that as that enlargement occurred, it wasassociated with a worsening of the psychotic symptoms, a worsening ofnegative symptoms. So here you actually have, with modern technology, avery powerful study. By imaging the brain, we see how an outside agentcomes in, disrupts normal chemistry, causes an abnormal enlargement ofthe basal ganglia, and that enlargement causes a worsening of the verysymptoms it’s supposed to treat. Now that’s actually, in essence, astory of a disease process — an outside agent causes abnormality,causes symptoms…
SS: But in thiscase, the outside agent that triggers the disease process is thesupposed cure for the disease! The psychiatric drug is thedisease-causing agent.
RW: That’sexactly right. It’s a stunning, damning finding. It’s the sort offinding you would say, “Oh Christ, we should be doing somethingdifferent.” Do you know what those researchers got new grants for,after they reported that?
SS: No, what? You’d guess they got funding to carry out these same studies on other classes of psychiatric drugs.
RW: Theygot a grant to develop an implant, a brain implant, that would deliverdrugs like Haldol on a continual basis! A grant to develop a drugdelivery implant so you could implant this in the brains of people withschizophrenia and then they wouldn’t even have a chance not to take thedrugs!
SS: Unbelievable. Designingan implant to provide a constant dose of a drug that they had justdiscovered causes pathology in the brain chemistry.
RW: Right,they had just found that they’re causing a worsening of symptoms! Sowhy would you go on to a design a permanent implant? Because that’swhere the money was.
And no one wanted to deal with this horriblefinding of an enlargement of the basal ganglia caused by the drugs, andthat is associated with the worsening of symptoms. No one wanted todeal with the fact that when you look at people medicated onantipsychotics, you start to see a shrinking of the frontal lobes. Noone wants to talk about that either. They stopped that research.
SS: What other side effects are caused by prolonged use of these antipsychotic drugs?
RW:Oh, you get tardive dyskinesia, a permanent brain dysfunction; andakathisia, which is this incredible nervous agitation. You’re justnever comfortable. You want to sit but you can’t sit. It’s like you’recrawling out of your own skin. And it’s associated with violence,suicide and all sorts of horrible things.
SS: Thosekinds of side-effects were notorious with the first generation ofantipsychotic drugs, like Thorazine, Haldol and Stelazine. But, just aswith Prozac, so many people are still touting the new generation ofatypical antipsychotics — Zyprexa, Clozaril and Risperdal — as wonderdrugs that control mental illness with far fewer side effects. Is thattrue? What have you found?
RW: No,it’s just complete nonsense. In fact, I think the newer drugs willeventually be seen as more dangerous than the old drugs, if that’spossible. As you know, the standard neuroleptics like Thorazine andHaldol have had quite a litany of harm with the tardive dyskinesia andall.
So when we got the new atypical drugs, they were touted asso much safer. But with these new atypicals, you get all sorts ofmetabolic dysfunctions.
Let’stalk about Zyprexa. It has a different profile. So it may not cause asmuch tardive dyskinesia. It may not cause as many Parkinsoniansymptoms. But it causes a whole range of new symptoms. So, for example,it’s more likely to cause diabetes. It’s more likely to causepancreatic disorders. It’s more likely to cause obesity andappetite-disregulation disorders.
In fact,researchers in Ireland reported in 2003 that since the introduction ofthe atypical antipsychotics, the death rate among people withschizophrenia has doubled. They have done death rates of people treatedwith standard neuroleptics and then they compare that with death ratesof people treated with atypical antipsychotics, and it doubles. Itdoubles! It didn’t reduce harm. In fact, in their seven-year study, 25of the 72 patients died.
SS: What were the causes of death?
RW: Allsorts of physical illnesses, and that’s part of the point. You’regetting respiratory problems, you’re getting people dying of incrediblyhigh cholesterol counts, heart problems, diabetes. With olanzapine(Zyprexa), one of the problems is that you’re really screwing up thecore metabolic system. That’s why you get these huge weight gains, andyou get the diabetes. Zyprexa basically disrupts the machine that weare that processes food and extracts energy from that food. So thisvery fundamental thing that we humans do is disrupted, and at somepoint you just see all these pancreatic problems, faulty glucoseregulation, diabetes, etc. That’s really a sign that you’re muckingwith something very fundamental to life.
