Friday, August 12, 2011

Has America Become a Nation of Psychotics on Psychotics?


An article reprint by James Ridgeway who writes for The Guardian newspaper, and is the senior Washington correspondent for Mother Jones magazine.

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. Adriane Fugh-Berman, whose Pharmed Out project tracks the industry's influence on American medicine, and who last month hosted a conference on the subject at Georgetown. 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 suggest that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.
Carl Elliott reports in Mother Jones 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 was over $1.8 billion.

Making patients worse

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 come reports of people turned into virtual zombies.
Elliott reports in Mother Jones: "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. Peter 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.

Monday, August 1, 2011

German Association of Psychiatrists Acknowledge Murdering the Mentally Ill during the Nazi Third Reich Nazi

(The following interview article is a translation of a November 26, 2010 article from the German online magazine The original article can be seen in Focus Magazin)

65 years after the end of the Third Reich, the German association of psychiatrists faces up to its dark history—at last. Only today it offers an apology for its crimes committed during the period of the National Socialism.
Only now the German association of psychiatrists officially faces up to its gruesome crimes during the period of the Third Reich. In a commemoration for the victims and the expelled Jewish doctors, president Frank Schneider offers an apology for the atrocities committed.
FOCUS: In this commemoration at the congress of the Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (German Association of Psychiatry, Psychotherapy and Neurology) you are about to offer an apology for the crimes committed by psychiatry during the period of the National Socialism. Why hasn’t this long been done?
Frank Schneider: I don’t know why we talk about this only now. We are at a loss of words why an event like this one can take place only now. It’s almost impossible to explain, there is no justification for it.
In our association DGPPN we refer to 160 years of tradition, and it existed even in the Third Reich. The president at that time was doing research on racial hygiene and propagated it externally. Inconceivable crimes were being done. And still, after 1945, we didn’t support the victims but we had a part in their renewed discrimination and disadvantage. This darkest part of our history has been shunned and repressed much too long. The persistent silence is also a debasement for the victims. We are ashamed of that.
Today we are going to apologize and ask for reconciliation. A lot of the victims are dead by now, and insofar our solicitation is too late. But maybe it isn’t too late for the people still alive and their descendants – and for all mentally ill people today, for today’s psychiatrists and for the association itself.
FOCUS: How exactly does your association face up to the crimes?
Schneider: To begin with, we decided to change the articles of association. Paragraph 1 now firmly states that the association commemorates the victims and is responsible for what happed back then. And that we are responsible that something like this will never ever happen again.
Furthermore an independent international commission of four outstanding science historians is engaged to research our association’s history in the Third Reich. We provided 150,000 Euros (about 200,000 USD) to accomplish that, and we stipulated to announce the results of the study no matter what comes out of it.
Subsequently we plan to do another study in order to clear up the postwar years, i. e. the period of the cover-up and the repression which went on until the 1980s.
FOCUS: What kind of victims do you commemorate?
Schneider: First of all the approximately 2,000 Jewish psychiatrists who were forced to emigrate and therefore lost their home and their belongings. Then also the people who suffered enforced sterilization and those who were killed.
We also commemorate the victims who bared misery due to psychiatric research, who were maimed or murdered.
FOCUS: You, as president, have made the subject of the National Socialism period to the core theme of this congress and your term in office. Why did you do that?
Schneider: The subject of psychiatry’s Nazi history is very important to me personally. I have always been aghast and wondered: How can psychiatrists kill their patients? And this has been done very extensively either by themselves or they have had other people do it.
Including the East European countries there were all in all about 300,000 mentally ill people whose psychiatrists caused their deaths. That’s incredible.
FOCUS: What kind of reactions did you encounter inside your association?
Schneider: I thought nobody liked the subject but the responses have been positive uniformely. I was surprised and happy about that. I just watered the seed. It was long overdue.
FOCUS: Weren’t there admonishers earlier that fought for a clearing-up and a confession?
Schneider: There was Professor Gerhardt Schmidt, head of psychiatry in Lübeck, Germany, who directly after 1945 came to a clinic where patients starved to death, meaning they were killed. He wrote a very outright book about these conditions. I read it as a student and I was highly impressed at the time. This man named Schmidt was not able to publish his book for 20 years because he was facing a Mafia of psychiatrists who didn’t want anybody to foul their nest. In the 1980s it was a moment of glory in our association to award him with a medal for it.
FOCUS: How come psychiatry’s atrocities have been ignored for so long?
Schneider: It was hushed up and repressed. After the war, three renowned psychiatrists, who made medical estimates for enforced sterilizations and who decided upon life or death, became presidents of our association and even honorary members. One of these former presidents, professor Ehrhardt from Marburg, Germany, was also the leading secretary. He wrote a booklet about the history of German psychiatry and its associations. It isn’t thick. It says that psychiatrists of the Third Reich had no knowledge of what was going on and they didn’t have anything to do with it and they found it all really terrible. This is an official document of the association.
What’s even worse: In the 1960s, when the question arose whether people who suffered forced sterilization should get any indemnity, Ehrhardt and also other psychiatrists appeared as an authority on the subject in the Bundestag (Lower House of German Parliament). In an advisory committee they declared that forced sterilization was compliant to the rules at that time and it was all done within the then current scope of science and nothing was to take back. This is once again a debasement for the victims. There was nobody to say anything against that.
FOCUS: How were the conditions in psychiatry after the war was over?
Schneider: It was awful how the mentally ill were kept back then, in the years after the war. People were locked up in big “loony bins” in the countryside. Especially chronically schizophrenic patients lived in these mental institutions for years.
The revolution in psychiatry in Germany emerged later than in other European countries. For one, there were too little psychiatrists due to the enforced emigration, and those who were here continued with the back then normal lock-up psychiatry for the time being. In other countries the social psychiatric movement started earlier. There the chains were opened more quickly.