15
“Receiving $750 checks for chatting with some
doctors during a lunch break was such easy money
that it left me giddy.”
—PSYCHIATRIST DANIEL CARLAT (2007)1
The walk from Jenna’s group home in Montpelier, Vermont, to the town’s Main Street is only two blocks long, and yet, on the late spring morning I visited, it took us twenty minutes to travel that distance, for Jenna had to stop every few steps and catch her balance, with her aide, Chris, constantly putting his hand up behind her in case she fell.* Jenna had first taken an antidepressant twelve years earlier, when she was fifteen years old, and now she was on a daily cocktail of eight drugs, including one for drug-induced Parkinsonian symptoms. As we sat outside a café, Jenna told me her story, although at times—because of her problems with motor control—it was difficult to understand her. Her tremors are so severe that when she dunked her pastry, the coffee spilled and she had trouble bringing the pastry to her lips.
“I’m sooooooo messed up,” she says.
I had gone to the interview thinking that Jenna had been diagnosed with tardive dyskinesia, an antipsychotic side effect that can disable people. But it wasn’t clear whether her motor impairments were due to that particular type of drug-induced dysfunction or to a more idiosyncratic drug-related process, and by the time the interview was over, Jenna had raised a new issue for me to think about. She told of how psychiatrists and other mental health workers had always resisted seeing any of her physical or emotional difficulties as drug-caused, but instead had regularly blamed everything on her illness, and, from her point of view, that was a thinking process dictated by monetary interests. If you wanted to understand the care she’d received, you had to understand that she was valuable to the pharmaceutical companies as a “consumer” of their medications. “Nobody,” Chris explains, “has addressed the fact that the drugs may be causing her problems.”
The first time that Jenna had been exposed to a psychiatric drug was when she was in the second grade, and that episode suggested that she would not be a good responder to psychotropics. Up until that time Jenna had been a healthy child, a star on a local swim team; only then she developed seizures, and when she was put on an anticonvulsive agent, she developed severe motor problems, her mother said, in a phone interview. But eventually the seizures went away and once Jenna stopped taking the anticonvulsant, her motor problems disappeared. Jenna took up horseback riding, excelling in show-jumping competition. “She was back to being totally normal,” her mother recalled.
When Jenna entered ninth grade, her mother and stepfather decided to send her to an elite boarding school in Massachusetts, as they didn’t trust the public schools in Tennessee, and it was then that her behavioral and emotional problems began. She was kicked out of that first school and sent to a second one for troubled teens, where she “got into all that Gothic stuff” and began “acting out” sexually, her mother said. Then, on a dare one night, Jenna stole a package of condoms from a drugstore and “freaked out” when she was arrested. Now she was sent to a third boarding school and prescribed Paxil.
“The minute she takes that drug, she starts shaking,” her mother said. “I tell the doctor, ‘Oh my gosh, it is from the medicine.’ The doctor says, ‘Oh no, it’s not the medicine.’ I said, ‘Yes it is.’ We went from one doctor to another, doing test after test, but they couldn’t find anything and so they kept her on the medications, which made everything worse. They just wouldn’t listen to me.”
In addition to the tremors, Jenna became suicidal while taking Paxil, and soon her life transformed into a psychiatric nightmare. She began cutting herself regularly, and at one point, she used an electric saw to take off the middle finger on her left hand. The Paxil gave way to cocktails of Klonopin, Depakote, Zyprexa, and other medications, and during a nearly four-year stay in a psych hospital, she ended up on a cocktail of fifteen or so drugs, so doped up she didn’t even know where she was. “I don’t know the exact date,” Jenna says, summing up this history, “but slowly my speech and my walking and my balance and the shaking got really bad at that hospital. And they just kept on adding drugs. That’s how f-f-f-fucked up they are.”
Today, Jenna’s psychiatric problems remain severe. On the day we met, her wrist was bandaged, as she had recently tried to cut herself, and thus the medications haven’t been much help in that regard, either. But, she says, “I don’t see anything different happening. I have brought up the issue of taking me off the meds billions of times.”
Before we left our sidewalk table, Chris provided me with the details of Jenna’s daily cocktail: two antidepressants, an antipsychotic, a benzodiazepine, a Parkinson’s medication, and three others for physical problems likely related to the psychiatric drugs. Later, I calculated that even if generics were prescribed whenever possible, she was consuming $800 of medication monthly, or roughly $10,000 annually. She had been on psychiatric medications for twelve years, which meant that her Rx bill for psychiatric medications might already have surpassed $100,000, and given that she will likely remain on the drugs for the rest of her life, this bill could eventually end up well north of $200,000.
