PRESCRIBING DRUGS: FIRST DO NO HARM
In the second part of our cover story, Dr James Davies shares his controversial but factual presentation at the parliamentary event chaired by shadow health secretary Andy Burnham.
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Parts 1 and 3 of the cover story:
Addiction to prescription drugs: parliamentary event
5,000 women poisoned by benzodiazepines
Today you will hear many tales of medical failure, offered by a few representatives of the millions each year being adversely affected by psychiatric medications. You will hear of unnecessary diagnoses, vaulting prescription rates, guidelines not being followed, patients being kept in the dark, and suffering being perpetrated in the name of healing and helping vulnerable people. Today I will give you a brief set of historical facts pointing to how we have arrived at this state of affairs – why the dominant medical model of mental-health treatment, despite its professed aim, is in many ways committing much harm individually, socially, and economically.
The research is clear: the categories of mental disorder, rather than painful experiences themselves, are psychiatric constructions and do not reflect scientifically discovered biological entities. In other words, for 95% of all mental-health disorders no clear biological causes have been found. And yet these disorders continue to proliferate in number: from about 100 in 1950 to about 370 today.
Also, the bar for what constitutes a mental- health condition has been progressively lowered. According to many academics, this situation has lead psychiatry to reclassify more and more of our natural and normal reactions to the difficulties of life indicating psychiatric disorders requiring treatment. By doing so, psychiatry has not only expanded its jurisdiction over more of us – apparently one in four of us now suffers from a mental disorder at any given time – but it has also created a huge market for psychiatric treatments.
The preferred treatments are pharmaceutical treatments, such as antidepressants, tranquillisers and antipsychotics. These are being prescribed at a remarkable rate.
>> There were 46.7million prescriptions of antidepressants dispensed in England in 2011 alone.
>> There were 16million prescriptions of tranquillisers dispensed in England in 2011.
>> There were many millions of antipsychotics dispensed in England in 2011 alone.
A rough estimate is that almost 15% of the British public is psychiatrically medicated at any given time. But the emerging reality is that these treatments do not work in the way that most people believe.
In addition, the efficacy and the safety of these drugs is far from reassuring. In the case of antidepressants, wide-scale meta-analyses show that they work no better than placebo pills for 85% people taking them.
Let us turn to antipsychotics. We know that they can stabilise patients short term – we also know that their long-term use can have countertherapeutic effects as well as damaging neurological effects we still do not understand.
Finally, concerning the tranquillisers, and as will soon become clear, they are not only highly addictive but unleash withdrawal effects often as catastrophic as those afflicting people withdrawing from illegal drugs.
In other words, research now shows that psychiatric drugs mostly unleash placebo effects, side effects, withdrawal effects and sometimes sedating or stabilising effects. But never do they have curing effects.
This is largely because, for the vast majority of problems for which they are prescribed, there is no discovered biological ‘disease’ for these pills to target and treat.
These inconvenient facts are not widely known. There are many reasons why. But one of critical note is that pharmaceutical companies over recent decades have systematically promoted their customised version of information via powerful marketing campaigns which aim to sway medical opinion.
Most UK psychiatry departments now receive departmental income from drug companies, while many employees receive personal income. Almost all research into psychiatric drugs in the UK – that’s almost 90% of all clinical trials – are conducted or commissioned by the industry. Most academic drug researchers have also received research funding, consultancy fees and honoraria from the industry.
This is graphically illustrated by how many members of the current guidelines on mental disorders, the Diagnostic & Statistical Manual v5, have received such payments. Out of the 29 people who wrote the recent edition, a full 21 have had strong financial ties to the industry, including the chair and vice chair.
This situation is compounded because, as is the case right now in the UK, doctors are not obliged to report to any agency or any authority precisely how much they personally receive each year from the pharmaceutical industry.
The reason we should be concerned about this is not only because research shows that doctors who receive such payments are more likely to be biased in their clinical activities and beliefs than doctors who do not (and that is concerning enough), but because industry-sponsored drug research has historically transgressed the bounds of what is right and proper.
From class actions taken against companies as widely varying as thalidomide and tobacco manufacturers, and from comprehensive academic studies, we know that negative trials into psychiatric drugs have been routinely buried.
We know that company research has been repeatedly manipulated to turn negative results into positive ones.
And we know that the regulatory agencies approving these drugs for public use have often seemed unmoved by these misdemeanours. In fact, the MHRA, the UK’s most important drug regulatory agency, itself entirely funded by the pharmaceutical industry, requires only a mere two positive trials to approve a psychiatric drug for public use – even if 5 or 10 negative trials exist for that same product.
In a practice that bemuses many of us working in universities, the MHRA discards the negatives.
In short, the real reason why we are gathered here today is because we sit at the end of a broken system. It is a system contrived not out of conspiratorial machinations, but out of diverse commercial, cultural and professional factors which have gradually fashioned a scenario in which lack of transparency, lack of accountability, weak drug regulation, poor internal regulation and over-reliance on pharmaceutical payments have compromised the integrity and publicly-spirited objectivity of our mental-health system.
So as the discussions unfold, I implore you to keep this backdrop in mind: a backdrop about which kneejerk incredulity might feel like the most sensible response. But we have the academic evidence… evidence that is freely available to any interested party, and certainly to those concerned, like me, about our growing cultural, corporate and institutional addiction to the prescribing and to the consumption of psychiatric drugs.
Bad Pharma: How drug companies mislead doctors and harm patients by Ben Goldacre, published by Harper Collins (ISBN 978-0007350742).
Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare by Peter Gotzsche, published by Radcliffe August 2013 (ISBN: 9781846198847).
Bad Medicine: Doctors doing harm by David Wootton, published by OUP Oxford (ISBN 978-0199212798).