SS: There’ssupposedly an alarming increase in mental illness being diagnosed inchildren. Millions are diagnosed with depression, bipolar and psychoticsymptoms, attention deficit hyperactivity disorder, and social anxietydisorder. Is this explosive new prevalence of mental illness amongchildren a real increase, or is it a marketing campaign that enrichesthe psychiatric drug industry, a bonanza for the pharmaceuticalcorporations?
RW: You’re touchingon something now that is a tragic scandal of monumental proportions. Italk sometimes to college classes, psychology classes. You cannotbelieve the percentage of youth who have been told they were mentallyill as kids, that something was wrong with them. It’s absolutelyphenomenal. It’s absolutely cruel to be telling kids that they havethese broken brains and mental illnesses.
There’s twothings that are happening here. One, of course, is that it’s completenonsense. As you remember as a kid, you have too much energy or youbehave sometimes in not altogether appropriate ways, and you do havethese extremes of emotions, especially during your teenage years. Bothchildren and teenagers can be very emotional. So one thing that’s goingon is that they take childhood behaviors and start defining behaviorsthey don’t like as pathological. They start defining emotions that areuncomfortable as pathological. So part of what we’re doing ispathologizing childhood with straight-out definition stuff. We’repathologizing poverty among kids.
For example, ifyou’re a foster kid, and maybe you drew a bad straw in the lottery oflife and are born into a dysfunctional family and you get put intofoster care, do you know what happens today? You pretty likely aregoing to get diagnosed with a mental disorder, and you’re going to beplaced on a psychiatric drug. In Massachusetts, it’s something like 60to 70 percent of kids in foster care are now on psychiatric drugs.These kids aren’t mentally ill! They got a raw deal in life. They endedup in a foster home, which means they were in a bad family situation,and what does our society do? They say: “You have a defective brain.”It’s not that society was bad and you didn’t get a fair deal. No, thekid has a defective brain and has to be put on this drug. It’sabsolutely criminal.
Let’s talk about bipolar disorderamong kids. As one doctor said, that used to be so rare as to be almostnonexistent. Now we’re seeing it all over. Bipolar is exploding amongkids. Well, partly you could say that we’re just slapping that label onkids more often; but in fact, there is something real going on. Here’swhat’s happening. You take kids and put them on an antidepressant –which we never used to do — or you put them on a stimulant likeRitalin. Stimulants can cause mania; stimulants can cause psychosis.
SS: And antidepressants can also cause mania, as you pointed out.
RW:Exactly, so the kid ends up with a drug-induced manic or psychoticepisode. Once they have that, the doctor at the emergency room doesn’tsay, “Oh, he’s suffering from a drug-induced episode.” He says he’sbipolar.
SS: Then they give him a whole new drug for the mental disorder caused by the first drug.
RW: Yeah,they give him an antipsychotic drug; and now he’s on a cocktail ofdrugs, and he’s on a path to becoming disabled for life. That’s anexample of how we’re absolutely making kids sick.
SS: It’slike society or their schools are trying to make them manageable andthey end up putting them on a chemical roller coaster against theirwill.
SS: There’san astonishing number of kids being given Ritalin to curehyperactivity. But what 10-year-old boy in a confined school settingisn’t hyperactive? You write that the effect of Ritalin on the dopaminesystem is very similar to cocaine and amphetamines.
RW: Ritalinis methylphenidate. Now methylphenidate affects the brain in exactlythe same way as cocaine. They both block a molecule that is involved inthe reuptake of dopamine.
SS: So they both increase the dopamine levels in the brain?
