Blog Archive: Oct. 2002

Blog subjects:

  • Pseudoscience in the mental-health industry

  • Unethical behavior among pharmaceutical companies

  • Whatever else strikes my fancy

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Thursday, October 31, 2002

My blog entries are often related, in some way, to problems with the pharmaceutical industry.  To be fair, though, some prescription drugs are true life-savers, and some pharmaceutical research is based on sound biology and medicine.

In contrast, the U.S. anti-drug-abuse industry is irrational to the core.  Good intentions will only get you so far (and you know what they say about that road to hell).  Pseudoscience, borderline-superstition, quasi-religious indoctrination, blind adherence to tradition – these are all rampant within the field (though you might not know it, based on the depressing lack of skeptical reporting in the media).  Addiction is certainly a huge social problem, but we're not going to make a dent in it without a major overhaul in the way we address the issue.

Journalist Maia Szalavitz has written an excellent article about irrational behavior in the American anti-drug movement.  The article originally appeared in a British publication (New Scientist magazine) in February, 2002.  So, it isn't particularly recent, but it's still well worth reading.  Here are some excerpts:

To outsiders, it will seem shockingly narrow-minded.  At a conference on drug abuse last year, sponsored by the US government's Center for Substance Abuse Prevention, a speaker was shouted down and told to “Shut the fuck up”.  Her crime?  Simply saying that government anti-drugs funds should go only to programmes based on methods that have been shown to work, and for suggesting that a popular scheme called Girl Talk wasn't one of them.  [...]

But for anyone following the debate over US drugs policy, intolerance of dissent will be depressingly familiar.  Lack of respect for research is an endemic problem in this area.  It is not helped by the media, whose uncritical support for anything that claims to be “anti-drugs” only encourages the proliferation of ineffective and expensive programmes.  [...]

Political change will be needed before anti-drugs efforts can begin to improve.  To stimulate this change there needs to be better research and reporting.  The quality British press, for example, has been far more sceptical of anti-drugs crusaders;  and Britain has better drugs policies to show for it.  The British government has been funding needle-exchange programmes for drug addicts since 1988, as a way to limit the spread of HIV.  The US government has still not managed to do anything similar, despite scientific support from every major concerned body.

Although the author doesn't address the question of addiction-treatment clinics, these rehab centers are just as ineffective and pseudoscientific as the drug-abuse-prevention programs described in the article.  It never ceases to amaze me why more journalists don't expose this fact.  You'd think that after Robert Downey, Jr. relapses for the umpteenth time (despite receiving the best treatment that money can buy), some hard-nosed reporter would scratch his or her head and say, “You know, maybe this rehab stuff is all a crock of shit.  I should look into it and write an article.”  There are certainly enough academic studies out there that demonstrate rehabs' lack of effectiveness, but these studies rarely get mentioned in the popular press.  Hello, hello – any reporters reading this blog?


Wednesday, October 30, 2002

In the late 1990's, pharmaceutical company Warner-Lambert (now a part of Pfizer) was apparently promoting its anti-epilepsy drug Neurontin for unapproved uses.  The U.S. Food and Drug Administration (FDA) prohibits such “off-label” marketing.  Now, a former insider is blowing the whistle:

Mr. Greene's client, Dr. David P. Franklin, worked for Warner-Lambert in 1996, and says that he resigned after finding that the company was involved in a nationwide marketing campaign that he thought was illegal and was endangering patients.

Mr. Franklin says that company gave financial incentives to hundreds of doctors to prescribe Neurontin for unapproved uses ranging from bipolar disorder to a myriad of pain syndromes, by inviting them to dinners and weekend trips to resorts.  He asserts that Warner-Lambert also paid doctors to speak about Neurontin and to prescribe Neurontin to patients who were enrolled in the company's clinical trials.


Here's another lawsuit against GlaxoSmithKline, the maker of the antidepressant Paxil (called “Seroxat” in some other countries).  The plaintiffs allege severe withdrawal effects upon discontinuing use of the drug.  I have mixed feelings about this lawsuit, and others like it.  I don't doubt that some patients experience very unpleasant symptoms when they stop taking antidepressants, but I don't think that this is a terribly common phenomenon.  Moreover, I believe that this lawsuit misses the major point:  The biggest problem with antidepressants isn't addiction or withdrawal – it's the fact that the drugs are actually glorified placebos.  I wish someone would sue the manufacturers for selling snake oil.  I wouldn't have any misgivings in supporting such lawsuits.


