For the last 33 years, David Healy, an Irish psychiatrist and professor at Cardiff University School of Medicine in Wales, has written heavily researched university press books and academic journal articles on various aspects of psychopharmaceuticals. His output includes 20 books, 150 peer-reviewed papers and 200 other published works. He is not only well-pedigreed, with degrees and fellowships from Dublin, Galway and Cambridge medical schools, he is a widely recognized expert in both the history and the science of neurochemistry and psychopharmacology.
Yet Healy says his output and reputation have had little to no effect—both on the pharmaceutical industry he argues buries relevant information about prescription drug harms, and on the psychiatric and medical professions he claims are being “eclipsed” by drug companies.
“It’s been clear to me that writing books or articles banging on the risks and hazards of drugs is just going to increase the sale of drugs,” said Healy, who speaks calmly, dresses mostly in black and looks a bit like Rod Serling.
Rather than write another university publication, Healy has taken his frustration to the street. In November, he launched a nonprofit website called Rxisk.org with a group of like-minded and highly credentialed international colleagues. The site aggregates FDA data about prescription drug side effects and urges patients to submit a detailed report on their own pharmaceutical drug reactions.
Healy is not the first psychiatrist to express boiling frustration with the pharmaceutical industry or to pen dire warnings about drug-based healthcare. He is joined by people like American psychiatrist Peter Breggin, who has written several books critical of “biological psychiatry,” and Irving Kirsch, who directs the Program in Placebo Studies at Harvard Medical School/Beth Israel Deaconess Medical School and is best known for The Emperor’s New Drugs: Exploding the Antidepressant Myth. Healy is the author of such dire sounding titles as Pharmageddon and Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.
For years, it was fairly easy for people in the pharmaceutical and medical industries to label Healy, Kirsch and Breggin as alarmists. But two summers ago, one of the most prominent members of U.S. medical establishment, Marcia Angell, former editor-in-chief of New England Journal of Medicine, published an article damning the over-prescription of psychoactive drugs. In two essays in the June 23, 2011 and July 14, 2011 New York Review of Books, Angell backed arguments by the university clinician Kirsh, the mental heath journalist Robert Whitaker, and Boston psychiatrist Daniel Carlat that there is something extremely suspicious about the following trends: the number of people treated for depression has tripled since the launch of Prozac in 1987; 10 percent of Americans over age six are taking antidepressants; and 30 antipsychotics like Risperdal, Zyprexa and Seroquel are replacing cholesterol-lowering agents as the top-selling class of drugs in the U.S., largely because they are being prescribed to children.
Angell’s articles should have been a bomb on the medical establishment. She wrote:
“The industry-sponsored studies usually cited to support psychoactive drugs—and they are the ones that are selectively published—tend to be short-term, designed to favor the drug, and show benefits so small that they are unlikely to outweigh the long-term harms. … Both the pharmaceutical industry and the psychiatry profession have strong financial interests in convincing the public that drug treatment is safe and the most effective treatment for mental illnesses, and they also have an interest in expanding the definitions of mental illness.”
But like Healy, Angell’s warnings have fallen on deaf ears. Recent data indicates that U.S. prescription drug use is growing. The September 2012 Consumer Reports National Research Center report found that among the 46 percent of American adults taking prescription drugs, a fourth of those ages 18 to 39 regularly take two prescription drugs, indicating that multiple drug use is no longer confined to older Americans. Congressional testimony in 2012 by the American Society of Interventional Pain Physicians revealed that Americans consume 80 percent of opiate painkillers produced in the world. And a January 2011 report from Stanford University Medical School warned that antispychotics are now regularly being prescribed to treat conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia.
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According to a Feb. 7, 2013 report from Drugs.com, the No. 1 best-selling U.S. drug (in dollar volume) is an atypical antipsychotic for schizophrenia treatment called Abilify. Sales for the last quarter of 2012 soared to $1.5 billion, because Abilify is widely prescribed off-label—i.e., not for schizophrenia in adults, but, for example, for irritability in children. Although Bristol-Myers Squibb, the maker of Abilify, was fined $515 million in September 2007 for recommending off-label uses of Abilify, doctors are still doling out the drug. Why?
“The reason for the increase in prescription drug use is that the entire Western medical complex is run by pharmaceutical companies,” said a Stanford University professor of medicine who preferred to remain anonymous (and who was not involved in the 2011 report on antipsychotics). “The medical training you get in Western medical schools is largely about learning which drugs to treat which diseases.” She added: “You would think that recent studies, such as the one that said antidepressants are no more helpful than a placebo, would have an effect. But they haven’t.”
Other university psychiatrists and medical doctors I contacted for this article either wouldn’t talk on the record or didn’t want to be interviewed, confirming an atmosphere Healy describes as “McCarthyist.” “There is a climate of fear,” he said during our interview. “You find that they are very nervous about saying anything about drug treatments or adverse effects of drugs at all. Doctors keep patients on lots of drugs, even if they are uncomfortable with it. And if you ask them why they’re doing so, the answer you’ll get is: ‘Well, this is the standard of care, and if I don’t take care of it this way, I’m going to be in awful trouble.’”
This standard of care is why Rxisk is directed at patients, not doctors, whose financial ties to the pharmaceutical industry are well documented. Rxisk allows users to enter into its search engine the name of a prescription drug and to see the side effects that have been reported to the FDA’s MedWatch website since 2004 as well as from Rxisk’s international data base, for more than 35,000 drug names from 103 countries, totaling 4.5 million adverse drug event reports. The site has information “zones for sex, violence, hair, skin, and withdrawal, designed to increase awareness of seldom-publicized drug effects. Rxisk.org also allows users to add their own reports of adverse drug reactions, creating their own “Rxisk report” to share with their doctor or pharmacist. Since November 2012, the website has collected 1,500 reports.
One could argue that Rxisk is doing the same thing as MedWatch, the FDA’s online gateway for “reporting serious problems with human medical products.” But Kalman Applbaum, a Rxisk founder and professor of medical anthropology and global studies at the University of Wisconsin, argues that MedWatch isn’t for patients—especially those “trying to sort out whether it’s the drug or the illness that’s causing the suffering.”
“We felt there were a number of things that were lacking on most or all of the FDA sites that collect information about drug side-effects,” said Applbaum. “First, there’s a reliance on doctor reporting, and doctors report very little, very infrequently—and this is true all over the world for a variety of reasons. And what they report is extremely slim. Very common is a single word to describe a side effect, such as hypertension, ataxia, etc.” Meanwhile, said Applbaum, research shows that patients are much more motivated to report than doctors. And more importantly, “their reported data is very high quality data, because they spend a lot of time,” said Applbaum.