Bad Pharma
Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients is the title of a book by Ben Goldacre. It’s fun to laugh at those late-night drug commercials where two thirds of the ad is taken up with “warning: may cause…” and “do not take if you’ve ever experienced…”
But the problem is a lot worse than we ever suspected. As the book’s preface says:
“Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials produce results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects.”
And this brings us to the recent pandemic of mass shootings — a subject which is discussed in the comments section at the end of the linked article.
Everyone — pro-gun, anti-gun, liberal, conservative — is reciting in unison “these mass murderers didn’t get the mental health treatment they needed.”
For conservatives, “mental health” is probably just a soundbite to take the focus away from assault rifles. When it comes to actually paying for mental health services on a mass scale, conservatives will freeze all funding. Or they’ll insist that mental health care can only be paid for by taking the required funding away from jobs training programs, environmental protection and other government programs they hate.
Anyway, would psychiatric medication — and other treatments — really have prevented any of these mass murders? I don’t have a solution; it’s much easier to pinpoint a problem than to solve it.
But with the horror stories about psychiatric drugs — mentioned in the linked comment section, plus the stories we’ve all heard elsewhere — you have to wonder if the mental “cure” is worse than the disease.
What say you?
Labels: Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, Ben Goldacre
posted by Tom Harper @ 3:15 PM
9 Comments:
The deal with meds is that a) They can make a significant difference in someone's life, but b) it's hard to figure out which one will do the job, and c) it's hard to get the dosage right, and d) the dosage required changes with time, and e) drugs can lose their effectiveness over time, requiring a change in drugs. And f) it's damnably hard for the person who does have a mental health problem to recognize that he or she has fallen off the effectiveness curve of whatever meds he or she is taking, requiring g) a third party to do so.
The reality is that pharmaceutical treatment of mental illness is a requirement in many cases for people to have a normal life, but works only with constant monitoring and followup. It's the constant monitoring and followup that is expensive, and which is the biggest fail of our current mental health system.
Regarding trials, for psychoactive drugs there are so many individual differences that trials and recommended doses are just a starting point anyhow. The goal is to find what drug and dosage works for a specific individual, i.e., effective uses of psychoactive drugs requires individual trials with a sample size of one. The end result is that for pharmaceuticals for mental health issues, the lack of sufficient trials is not a big deal -- none of them are one-size-fits-all anyhow, since nobody's brain chemistry is identical to anybody else's brain chemistry, meaning that it's the doctor's responsibility to be monitoring behavior and symptoms to arrive at the correct drug and dosage.
An aside -- the above is based on direct observation in a clinical setting (a behavior unit for mentally ill youngsters) rather than on pull-s***-out-of-my-rear. It always annoys me that people who have no experience dealing with the mentally ill on a long term personal basis pull **** out of their a**.
We are still paying for the “Fast Track” policy during the Clinton years when Drug companies (including the one I worked for) complained the trials period was too long and too costly. The Government said you can speed up the trial as long as you believe the drug was safe. The Magic word is “Trust Me!” Turns out they all lied, hid the facts and those Multi Billion lawsuits by those Personal Injury Lawyers that Conservatives hate so much is the result.
As for mental health, the US ranks just about the lowest in mental health treatments for all of the civilized world. Many people don’t realize that Doctors have just one goal in treatment - to prevent you from becoming a danger to yourself and others. That means if they have to dope you to the point where you are barely coherent for the rest of your life - they have achieved their goals.
It was always difficult to get Mental Health funding when Conservatives were in charge, I suspect because they are afraid the drug companies are going to find a cure for Conservatism.
Erik
Getting the help needed for mental health issues is important, no doubt about that but getting assault rifles off the streets is just common sense and the ban on assault rifles should be reinstated, stat!
Not even remotely surprising that follow-up care is neglected. Magic pills only work in Jefferson Airplane songs.
Pharmaceutical companies have but one goal in life...the bottom line...as do contemporary politicians. So, they are in cahoots. Therefore, it is doubtful that the problem regarding testing of drugs will ever get the scrutiny that is needed.
As to mental health funding, it has not and will not be forthcoming because it is controlled by mentally deficient politicians...from my strictly layman and cynical point of view, mind you.
BT: Through the experiences of a close relative, I'm quite familiar with steps a) through g) that you described. Since there are hundreds of thousands, if not millions, of people with psychiatric issues, and a lot of them have a friend or relative who's following their treatment, I'm guessing that most of the horror stories are based on people's personal observations; not people "pulling **** out of their a**."