Monday, October 28, 2002

Alex Beam, a columnist for the Boston Globe, wrote an interesting article called, “The biggest drug dealer on campus”.  The article discusses how pharmaceutical companies are targeting college students as a large potential market for antidepressant drugs.  Beam failed to address a major point, though – namely, that these drugs are glorified placebos.  I sent him an e-mail message containing the text from this USA Today article.  We'll see if he responds.


The BBC has another treatment of the same subject I brought up a few days ago:  the new study showing severe problems that occur when drug companies act as sponsors of academic research (e.g., clinical trials).


The New York Times editorializes, “Keep Drug Makers Honest”.


A report from HealthScout News asks, “Antidepressants: Too much of a good thing?”


Saturday, October 26, 2002

Betty Ford is the wife of former U.S. president Gerald Ford.  Back in the 1970s, she apparently abused prescription drugs and alcohol.  After undergoing treatment herself, she helped establish an addiction-treatment facility – a facility that was then named in her honor.  A few weeks ago, the Betty Ford Center marked its 20th anniversary, and celebrated with great fanfare.

I hate to be a grouch, but what exactly are they so proud of?

Rehabs have a terrible track record.  Repeated studies show that only a small fraction of patients remain sober after treatment (recall the infamous relapses of Robert Downey, Darryl Strawberry, and Noelle Bush).  You might think that places such as the Betty Ford Center would be scrambling to figure out why their treatment methods are so ineffective and what can be done to improve those methods.  Hah.  It's a supreme irony that the addiction-treatment industry is in denial:  their actual success rate is abysmal, but they never admit this fact.

Here are some suggestions for how the Betty Ford Center can better serve its patients:

  1. Recognize that alcoholics and addicts are a diverse lot.  Addiction-treatment centers are founded on the (false) premise that all substance-abusers are essentially the same and need the same treatment.  Instead, people need to be given some choices in the type of treatment they receive.

  2. Don't treat Alcoholics Anonymous as some kind of miracle program.  12-step groups appeal to some people, but these groups certainly don't work for everyone.  Strangely, though, the addiction-treatment industry in the U.S. is almost exclusively based on this quasi-religious system – a system that has quite a few problems.

  3. Teach people life skills.  Patients stay at these centers for a month.  Use that time to teach people how to put together a résumé and dress for a job interview;  how to get along better with their spouses;  how to develop healthier eating, exercising, and sleeping habits;  etc.  Help people find out exactly what specific changes need to be made in their lives to avoid going back to drugs or alcohol.  Sitting in a circle and complaining about your relatives for hours on end is not an efficient use of patients' time.

  4. Listen to your critics – you might learn something valuable.

Addiction is certainly a tough nut to crack, and I don't claim that the above changes would make a huge difference in the success rate of rehabs.  Still, the system we have now is terrible, and it's time that society recognized the need to reform the addiction-treatment industry (and, for that matter, the mental-health industry as a whole).


Lots of interesting books listed on the web page of the American Iatrogenic Association.  I've read some of them, and I wish I had time to read all the rest.


Thursday, October 24, 2002

United Press International (UPI) reports on problems that occur when corporations (such as drug companies) sponsor research in an academic setting.  (Note: The Associated Press (AP) has a better version of essentially the same story.)


Wednesday, October 23, 2002

Interesting article in the New York Times:

Mifepristone, once called RU-486, is best known as the abortion pill.

But some scientists believe that the drug may eventually serve another, far less controversial, purpose:  treating a particularly fierce and intractable form of depression.

Two small studies, the latest appearing last month in the journal
Biological Psychiatry, have found that mifepristone is effective in helping people whose severe depression is accompanied by delusional beliefs or hallucinations.