“They are making a lot of money on me,” Jenna says. “But these drugs have ruined my life. They make me all f-f-f-fucked up.”
A Business Triumph
Jenna’s perspective on her care was not an unusual one. Many of the people on SSI and SSDI that I interviewed spoke about how they felt they were caught in the tangles of a business enterprise. “There is a reason we are called consumers” was a comment I heard several times. They are right of course that the pharmaceutical companies want to build a market for their products, and when we view the psychopharmacology “revolution” through this prism, as a business enterprise first and a medical enterprise second, we can easily see why psychiatry and the pharmaceutical companies tell the stories they do, and why the studies detailing poor long-term outcomes have been kept from the public. That information would derail a business enterprise that brings profits to so many.
As we saw earlier, during the late 1970s psychiatry was worried about its survival. The public viewed its therapies as “low in efficacy,” and sales of psychiatric drugs were in decline. Then, in what might be called a “rebranding” effort, psychiatry published DSM-III and began telling the public that mental disorders were “real” diseases, just like diabetes and cancer, and that their drugs were chemical antidotes to those diseases, just like “insulin for diabetes.” That story, while it may have been false in kind, created a powerful conceptual framework for selling psychiatric medications of all types. Everyone could understand the chemical-imbalance metaphor, and once the public came to understand that notion, it became relatively simple for pharmaceutical companies and their storytelling allies to build markets for psychiatric drugs of various types. They ran “educational” campaigns to make the public more “aware” of the various disorders the drugs were approved to treat, and, at the same time, they expanded the diagnostic boundaries of mental disorders.
After Prozac was introduced, NIMH’s DART campaign informed the public that depression regularly went “undiagnosed and untreated.” Upjohn partnered with the APA to tell the public that “panic disorder” was a common affliction. In 1990, the NIMH launched its “Decade of the Brain,” telling the public that 20 percent of Americans suffered from mental disorders (and thus might be in need of psychiatric medications). Soon psychiatric groups and others were promoting “screening programs,” which from a business perspective are best described as customer-recruitment efforts. NAMI, for its part, understood that its “educational” efforts served a commercial end, writing in a 2000 document filed with the government that “providers, health plans, and pharmaceutical companies want to grow their markets and to increase their share of the market…. NAMI will cooperate with these entities to grow the market by making persons aware of the issues involving severe brain disorders.”2
The APA is in charge of defining diagnostic categories in our society, and DSM-IV, an 886-page tome published in 1994, listed 297 disorders, 32 more than DSM-III. New and expanded diagnoses invite more people into the psychiatric drugstore, and one of the best examples of this type of market-building occurred in 1998, when GlaxoSmithKline got the FDA to approve Paxil for “social anxiety disorder.” In the past, this might have been perceived as a character trait (shyness), but GlaxoSmithKline hired a PR firm, Cohn & Wolfe, to promote awareness of this newly recognized “disease,” and soon newspapers and television shows were telling of how SAD afflicted 13 percent of the American population, making it “the third most common psychiatric disorder in the United States, after depression and alcoholism.” Those afflicted with this illness, the public learned, were in some ways biologically “allergic to people.”3
Diagnostic changes lay behind the bipolar boom, too. In DSM-III (1980), bipolar illness was identified for the first time (the old manic-depressive cohort was splintered into different groups), and then psychiatry steadily loosened the diagnostic boundaries for this illness, such that today the field talks about bipolar I, bipolar II, and a “bipolarity intermediate between bipolar disorder and normality.” This once rare disease is now said to afflict 1 to 2 percent of the adult population, and if the “intermediate” bipolar folk are counted, 6 percent. As this diagnostic expansion happened, pharmaceutical companies and their allies mounted their usual “educational” campaigns. Abbott Laboratories and NAMI teamed up to promote a “Bipolar Awareness Day;” in 2002, Eli Lilly joined with the Depression and Bipolar Support Alliance to launch a new online destination, bipolarawareness.com. Today many websites offer visitors a quick question-and-answer test to see if they have this illness.
