Sunday, September 21, 2014
Dr. David Healy has spent decades delving into the dark corners of the pharmaceutical industry, where, for instance, drug companies have tried to hide the worrisome connection between antidepressant drugs and suicide. In the psychiatrist’s best-known previous books, The Antidepressant Era and Let Them Eat Prozac, Healy explored the often vexing history of the mental health field and its troubled relationship with Big Pharma. In his latest book,Pharmageddon, he presents an even bleaker picture of the way industry has co-opted medicine in general — not just mental health. Healthland spoke with Healy about his findings.
What do you mean by ‘pharmageddon’?
At the moment, treatment-induced death is the fourth leading cause of death [overall], and within the mental health field, it’s probably the leading cause of death.
It’s a little bit like climate change. It may feel great to have a car, the convenience you get is a thing we appreciate each time we hop in the car and drive down to the market. But the use of cars is contributing to the bigger picture of climate change. In the same way, quite a few medications we take produce good outcomes. But we’ve [had a] climate change in medicine, which runs the risk of completely destroying medicine as we’ve known it.
And the key tool in all of this is how companies use the scientific evidence. They construct trials to get the outcomes they want; they only publish positive trials. The study often shows the opposite of what the data actually shows.
In the book, you look at how drug companies sell us on reducing risks — like say, high cholesterol — that may not actually do much to keep us healthy because high cholesterol itself is just a marker for cardiovascular disease risk, not an illness itself.
If you [look at] statins to lower cholesterol or drugs for osteoporosis, there’s no obvious benefit like there is from wearing a parachute when you jump out of a plane. You often just don’t feel good and you may feel a good deal worse. There isn’t even a proven benefit at the end. What you’ve got is proof in the sense of demonstrating that over a six-week period, you can show a marginal change that we have agreed to call a change for the ‘better.’ [The point is that the measure doesn’t necessarily mean your health will improve, but rather is just a marker linked with a reduction in risk.]
Trials get used as tool to persuade doctors to persuade you to have treatment. [And making drugs] available on prescription only is a means to persuade you to take things that if you were more naturally cautious, you’d be less inclined to take.
But don’t we need clinical trials to eliminate quack remedies and look systematically at the best treatments?
There’s two [situations] where trials are useful. There’s an area were you don’t need trials at all, where the treatment really works, such as antibiotics for serious infections. And they’re also really useful when they show that something doesn’t work.
What we’ve got is what’s in between, where in actual fact [some] people would say, for example, if you take all the trials of antidepressants, they actually show that the drugs didn’t work.
Yet many people say they experience profound changes after taking the antidepressant drugs like Prozac — some positive and some negative.
That’s not saying that they don’t work — a bunch of people swear that they’re working. The problem is that if we had all the data available [including the data that the drug companies hid], we ought to have said, ‘We’re not impressed by these drugs. We need to go to back to the drawing board and find the people who really benefit.’ There’s a bunch of people on [antidepressants] who clearly do well. But the companies have made whatever billions of dollars [selling them to a lot of people who don’t].
What do you think about the link between antidepressants and suicide? You’ve found some pretty damning evidence that healthy people may become suicidal or aggressive when they take these drugs.
There’s a group of people for whom antidepressants in general work awfully well, but there’s also a group for whom they don’t work well and they can become either violent or suicidal. The problem again comes back to the role of the doctor. If doctors can’t see that drugs may be good and may be bad, that they can be useful and problematic — if they aren’t experts and can’t handle a bit of complexity — they’re going to go out of business. The problem with doctors and antidepressants making people commit suicide is when it first came out about some children being suicidal, the American Psychiatric Association said that it believed that antidepressants save lives.
I’ve been trying to say to doctors, this is a professional suicide note. What they should say is, Psychiatry can save lives. We know that these pills are good for some and not others and it takes expertise to manage this. If don’t take that [perspective], well, there are cheaper people like nurses, and if pills have no risk and work well, there are cheaper people going to be prescribing.
Why do you emphasize the issue of prescribing privileges so much?
When you come to me for treatment, in sense you’re my hostage. If I ask you if something is wrong [in terms of side effects, you say], ‘No, things are fine.’ You may be having strange thoughts, you may be getting aches and pains you didn’t have before, but the problem is that you either want to keep me happy and so you don’t mention it, [or you say nothing] because I’ve told you that you have to be on these pills because otherwise you will have a heart attack or stroke. You may not even know that the problem is caused by the pill. As a doctor, I’m not trained to pick up that these things may be going on.
The other I’m thing not trained in is that when things are available by prescription only, it’s me, the doctor that ‘consumes’ the pill. I’m the consumer in the sense that companies market these drugs [to me] — in the case of pharma, they’re spending more on marketing than Apple spends or Microsoft or GM. [While those companies] market to all of us, the amount of dollars per head is small. But pharma markets to doctors. Direct-to-consumer ads are only a small part of budget and they’re designed not [just] to get you to believe in the pill, but get you to bring pressure to bear on doctors.
Wouldn’t a big part of the problem be solved simply by requiring drug companies to release all their data?
There should be a law requiring them to reveal all the data. I think that’s a key thing: there should be access to all of the data from the clinical trials. We take risks with new pills on an understanding that the data is going to be made available to experts to sift through and let us all know what the true profiles of these pills are.
If people entering into trials were asked to sign form saying, ‘Do you agree to have pharmaceutical companies sequester the data from this trial?’ they wouldn’t have signed it. Most assumed that because it appears to be science, that the scientific community will get to scrutinize the trials.
You’re personally working on a project to help bring more of the risks to light.
What we’re trying to do with our colleagues is to open up patient adverse event reporting. It’s called rxrisk.org, which will be a website where both people on pills and their doctors can go to report adverse events that may be happening. The idea is to give you a tool so that if things are going wrong, you can get an expert report from us about what is known about the links between the problem and the pills you’re on and by asking a few questions, try to pinpoint whether the pill actually causing the problem. That will give you a report to take to your doctor to make it easier to overcome the kind of hostage problem most people have when they go to the doctor and want to keep him or her happy. The idea is ultimately to create teamwork between doctors and patients and let them know in real time how many other people have reported this problem also.
We’re trying to put patients and doctors in the kind of position where, if they know that thousands of others have had this problem and then the pharmaceutical company says there’s no linkage, people won’t believe it and will say, This isn’t right. It’s in beta at moment.
So what else can be done?
There are ways to play with the system to get the outcomes we want. At the moment, we have a system that works well for the health of pharmaceutical companies but not so well for our health. I’m just trying to raise these issues. How best we solve them is a different matter, but we can’t begin to try to solve them if we don’t raise them. I’m not hugely hopeful but not entirely pessimistic either.