Still, I wouldn't get too excited.  The studies were small, and at least one of them wasn't even double-blind (I can't understand this – it seems to me that anything worth doing at all, is worth doing right.  Why even bother with non-double-blind studies?).  Apparently, larger-scale, double-blind studies are in the works.  We'll see.


Pharmaceutical company Pfizer is facing a serious investigation over the company's marketing practices with respect to the epilepsy drug Neurontin.


Tuesday, October 22, 2002

The Boston Globe reports that the U.S. Food and Drug Administration (FDA) is backing away from strict enforcement of regulations that cover the promotion of prescription drugs.  Good for the pharmaceutical industry, bad for us.


A Columbine student is suing Solvay, the pharmaceutical company that makes the antidepressant “Luvox”.  One of the Columbine shooters (Eric Harris) was taking the drug at the time of the massacre.  Far be it from me to defend antidepressants, but the case sounds pretty iffy to me.  I doubt that Luvox turned Harris into a psycho killer.


Democrats are accusing the drug industry of waging a “stealth campaign”.


The Sydney Morning Herald is just now running a story about the “Emperor's New Drugs” – a study that exposed antidepressants as glorified placebos.


Sunday, October 20, 2002

The American Prospect has a good article on the deceptive, underhanded methods used by pharmaceutical companies to promote their interests.  The article is called, “Drug Money:  How PhRMA's front groups buy elections”.


Saturday, October 19, 2002

The New York Times published a good article about the importance of conducting clinical trials:

Clinical trials are the backbones of medical progress.  They have demonstrated the value of vaccines to prevent devastating diseases and drugs to treat them.  They have shown, for example, that certain drugs given immediately after a heart attack or stroke can markedly increase survival while others do not help.  And clinical trials are behind nearly all the progress that has been made in treating various kinds of cancers in the last four decades.

All of that is absolutely true, which makes it all the more puzzling to consider why the addiction-treatment industry is so irrational and unresponsive to new research.  The Betty Ford Center (and other rehabs) today are pretty much the same as they were twenty or thirty years ago.  You'd think that their startlingly low success rate would prompt them to consider ways to improve their programs.  Other fields of medicine make progress and incorporate the results of clinical trials, but addiction-treatment stays in the same old rut.


Is menstruation a disease?  “Serafem Nation” isn't exactly a recent story, but it's still worth reading.


Friday, October 18, 2002

I really dislike secret, out-of-court settlements.  I've heard that some states are going to outlaw them.  The Eli Lilly Company recently settled the oldest Prozac-suicide lawsuit.  Of course, the terms of the settlement were not released.  Incidentally, I'm not certain that Prozac actually causes people to commit suicide.  Maybe it does, but I don't know.  I know that British psychiatrist David Healy has long maintained that selective serotonin re-uptake inhibitors (SSRIs) like Prozac can cause suicidal thoughts, but I've never really examined his evidence in any detail.  In any case, it would still be interesting to see the terms of the settlement.


Wednesday, October 16, 2002

The U.S. Food and Drug Administration (FDA) has approved a new drug (buprenorphine) for treating heroin addiction.  Addicts will be able to get a prescription from their doctor.  It sounds a bit too good to be true, though I certainly hope it works.  In any case, I'm always in favor of testing any new treatment that doesn't involve a month-long stay in a rehab facility.  I've never understood why people think that they can beat their addiction by sitting in a circle, complaining about their childhood, and promising to turn their will and their life over to the care of God (A.A.'s third step).


“Drug companies face backlash from new foes”, says the Christian Science Monitor.


Bad news reported in the British press:

Children could soon be given the controversial anti-depressant drug Seroxat [called Paxil in the U.S.] – despite evidence linking it to suicidal thoughts and mental problems in young teenagers.

In a move that will alarm the drug's critics, the British pharmaceuticals giant GlaxoSmithKline has asked for permission to market Seroxat to children in the United States. The application is expected to be followed by a similar bid in Europe.

Glaxo's decision comes despite evidence that its own clinical trials found that 10 per cent of depressed children who were given the drug endured serious psychiatric problems within weeks of using it.


Monday, October 14, 2002

Unfortunately, I have to take a break from daily updates of this blog.  I have more-pressing obligations that are piling up, and I can no longer afford to spend a couple of hours every morning scanning news articles.  I'll continue posting items as time permits, probably every two or three days.