Erik: "That means if they have to dope you to the point where you are barely coherent for the rest of your life - they have achieved their goals." That's exactly what I heard from a psychology professor who had a long history of psychiatric treatment, including being institutionalized. Between the forced mass dosing of patients and the fact that the drugs' testing and approval has been fast-tracked, it's some scary stuff.
"...they are afraid the drug companies are going to find a cure for Conservatism." LOL.
Life: The assault rifle ban is common sense, but unfortunately too many powerful people are against it.
Randal: Aw, why can't life be a Jefferson Airplane song?
jadedj: How convenient that the bottom lines of politicians and drug companies are mutually beneficial. The only people left out are, well, the rest of us.
Excellent post and comments. BadTux notes drug therapy is necessary in many cases "for people to have a normal life," but monitoring and follow-up are required. I would say for a more-like-normal life, because many of these drugs have pronounced side effects and, as stated, diminishing returns over time. Plus, monitoring and follow-up aren't hallmarks of a normal life.
IMO, there is ongoing over reliance on outpatient drug therapy/monitoring/follow-up. That can and does work for some, but fails for too many — sometimes with tragic consequences. I attribute this over reliance to policy decisions of decades ago to save money by closing psychiatric hospitals all over the country.
Government should assert its authority to require independent testing of drugs of all kinds. Government should also regularly inspect pharmaceutical production facilities, and the facilities of their suppliers of chemicals and materials.
What some of our conservative, free-market evangelists can't get through their thick, warped skulls is that the market brings buyers and sellers together, arrives at values and helps allocate resources, which are all good things to do. But the market doesn't give a happy damn if Joe Blow's medication is half the strength it's supposed to be or if it was compounded in a place with mold creeping down the walls and roaches scurrying across the floor. Businesses, concerned with profitmaking above all else, are obviously less concerned with those things than with the bottom line.
Our public officials are supposed to be concerned with things like the efficacy and safety of medications, and some are. But some of our fellow Americans keep electing public officials who are much more concerned about pharmaceutical companies' bottom line than they are about our health and safety. Voting that way is crazy, and we need some pills, monitoring and follow-up for it. So far, no luck.
IMO, there is ongoing over reliance on outpatient drug therapy/monitoring/follow-up. That can and does work for some, but fails for too many — sometimes with tragic consequences.
The alternative you mention -- involuntary treatment of adults who don't want to be treated -- was ruled unconstitutional by the U.S. Supreme Court back in the 1970's except in the case that there is an immediate threat to self or others because people have a constitutional right to be crazy if they want to be. Even if we wanted to go back to the days where the majority of the mentally ill were locked into gulags because there was no effective treatment that could lead to them having a reasonably normal life, legally speaking that simply isn't happening.
Those Supreme Court rulings arose out of some truly horrific abuses of the old system, including one semi-hilarious case where the governor of Louisiana was involuntarily confined in one of his own state mental hospitals by an angry jealous wife who'd found out that he had a stripper girlfriend and found a judge who was a political enemy of the governor to sign the involuntary confinement order. That one worked out reasonably well because he could order his own release once his stripper girlfriend found another judge to rule that being insane was not a disqualification for being Louisiana's governor (heh! Only in Louisiana!), but it didn't work out so well for far too many people. The insane asylum system was developed during a time where there was no psychiatric treatment at all except religious zeal or, later, talk therapy, neither of which do a whole lot for those mentally ill who have something actually chemically wrong in their brains as vs. behaving inappropriately due to things that have occurred during their lives (think schizophrenia vs. PTSD).
It is indeed tragic that the drug companies are so slapdash at coming up with psychoactive drugs to treat these disorders. That said, people react to drugs in such different ways that even if they were more thorough, it would make effective treatment easier but still not be a substitute for monitoring and followup.
And yes, drug therapy for things like PTSD are an area where I do agree it's probable that psychiatric drugs are being overprescribed or misprescribed, since PTSD is quite amenable to various cognitive-behavioral talk therapies that basically either compress the normal recovery period from a traumatic event to make it happen faster, and/or find what thought patterns are causing the recovery to not happen and teach the person to recognize those thought patterns and break out of them. Given the nasty side effects of most psychiatric drugs and the difficulties of constant monitoring and followup required for their effective use, relying on drugs as the primary treatment for PTSD simply is not the best treatment. But there's still plenty of people who no amount of talk therapy will cure. I've dealt with clients with schizophrenia before. You can't talk out things with people whose brain chemistry is simply not there to think lucidly with.
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