RW: Exactly.And they do it with a similar degree of potency. So methylphenidate isvery similar to cocaine. Now, one difference is whether you’re snortingit or if it’s in a pill. That partly changes how quickly it’smetabolized. But still, it basically affects the brain in the same way.Now, methylphenidate was used in research studies to deliberately stirpsychosis in schizophrenics. Because they knew that you could take aperson with a tendency towards psychosis, give them methylphenidate,and cause psychosis. We also knew that amphetamines, likemethylphenidate, could cause psychosis in people who had never beenpsychotic before.
So think about this. We’re giving adrug to kids that is known to have the possibility of stirringpsychosis. Now, the odd thing about methylphenidate and amphetamines isthat, in kids, they sort of have a counterintuitive effect. What doesspeed do in adults? It makes them more jittery and hyperactive. Forwhatever reasons, in kids amphetamines will actually still theirmovements; it will actually keep them in their chairs and make themmore focused. So you’ve got kids in boring schools. The boys are notpaying attention and they’re diagnosed with ADHD and put on a drug thatis known to stir psychosis. The next thing you know, a fair number ofthem are not doing well by the time they’re 15, 16, 17. Some of thosekids talk about how when you’re on these drugs for the long term, youstart feeling like a zombie; you don’t feel like yourself.
SS: Hollowed-out, blunted emotions. And this is being done to millions of kids.
RW:Millions of kids! Think about what we’re doing. We’re robbing kids oftheir right to be kids, their right to grow, their right to experiencetheir full range of emotions, and their right to experience the worldin its full hue of colors. That’s what growing up is, that’s what beingalive is! And we’re robbing kids of their right to be. It’s socriminal. And we’re talking about millions of kids who have beenaffected this way. There are some colleges where something like 40 to50 percent of the kids arrive with a psychiatric prescription.
SS: Itlooks like a huge social-control mechanism. Society gives kids Ritalinand antidepressants to subdue them and make them conform. On the onehand, it’s all about social control and conformity. But it also has ahuge marketing payoff.
RW: You’reright, it creates customers for the drugs, and hopefully lifelongcustomers. That’s what they’re told, aren’t they? They’re told they aregoing to be on these drugs for life. And next thing they know, they’reon two or three or four drugs. It’s brilliant from the capitalist pointof view. It does serve some social-control function. But you take akid, and you turn them into a customer, and hopefully a lifelongcustomer. It’s brilliant.
We now spend more onantidepressants in this country than the Gross National Product ofmid-sized countries like Jordan. It’s just amazing amounts of money.The amount of money we spend on psychiatric drugs in this country ismore than the Gross National Product of two-thirds of the world’scountries. It’s just this incredibly lucrative paradigm of the mindthat you can fix chemical imbalances in the brain with these drugs. Itworks so well from a capitalistic point of view for Eli Lilly. WhenProzac came to market, Eli Lilly’s value on Wall Street, itscapitalization, was around 2 billion dollars. By the year 2000, thetime when Prozac was its number-one drug, its capitalization reached 80billion dollars — a forty-fold increase.
So that’swhat you really have to look at if you want to see why drug companieshave pursued this vision with such determination. It brings billions ofdollars in wealth in terms of increased stock prices to the owners andmanagers of those companies. It also benefits the psychiatricestablishment that gets behind the drugs; they do well by this. There’sa lot of money flowing in the direction of those that will embrace thisform of care. There’s advertisements that enrich the media. It’s all abig gravy train.
Unfortunately, the cost is dishonestyin our scientific literature, the corruption of the FDA, and theabsolute harm done to children in this country drawn into this system,and an increase of 150,000 newly disabled people every year in theUnited States for the last 17 years. That’s an incredible record ofharm done.
SS: Everyone getsrich — the drug companies, the psychiatrists, the researchers, theadvertising agencies — and the clients get drugged out of their mindsand damaged for life.
RW: And youknow what’s interesting? No one says that the mental health of theAmerican people is getting better. Instead, everyone says we have thisincreasing problem They blame it on the stresses of modern life orsomething like that, and they don’t want to look at the fact that we’recreating mental illness.
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