Naturally, pharmaceutical companies want to sell their drugs to people of all ages, and they built the pediatric market for psychotropics step by step. First, in the 1980s, the prescribing of stimulants to “hyperactive” children took off. Next, in the early 1990s, psychiatrists began regularly prescribing SSRIs to teenagers. But that meant prepubertal children weren’t being prescribed these new wonder drugs, and in 1997, the Wall Street Journal reported that the manufacturers of SSRIs were “taking aim at a controversial new market: children.” The drug firms were “preparing their medications in easy-to-swallow forms that will be more palatable to even the youngest tykes,” the newspaper said, with Eli Lilly formulating a “minty liquid” Prozac for the tots to down.4 The New York Times, in its coverage of this initiative, explained quite clearly what was driving it: “The adult market for [SSRIs] has become saturated…. The companies are looking for expanded markets.”5 Psychiatry quickly provided a medical cover for this marketing effort, with the American Academy of Child and Adolescent Psychiatry announcing that 5 percent of all children in the United States were clinically depressed. “Many of these young patients now are inadequately treated, experts say, often leading to long-term emotional and behavioral problems, drug abuse, or even suicide,” the Wall Street Journal reported.6
The creation of the “juvenile bipolar” market was a bit more complicated. Prior to the 1990s, psychiatry thought that bipolar illness simply didn’t occur in prepubertal children, or was extremely rare. But children and teenagers prescribed stimulants and antidepressants often suffered manic episodes, and thus pediatricians and psychiatrists began to see more youth with “bipolar” symptoms. At the same time, once Janssen and Eli Lilly brought their atypical antipsychotics to market, they were looking for a way to sell those drugs to children, and during the mid-1990s, Joseph Biederman at Massachusetts General Hospital in Boston provided the diagnostic framework that made that possible. In 2009, while being deposed in a legal case, he explained his handiwork.
All psychiatric diagnoses, he said, “are subjective in children and in adults.” As such, he and his colleagues decided that children who in the past had been seen as having pronounced behavioral problems should instead be diagnosed with juvenile bipolar illness. “The conditions that we see in front of us are reconceptualized,” Biederman testified. “These children have been called in the past conduct disorder, oppositional-defiant disorder. It’s not that these children did not exist, they were just under different names.”7 Biederman and his colleagues decided that “severe irritability” or “affective storms” would be the telltale signs of juvenile bipolar disorder, and with this new diagnostic criteria in hand, they announced in 1996 that many children diagnosed with ADHD were in fact “bipolar” or else “comorbid” for both illnesses.8 The illness was a “much more common condition than was previously thought,” often appearing when children were only four or five years old, Biederman said.* 9 Soon parents in the United States were reading newspaper articles about this newly recognized illness and buying The Bipolar Child, a book published by Random House in 2000. Child psychiatrists, meanwhile, began treating it with atypical antipsychotics.
That was the marketing machinery that lured more and more Americans into the psychiatric drugstore. As new drugs were brought to market, disease “awareness” campaigns were conducted and diagnostic categories were expanded. Now, once a business gets a customer into its store, it wants to keep that customer and get that customer to buy multiple products, and that’s when the psychiatric “drug trap” kicks in.
The “broken brain” story helps with customer retention, of course, for if a person suffers a “chemical imbalance,” then it makes sense that he or she will have to take the medication to correct it indefinitely, like “insulin for diabetes.” But more important, the drugs create chemical imbalances in the brain, and this helps turn a first-time customer into a long-term user, and often into a buyer of multiple drugs. The patient’s brain adapts to the first drug, and that makes it difficult to go off the medication. The store’s exit door is hard to squeeze through, so to speak. At the same time, since psychiatric drugs perturb normal function, they regularly cause physical and psychiatric problems, and this greases the path to polypharmacy. The hyperactive child is put on a stimulant that rouses him during the day; at night he needs a sleeping pill to go to sleep. An atypical causes people to feel depressed and lethargic; psychiatrists may prescribe an antidepressant to treat that problem. Conversely, an antidepressant may stir a bout of mania; in that case an atypical antipsychotic may be prescribed to tamp down the mania. The first drug triggers a need for a second, and so on.
