Friday, August 20, 2010

Anatomy of an Epidemic - exposing one of the great scandals in US history

I happened upon another eloquent and thoughtful review of "Anatomy of an Epidemic" By Robert Whitaker that is worth sharing here.

Existential Psychology Weblog by Louis Hoffman -

http://existentialpsychology.typepad.com/my_weblog/2010/08/the-anatomy-of-an-epidemic-by-robert-whitaker-book-review.html

The Anatomy of an Epidemic By Robert Whitaker Book Review

I find the overuse of the idea of "must-read" books to be quite annoying, yet Whitaker's The Anatomy of an Epidemic is a book that I would say is a must-read for mental health professionals and consumers, or anyone whose life is impacting by someone on psychotropic medications. Whitaker is not a mental health professional; he is a journalist. He began his interest in psychotropic medications when he was part of a group that wrote mostly "industry-friendly" articles about new medications and clinical trials. He did not begin with an agenda against big pharma or psychiatry, but his investigations gradually caused concern. The more he investigated the more he became concerned with psychotropic medications. It was the data and the stories of how these medications impacted the lives of so many that drew him to this topic. In other words, he came to it honestly. And he's done his research. He knows the topic well. In fact, I would say that he has likely developed a much better understanding of the outcome studies than the majority of the professionals prescribing these medications.

Whitaker looks at the major groups of psychotropic medications - anti-depressants, anxiety meds, antipsychotics, bipolar meds, and meds for Attention-Deficit/Hyperactivity Disorder. Remarkably, an honest look at the literature seems to lead to the same conclusions on all of these meds and can be easily summarized:

  1. Medications often are effective in the short-term.
  2. The effectiveness of medications decrease over time and are associated with a greater likelihood of the problem become chronic.
  3. Medications often lead to poorer long term outcomes along with the likelihood of increased psychological and physical problems (in fact, long-term use of many medications are associated with shorter lifespan).

Given this, why would one take medication for psychological disorders?? The data seems to support the position that being heard more frequently: medications tend to only be effective and beneficial in the long-term for very severe impairment. Yet, medications seem to be prescribed with little more concern than recommending ibuprofen for a headache. In fact, Whitaker says that 1 in 8 people in the US are on a psychotropic medication. Furthermore, for the vast majority of these individuals, the research suggests these medications over time will decrease their quality of life, increase the length and severity of their impairment, and cost them (and the rest of us) a great deal of money. In particular, Whitaker demonstrates that use of these medications increases the likelihood that someone will be legitimately unable to work and in need of government financial support.

One wonders how this occurs. Although Whitaker did not go as deep into the corruption as some other books on the topic, he does expose how pharmaceutical companies and psychiatry have colluded in one of the greatest marketing scams in history. On many occasions, this includes outright deception regarding the research results and hiding or covering up information on dangerous side effects, including the increased risk of suicide. This scandal has literally cost people their lives. Yet big pharma and psychiatry continue to be allowed to proceed with these gross deceptions.

As Whitaker demonstrates, big pharma spends millions of dollars sponsoring events at the American Psychiatric Association's convention. They give large gifts to top academics to be spokespersons for them. They even give gifts to the local experts to promote various drugs. Indeed, it seems big pharma has bought the opinions of many "so-called experts" who are often even coached in what specifically to say at various conferences, conventions, and other speaking presentations. It is a disgrace to the academy that they have not intervened stronger in the corruption of many academics who receive large amounts of grant money and other gifts to promote medications using false and distorted interpretations of the research. Many of these distortions end up in the text books and other professional sources, including text books in mental health professions outside of psychiatry. The corruption is pervasive.

I have concerns, too, that the next market is the international one. Whitaker addresses this issue indirectly. He went well beyond the outcome literature and did comparisons between different regions and countries. The results are clear. The US and many other developed countries are fairing much more poorly than the developing countries. Countries that do not rely upon psychotropics have greater recovery rates. Similarly, the recovery rates in the US were much higher and chronicity of problems much lower before the reliance on psychotropics became the primary form of treatment.

But before encouraging people to throw away their medications, there is another problem. It is not easy and, sometimes, not safe to get off these medications. Quickly discontinuing medications can cause "rebounds" and other side effects that can be quite dangerous. Getting off medications safely generally requires that this be done gradually under the care of a medical doctor. However, Whitaker points out that there is little research on how to do this.

To resolve the problems created by the gross, broad-based misuse of psychotropic medications will take many, many years if we set an agenda to resolve this now. For many, there will be no recovery from the damage that has been done. This is a sad story, but a story that requires action to prevent further harm being done.

If you are skeptical about the importance of this issue, don't just read Whitaker's book. Go to the original sources and read on both sides of the issues. I am confident that most who engage in such an endeavor will come out realizing that Whitaker is exposing one of the great scandals in US history.





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