USA Today has a good editorial about unethical marketing practices in the pharmaceutical industry:  “Drugmakers' gifts to doctors finally get needed scrutiny”.


Sunday, October 13, 2002

The newspaper in Spokane, Washington ran an excellent article about “disease-mongering” – the process by which pharmaceutical companies try to turn ordinary human frailties into diseases that are (of course) “treatable” by expensive prescription drugs.  The latest alleged disease is “female sexual arousal disorder”, and a California-based company is conducting clinical trials of a drug designed to “cure” this “disease”:

“Where is this medicalization going to end?” asked [Ray] Moynihan [a critic of the pharmaceutical industry] from his office in Washington, D.C.  “What aspect of human life is not going to be characterized as a disease by a company trying to make a quick buck?”  Even the lead researcher on the medication, speaking about women with sexual troubles, acknowledges: “Maybe they don't need a new drug.  They need a new Steve.”


Saturday, October 12, 2002

Pharmaceutical company GlaxoSmithKline got into some trouble in Britain.  A regulatory body ruled that Glaxo had issued misleading statements about the company's antidepressant drug Paxil (known as “Seroxat” in Britain).  My impression is that the British authorities tend to be more skeptical of antidepressants than their American counterparts.

Here in the U.S., a court has reversed itself and allowed Glaxo to advertise Paxil as “non-habit forming”.  It's true that Paxil doesn't cause drug-seeking behavior, since users don't experience any euphoria from the drug.  Nevertheless, it's also true that many people suffer from withdrawal effects when discontinuing the drug.  The whole debate is academic, in a sense.  The biggest problem with antidepressants isn't withdrawal – it's the fact that the drugs are glorified placebos.


Swiss pharmaceutical and chemical company Roche Holding is continuing to pay the piper after the company was involved in a price-fixing scandal in the 1990s.  I'm always amazed by the disparity between the marketing image projected by drug companies versus the Machiavellian business tactics used by those same companies.


Friday, October 11, 2002

Akzo Nobel is a Dutch pharmaceutical company that makes the antidepressant Remeron.  Akzo has been trying to get approval for a new antidepressant named “gepirone ER” (formerly known as “Ariza”).  Things aren't going so well, though.  The U.S. Food and Drug Administration (FDA) is skeptical of the experimental drug's effectiveness, and the company is apparently having a hard time recruiting subjects for clinical trials.


A few days ago, Japanese scientist Masatoshi Koshiba won the Nobel Prize in physics.  It turns out that he had graduated last in his class from Tokyo University.  This reminds me of an old Calvin & Hobbes cartoon where Calvin says to his mother, “You know how Einstein's grades were bad?  Well, mine are even worse.”


Britain's “Critical Psychiatry Network” website has some interesting information on it.


Thursday, October 10, 2002

A blue-ribbon panel of scientists has concluded that polygraphs (lie-detectors) are highly unreliable.  Well, duh.  How 'bout debunking some of the other pseudoscientific areas of psychology – like addiction-treatment, antidepressants, and neuroleptics (anti-psychotic drugs)?


Seems that pharmaceutical giant Bristol-Myers Squibb (BMS) might be in trouble for cooking the books.


In another case involving BMS, “two drug companies on Monday settled more than 300 lawsuits alleging that they had negligently failed to prevent former Kansas City pharmacist Robert Courtney from diluting cancer medications.”


Wednesday, October 9, 2002

Robert Whitaker's Mad in America is one of the best books I've ever read.  Reason magazine ran a good review of the book.  After you've read Mad in America, you'll never look at psychiatry the same way again.


Tuesday, October 8, 2002

Eli Lilly's new antidepressant Cymbalta hasn't even received final FDA approval yet, and already the hype has started:

Scientists at Lilly say that Cymbalta may be more effective than Prozac ever was.  Madeleine Wohlreich, a clinical research physician at Lilly, notes that in company-run studies, patients on Cymbalta were 112% more likely to have their depression vanish than those who were on placebo.  In studies for drugs like Prozac, that number is generally only 40%.  Better yet, she says, Cymbalta may do a very good job of easing aches and pains, an area where other antidepressants haven't been tested.  (emphasis added)

Sounds pretty good, until you realize that the pharmaceutical industry has been crying “wolf” for decades now, only to have their claims discredited by subsequent studies.  It would be nice, of course, if Cymbalta did turn out to be some kind of wonder-drug, but I'm very skeptical.