Eli Lilly even capitalized on this fact when it brought Zyprexa to market. As it well knew, Prozac and other SSRIs could trigger manic episodes, and so it instructed its sales representatives to tell psychiatrists that Zyprexa “is a great mood stabilizer, especially for patients whose symptoms were aggravated by an SSRI.”10 In essence, Eli Lilly was telling doctors to prescribe its second drug to fix the psychiatric problems caused by its first one. We can also see this cascading effect operating at a societal level. The SSRIs came to market and suddenly bipolar patients were cropping up everywhere, and then this new group of patients provided a market for the atypicals.*
All of this has produced a growth industry of impressive dimensions. In 1985, outpatient sales of antidepressants and antipsychotics in the United States amounted to $503 million.11 Twenty-three years later, U.S. sales of antidepressants and anti psychotics reached $24.2 billion, nearly a fiftyfold increase. Anti psychotics—a class of drugs previously seen as extremely problematic in kind, useful only in severely ill patients—were the top revenue-producing class of drugs in 2008, ahead even of the cholesterol-lowering agents.12 Total sales of all psychotropic drugs in 2008 topped $40 billion. Today—and this shows how crowded the drugstore has become—one in every eight Americans takes a psychiatric drug on a regular basis.13
The Money Tree
Naturally, this flourishing business enterprise generates great personal wealth for executives at pharmaceutical companies, and money also flows in fairly copious amounts to the academic psychiatrists who tout their drugs. Indeed, the profits from this enterprise trickle down to nearly all of those who tell the “psychiatric drugs are good” story to our society. To get a sense of the amounts involved, we can look at the money that the different players in this enterprise receive.
We can start with Eli Lilly, as it serves as a good example of the profits that go to a drug company’s shareholders and its executives.
Eli Lilly
In 1987, Eli Lilly’s pharmaceutical division generated $2.3 billion in revenues. The company did not have a central nervous system drug of any importance, as its three bestselling drugs were an oral antibiotic, a cardiovascular drug, and an insulin product. Eli Lilly began selling Prozac in 1988, and four years later it became the company’s first billion-dollar drug. In 1996, Eli Lilly brought Zyprexa to market, and it became a billion-dollar drug in 1998. By 2000, these two drugs accounted for nearly half of the company’s revenues of $10.8 billion.
Prozac soon after lost its patent protection, and thus the wealth-generating effects of the two drugs can best be assessed across a thirteen-year period, from 1987 to 2000. During this time, Eli Lilly’s value on Wall Street rose from $10 billion to $90 billion. An investor who bought $10,000 of Eli Lilly stock in 1987 would have seen that investment grow to $96,850 in 2000, and along the way the investor would have received an additional $9,720 in dividends. At the same time, Eli Lilly’s executives and employees, in addition to their salaries and bonuses, netted around $3.1 billion from the stock options they exercised.14
Academic psychiatrists
The pharmaceutical companies would not have been able to build a $40 billion market for psychiatric drugs without the help of psychiatrists at academic medical centers. The public looks to doctors for information about illnesses and how best to treat them, and so it was the academic psychiatrists—paid by drug companies to serve as consultants, on advisory boards, and as speakers—who in essence acted as the salesmen for this enterprise. The pharmaceutical companies, in their internal memos, accurately call these psychiatrists “key opinion leaders,” or KOLs for short.
Thanks to a 2008 investigation by Iowa senator Charles Grassley, the public got a glimpse of the amount of money that the pharmaceutical companies pay their KOLs. The academic psychiatrists regularly receive federal NIH grants, and as such, they are required to inform their institutions how much they receive from pharmaceutical companies, with the medical schools expected to manage the “conflict of interest” whenever this amount exceeds $10,000 annually. Grassley investigated the records of twenty or so academic psychiatrists, and he found that not only were many making much more than $10,000 a year, they were also hiding this fact from their schools.
Here are a few examples of the money paid to KOLs in psychiatry.
· From 2000 to 2007, Charles Nemeroff, chair of the psychiatry department at Emory Medical School, earned at least $2.8 million as a speaker and consultant for drug firms, with GlaxoSmithKline alone paying him $960,000 to promote Paxil and Wellbutrin. He is a coauthor of the APA’s Textbook of Psychopharmacology, which is the bestselling textbook in the field. He also wrote a trade book about psychiatric medications, The Peace of Mind Prescription, for the general public. He has served on the editorial boards of more than sixty medical journals and for a time was editor in chief of
· Neuropsychopharmacology. In December of 2008, he resigned as chair of Emory’s psychiatry department, as he had failed to inform Emory of his drug-company paychecks.15
· Zachary Stowe, also a professor of psychiatry at Emory, received $250,000 from GlaxoSmithKline in 2007 and 2008, partly to promote the use of Paxil by breast-feeding women. Emory “reprimanded” him for failing to properly disclose these payments to the school.16
· Another member of GlaxoSmithKline’s speaker bureau was Frederick Goodwin, a former director of the NIMH. The company paid him $1.2 million from 2000 to 2008, mostly to promote the use of mood stabilizers for bipolar illness (GlaxoSmithKline sells Lamictal, which is a mood stabilizer). Goodwin is the coauthor of Manic-Depressive Illness, the authoritative textbook on this disorder, and he also was the longtime host of a popular radio show, The Infinite Mind, which was carried on NPR stations nationwide. His show regularly featured discussions of psychiatric medications, with Goodwin, in a program broadcast on September 20, 2005, warning that if children with bipolar disorder were not treated, they could suffer brain damage. Goodwin has been a speaker or consultant for a number of other pharmaceutical companies; the $1.2 million was what he received from GlaxoSmithKline alone. In an interview with the New York Times, Goodwin explained that he was only “doing what every other expert in the field does.”17
· From 2000 to 2005, Karen Wagner, director of child and adolescent psychiatry at the University of Texas, collected more than $160,000 from GlaxoSmithKline. She promoted the use of Paxil in children, and did so in part by coauthoring an article that falsely reported the results of a pediatric trial of the drug.
