Has Big Pharma Corruption Suppressed Effective Treatment Options?
American psychiatry has been rocked by Congress. Congressional investigators first exposed the financial relationships between high-profile psychiatrists and drug companies. "But now the profession itself is under attack in Congress," reported the New York Times on July 12, 2008.
Specifically under attack is psychiatry's premier professional organization, the American Psychiatric Association. The New York Times stated, "In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association's $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting."
The American Psychiatric Association is, as the New York Times notes, "the voice of establishment psychiatry." It publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the standard diagnostic manual. It also publishes influential professional journals. And it is the primary lobbying organization for American psychiatry.
The president-elect of the American Psychiatric Association is Alan Schatzberg of Stanford University, and his $4.8 million stock holdings in a drug development company raised a red flag for Congressional investigators. Sen. Charles Grassley, R-Iowa, informed the American Psychiatric Association, "I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions."
One example of how psychiatric treatment practices are corrupted by drug-company money was revealed in a 2007 analysis of Minnesota psychiatrists. The analysis showed that psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs wrote, on average, three times as many prescriptions to children for these drugs as psychiatrists who received less money or none.
The New York Times did track down one psychiatrist in private practice not on the take from drug companies, William Niederhut. Niederhut said that studies have shown that researchers who are paid by drug companies are more likely to report positive findings when evaluating that company's drugs. Niederhut was upset that drug company influence has pushed psychiatrists to prescribe expensive drugs rather than the off-patent inexpensive ones.
While the truly anti-psychiatry establishment psychiatrists were not quoted by the New York Times, reporters Benedict Carey and Gardiner Harris did provide an important service by using the term establishment psychiatry, which at least gives a clue that there are anti-establishment psychiatrists. Among this group of anti-establishment psychiatrists, two of the most well known are Peter Breggin and Grace Jackson, both of whom have testified at Food and Drug Administration advisory meetings. Breggin and Jackson, for several years, have been reporting that the dangers of psychiatric drugs are downplayed or ignored by establishment psychiatry, that many blockbuster psychiatric drugs are no more effective than sugar pill placebos, and that the chemical imbalance theories that sell these drugs are based on drug-company marketing rather than legitimate science.
Prior to exposing the American Psychiatric Association's financial dependency on Big Pharma, Congressional investigators had focused on individual establishment psychiatrists' financial relationships with drug companies. One high-profile example being Joseph Biedeman, about whom the New York Times reported: "A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007." Biederman and two of his colleagues in the psychiatry department at Harvard Medical School (who received an additional $2.6 million from drug companies from 2000 to 2007), by failing to report income from drug companies while at the same time receiving federal funds from the National Institutes of Health, violated rules designed to police conflicts of interest, according to Sen. Grassley.
I can only hope that Congress and the mainstream media will get around to the most important issue of all: How Big Pharma corruption of psychiatry has eliminated options for people with severe emotional problems who have been failed by establishment psychiatric treatments. One such option that was eliminated is Soteria House, the creation of psychiatrist Loren Mosher.
Loren Mosher (1933-2004) was chief of the National Institute of Mental Health's Center for the Study of Schizophrenia from 1968 to 1980. Mosher wanted to create an effective and more humane way to help psychiatry's most seriously troubled patients. Using National Institute of Mental Health funds, Mosher opened the first Soteria House in Santa Clara, California in 1971.
Mosher's Soteria House experiment is detailed by former Boston Globe reporter Robert Whitaker in Mad in America. In Soteria House, newly diagnosed schizophrenic patients lived medication-free with a young, nonprofessional staff trained to listen to and understand them and provide companionship. Mosher tested his idea that "schizophrenia can often be overcome with the help of meaningful relationships rather than with drugs, and that such treatment would eventually lead to unquestionably healthier lives."
The Soteria House experiment worked better than Mosher had expected. Over the initial six weeks, patients recovered as quickly as those treated with medication in hospitals. Whitaker notes, "Even more striking, the Soteria patients were staying well longer. Relapse rates were lower for the Soteria group at both one-year and two-year follow-ups. The Soteria patients were also functioning better socially -- better able to hold jobs and attend schools."
Mosher's success with nonprofessional caregivers and without drugs embarrassed establishment psychiatry. The National Institute of Mental Health choked off funding causing Soteria House to close down. By 1998 Mosher was so disgusted with establishment psychiatry that he wrote a widely publicized letter of resignation from the American Psychiatric Association. Establishment psychiatry, which in recent times usually ignores anti-establishment psychiatrists such as Mosher, had to respond and did so by accusing Mosher of wanting to abolish drug treatments. However, abolishing the option of drug treatment was never Mosher's goal.
Loren Mosher remains a hero for many anti-establishment consumer- and patient-rights organizations such as MindFreedom. MindFreedom also does not advocate for abolishing the option of drug treatment but instead advocates for truly informed choice as well as for alternatives beyond establishment psychiatric treatments -- alternatives such as Soteria House. I recently spoke with two members of MindFreedom, a married couple. Both wife and husband had been diagnosed in the past with schizophrenia. The wife chose to stay on psychiatric drugs, while the husband -- who had especially debilitating adverse effects with his psychiatric drugs -- chose to go without drugs. Their different paths initially created tension in the marriage but both ultimately quite graciously accepted each other's decision.
These are the true issues: Do Americans have mental health treatment choices that are informed choices? Why, when Big Pharma corruption has long been known, does it take Congressional investigations for the mainstream media to inform Americans of the financial relationships that drug companies have with high-profile psychiatrists and major psychiatry institutions? And most importantly, when will Americans get real choices when it comes to their mental health?
A real choice is not a choice between Prozac or Zoloft, not between Zyprexa or Risperdal. One example of a real choice is the choice between establishment psychiatry or Soteria House.
Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green, 2007).