Monday, October 7, 2002

Seems that there is mental illness among the Al Qaeda detainees at Guantanamo Bay.  Twenty-six of them are taking antidepressants or antipsychotic drugs.  Given that agitation and suicidal thoughts are among the known side-effects of drugs like Prozac, is it really wise to give antidepressants to people who might be terrorists?


A British researcher thinks that Gulf War Syndrome is a myth.


Sunday, October 6, 2002

By the ripe old age of 33, Rochelle Pennex had already given birth to a stunning 13 children, at least five of them born with cocaine in their systems.  What are we to do with people like Rochelle?  Beats the hell out of me.  However, I doubt that the answer involves coddling them and telling them that they're victims of a brain disease.


The New York Times claims that going to rehab is quite trendy these days.  All the cool people are doing it.  The article appears in the newspaper's “Fashion & Style” section.


Having trouble keeping track of which celebrities have undergone treatment for alcoholism/drug addiction?  Check out www.starsinrehab.com!


Saturday, October 5, 2002

Now here's something you don't see every day – a newspaper article that actually questions the disease concept of addiction:

Federal researchers have long suggested the stigma of addiction should be removed since the behavior is based in the brain.  How, they reason, can people be blamed for following through on a compulsion their brain is wired to slavishly follow?

[Psychiatrist Sally] Satel is opposed to this thinking.  “You can't remove the stigma,” she said.  Fear of being stigmatized and being ostracized by society is what keeps many people from using addictive substances, she said.  “They are not doing something that is good when they use.  Why can't we say that?”

The notion that addiction may be rooted in biology also throws her, she said, because it makes it sound as if addicts didn't have a choice.  “Addiction is self-induced – that's not inevitable,” she said.  “It's not like bipolar illness or something.”

For more straight-talk about addiction and recovery, see these two books:

Heavy Drinking: The Myth of Alcoholism as a Disease, by Herbert Fingarette, Ph.D.

The Diseasing of America: How We Allowed Recovery Zealots and the Treatment Industry to Convince Us We Are Out of Control, by Stanton Peele, Ph.D.

I reviewed these books in my “Favorite Books” section (see the link on the left).


Friday, October 4, 2002

In the late 1960s, a gynecologist named Robert Wilson became a crusader for hormone-replacement therapy.  Dr. Wilson wrote a book that compared (untreated) menopausal women to castrated men.  Post-menopausal women were obviously sick and needed treatment.  Or so said Dr. Wilson and Wyeth, the drug company that funded Wilson and made billions of dollars from selling hormone pills.


Thursday, October 3, 2002

Although it is still remarkably profitable, the pharmaceutical industry has seen better days.  An article in the New Republic argues that new, innovative drugs are becoming fewer and further between.  Perhaps all the low-hanging fruit have been picked, or maybe aggressive marketing simply pays better than aggressive research.


Wednesday, October 2, 2002

Twelve-step groups are quite over-rated, according to an on-line book written by someone pseudonymously named, “A. Orange”.


Tuesday, October 1, 2002

The government is finally starting to crack down on unethical promotional practices in the pharmaceutical industry.  I'm actually surprised by this development – I didn't know that this was even in the works:

The government warned pharmaceutical companies today that they must not offer any financial incentives to doctors, pharmacists or other health care professionals to prescribe or recommend particular drugs, or to switch patients from one medicine to another.

The government informed the industry that many practices commonly used in the marketing and sale of prescription drugs could run afoul of federal fraud and abuse laws.


For roughly 15 years, psychologists (and other so-called “experts”) kept telling us that low self-esteem is the cause of many, if not most, social ills:  addiction, bad marriages, violent crime, stinky feet, etc.  Well, um, maybe not.  Yet another reason why we should be skeptical of expert opinions.