In a confidential document written in October 1998, GlaxoSmithKline concluded that in the study, Paxil “failed to demonstrate a statistically significant difference from placebo on the primary efficacy measures.”18 In addition, five of the ninety-three adolescents treated with Paxil in the study suffered “extreme lability,” versus one in the placebo group, which meant that the drug markedly elevated the suicide risk. The study had shown Paxil to be neither safe nor effective in adolescents. However, in a 2001 article published in the Journal of the American Academy of Child & Adolescent Psychiatry, Wagner and twenty-one other leading child psychiatrists stated that the study proved that Paxil is “generally well tolerated and effective for major depression in adolescents.”19 They did not discuss the sharply elevated suicide risk, writing instead that only one child treated with Paxil had suffered a serious adverse event, with that child developing a “headache.” New York State attorney general Eliot Spitzer sued GlaxoSmithKline for fraudulently marketing Paxil to adolescents, a case which was settled out of court.
All told, Wagner has been a consultant or advisor to at least seventeen pharmaceutical companies. The $160,000 was the amount she received from GlaxoSmithKline alone; she told her school that she had received $600.20
· From 1999 to 2006, Jeffrey Bostic, a psychiatrist at Massachusetts General Hospital in Boston, collected more than $750,000 from Forest Laboratories to promote the prescribing of Celexa and Lexapro to children and adolescents. He gave more than 350 talks in twenty-eight states during this period, leading one Forest sales rep to boast: “Dr. Bostic is the man when it comes to child psych!”21 In March of 2009, the federal government charged Forest with illegally marketing these drugs to this patient population, alleging that it had paid “kickbacks, including lavish meals and cash payments disguised as grants and consulting fees, to induce doctors to prescribe the drugs.” Dr. Bostic, the federal government said, served as the company’s “star spokesman” in this scheme. The federal government noted that the company had also failed to disclose the results of a study of these drugs in children that had produced “negative” results.
· From 2003 to 2007, Melissa DelBello, an associate professor of psychiatry at the University of Cincinnati, received at least $418,000 from AstraZeneca. She promoted the prescribing of atypical antipsychotics, including AstraZeneca’s Seroquel, to juvenile bipolar patients. DelBello worked for at least seven other pharmaceutical companies. “Trust me, I don’t take much” from drug firms, she told the New York Times prior to Grassley’s report.22
· Joseph Biederman may have been the KOL who did the most to help the pharmaceutical industry build a market for its products. To a large extent, juvenile bipolar illness was his creation, and children and adolescents so diagnosed are often treated with drug cocktails. Pharmaceutical companies paid him $1.6 million for his various services from 2000 to 2007, with much of this money coming from Janssen, the division of Johnson & Johnson that sells Risperdal.23
Biederman also got the company to pay $2 million from 2002 to 2005 to create the Johnson & Johnson Center for Pediatric Psychopathology at Massachusetts General Hospital.24 In a 2002 report on the center, he candidly set forth its aims. The center, he explained, was a “strategic collaboration” that would “move forward the commercial goals of J&J.” He and his colleagues would develop screening tests for juvenile bipolar illness, and then teach CME (continuing medical education) courses to train pediatricians and psychiatrists to use them. Their research, Biederman wrote, would “alert physicians to the existence of a large group of children who might benefit from treatment with Risperdal.” In addition, the center would promote the understanding that “pediatric mania evolves into what some have called mixed or atypical mania in adulthood, [which] will provide further support for the chronic use of Risperdal from childhood through adulthood.”* In the past, Biederman noted, he had successfully led the medical profession to conceive of ADHD as a “chronic” illness, and now he would do the same for bipolar disorder.25
Biederman has been the Pied Piper of pediatric bipolar illness in our society, and in this document we can see the future that he was laying out for the children given this diagnosis. They were being groomed to be lifelong consumers of psychiatric medications. The child diagnosed with bipolar disorder would be put on an antipsychotic, and that child could then be expected to become chronically ill, and that would require a lifetime of “aggressive treatments such as Risperdal.” Perhaps there is a file tucked away in a drug company cabinet that estimates the expected lifetime consumption of psychiatric medications by a child diagnosed with bipolar illness; all we can say, in this book, is that every child so diagnosed is, from a business standpoint, a new Jenna.
