Healthy Skepticism Library item: 1025

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Publication type: news

Drug argument embroils psychiatrists, pharm cos: Critics question whether medication trumps other treatments
CNN 2003 Mar 24
http://www.cnn.com/2003/HEALTH/conditions/03/24/health.psychiatry.reut/index.html

Full text:

WASHINGTON (Reuters) —At 7, Susan was diagnosed with major depression and
given antidepressant drugs. At 12, she was tagged with both depression and
borderline personality disorder, and more drugs were prescribed.
“At 12, I was on uppers and downers,” said Susan, who asked that her real
name not be used.
At 18 Susan, now 27, took herself off all psychiatric drugs and has been
healthy and productive ever since.
A miracle cure, thanks to modern psychiatric wonder drugs?
Not quite, she insists. “I recovered not because of the mental health system
but in spite of it,” Susan, a university administrator, writer and poet said
in a recent interview.
With little fanfare but much passion, a movement has arisen in recent years
against what critics regard as a psycho-pharmacetical industry that has
slowly undermined the therapeutic foundations of psychiatry with a drug- and
profit-driven model for treatment of illnesses, real and — they say —
imagined.
Psychiatrists say Susan represents a small fraction of those treated with
newer classes of psychiatric drugs, many of which have proven highly
effective with fewer side effects than older drugs — which are potentially
addictive or cause drowsiness, disorientation and other serious side
effects.
Still, she is not alone in her beliefs.
The more radical of these activists say the system serves to enrich
psychiatrists, drug makers and insurers while doing little to help those
labeled with psychiatric diagnoses.
Anxiety disorder a creation of pharmaceutical companies?
Advocates for the mentally ill, including groups like the Anxiety Disorders
Association of America, strongly disagree. On its Web site, the ADAA says
some 19.1 million Americans suffer from these disorders, which it says costs
the United States more than $42 billion a year.
The group claims some 4 million Americans suffer from generalized anxiety
disorder — a condition which many anti-psychiatry activists say was
invented to sell drugs.
Among the best-selling psychiatric drugs are three that Susan took: Eli
Lilly and Co.‘s anti-depressant Prozac; Pfizer Inc.‘s Zoloft, used to combat
depression and anxiety and recently approved to treat social anxiety
disorder; and GlaxoSmithKline Plc’s , Paxil used for depression and anxiety.
“Both GAD and SAD (social anxiety disorder) are acknowledged and recognized
as serious … health conditions by the APA (American Psychiatric
Association),” said Michael Fleming, a spokesman for GlaxoSmithKline.
Are “psychiatric survivors,” as many call themselves, just disgruntled
individuals, isolated cases in a psychiatric system that has found new
pharmaceutical cures for illnesses once deemed untreatable? Perhaps.
But some in the medical profession now also find fault with the rising tide
of diagnoses for behaviors once thought of simply as troublesome or odd, and
especially the rising number of children and young adults labeled “sick” and
medicated.
Dr. Lawrence Plumlee was one of about 150 people crammed into a tiny
classroom at American University in Washington for a recent seminar called
“Fighting Corporate Psychiatry,” part of a larger anti-corporate,
anti-globalization forum.
Plumlee, 66, a retired toxicologist with the Environmental Protection
Agency, was diagnosed with schizophrenia as a troubled young solder in the
Army in the 1960s. He believes his personal turmoil in turbulent times was
misinterpreted as mental illness because society wasn’t prepared to confront
the difficult ethical and cultural issues he felt he had to face.
“The reasons we get visions and some delusions when we’re coming of age is
because we’re looking for meaning in life,” he told that forum. “When you’re
having this kind of personal turmoil, you’re labeled as schizophrenic.”
While some of these critics scorn psychiatry as a pseudo-science of
hucksters in an unholy alliance with predatory drug companies, others simply
see an overburdened profession that relies too heavily on drugs.
But the strand that binds them is a belief that the psychiatric profession
is being led astray by an overdependence on drugs at the expense of
time-intensive “talk” therapy — and intangibles like compassion, societal
and family support, meaningful work and creative outlets for troubling
thoughts and emotions.
Pressure from insurers
That they find common ground with the anti-globalization movement is little
surprise in light of the fact that more than half the new patients of
corporate psychiatry are children or young adults.
The drugging of millions of children diagnosed with attention deficit
hyperactivity disorder (ADHD) is a rallying point for many who say such
children need patience, not drugs.
Susan is among the moderates in this backlash against a system she believes
stole more than a decade of her young life. Psychiatric drugs are useful for
some, she conceded, “as long as it’s with extremely informed consent.”
Dr. Paul Applebaum, president of the American Psychiatric Association (APA)
and chairman of the psychiatry department at the University of Massachusetts
Medical School, said increased reliance on drugs over more expensive and
time-consuming therapies stems in part from “pressure” from insurers.
Behavioral health insurers “have made a great deal of money and come to
dominate their industries … by in some cases denying extended care … and
in some cases only agreeing to care if relatively brief and few therapeutic
sessions are used and medication is applied,” he said.
“The profession as a whole is extremely unhappy about that situation,”
Applebaum said in a telephone interview. “There are new forms of therapy …
cognitive behavioral approaches that have proven as effective with many
forms of anxiety disorders and depression, if not more so than drugs.”
Still, Applebaum insists, the new anti-depressant and anti-anxiety drugs are
in many cases effective, with fewer side effects and liabilities — like
addiction — than older classes of drugs including sedatives and
tranquilizers.
The anti-drug activists say the focus on relatively new emotional and
psychiatric complaints like GAD and SAD are cynical attempts to apply the
disease model to — and sell drugs to correct — perfectly normal behavior.
Applebaum counters that for such disorders to warrant diagnoses as a mental
illness, “they must cause significant objective distress and disfunction in
the individual.”
The critics point to a well-documented surge in advertising for anti-anxiety
drugs in the post-September 11 world, saying drug companies are capitalizing
on widespread fear of further attacks to sell drugs to people who might not
need them.
While the APA doesn’t have a formal position on direct marketing of
psychiatric drugs to consumers, Applebaum said there is “a plus side and a
minus side” to the practice.
“The plus side is that consumers are so much better informed as to their
choices,” he said. “The down side is that people should unnecessarily
request medications of their physicians that they have a hard time
refusing.”
Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers
of America, said the mass-marketing of psychiatric drugs “is not something
that’s on the radar screen for us.”
However, “direct consumer advertising is closely monitored and regulated” by
the Food and Drug Administration, he said, “and the FDA is a rough
regulatory task master.”

Copyright 2003 Reuters. All rights reserved.