The next tier down
The KOLs are the “stars” of the field, as they are the ones who “influence” their peers at a national and international level, but the pharmaceutical companies also pay physicians to promote their drugs on a more local basis, with these speakers giving talks at dinners or to other physicians in their offices. Pay typically starts at $750 per event and rises from there. Two states, Minnesota and Vermont, have passed “sunshine” laws that disclose these payments, and their reports provide insight into the flow of money to these doctors.
In 2006, pharmaceutical firms gave $2.1 million to Minnesota psychiatrists, up from $1.4 million in 2005. From 2002 to 2006, the recipients of drug-company money included seven past presidents of the Minnesota Psychiatric Society and seventeen faculty psychiatrists at the University of Minnesota. John Simon, who was a member of the state’s Medicaid formulary committee, which guides the state’s spending on drugs, was the top-paid psychiatrist, earning $570,000 for his services to drug companies. All told, 187 of 571 psychiatrists in Minnesota received pharmaceutical money for some reason or other during this period, a percentage that was “much higher” than for any other specialty. Their collective take was $7.4 million.26
Vermont’s reports tell much the same story. Of all the medical specialties, psychiatry received the most money from the drug companies.
The community psychiatrist
The pharmaceutical companies also provide freebies to community psychiatrists. They invite them to free dinners where the KOLs and the local experts give their talks, and their sales representatives regularly come to their offices bearing small gifts. “Gave Dr. Child a cupcake sized peanut butter cup,” wrote an Eli Lilly sales representative, in a 2002 report to her boss. “He was kind of tickled.” Or as she said after another sales call: “Doc and staff loved the goodie box I brought in, filled with useful items for their new clinic.”27 These are very small bribes, but even a small gift helps build a social bond. A California group surveyed the drug firms and found that they do set a limit on the freebies that are offered to a psychiatrist each year; GlaxoSmithKline’s was $2,500 per physician, while Eli Lilly’s was $3,000. There are many companies that sell psychiatric drugs, and thus any psychiatrist who welcomes sales reps can enjoy a regular supply of goodies.
NAMI and all the rest
Eli Lilly now posts on the Web a list of the “educational” and “philanthropy” grants it makes, and this provides a peek at the money going to patient advocacy groups and various educational organizations. In the first quarter of 2009 alone, Eli Lilly gave $551,000 to NAMI and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention. The company gave more than $1 million to various educational organizations, including $279,533 to the Antidote Education Company, which runs a “continuing medical education” course. Those are the amounts from one pharmaceutical company for three months; any full accounting of the flow of money to patient advocacy groups and educational organizations would require adding up the grants from all of the makers of psychiatric drugs.28
We All Pay the Tab
According to a 2009 report by the federal Agency for Healthcare Research and Quality, spending on mental health services is now rising at a faster rate than for any other medical category.29 In 2008, the United States spent about $170 billion on mental health services, which is twice the amount it spent in 2001, and this spending is projected to increase to $280 billion in 2015. The public, primarily through its Medicaid and Medicare programs, picks up close to 60 percent of the nation’s spending on mental health services.30
Such is the story of the psychiatric drug business. The industry has excelled at expanding the market for its drugs, and this generates a great deal of wealth for many. However, this enterprise has depended on the telling of a false story to the American public, and the hiding of results that reveal the poor long-term outcomes with this paradigm of care. It also is exacting a horrible toll on our society. The number of people disabled by mental illness during the past twenty years has soared, and now this epidemic has spread to our children. Indeed, millions of children and adolescents are being groomed to be lifelong users of these drugs.
From a societal and moral point of view, that is a bottom-line that cries out for change.
* Although Jenna said that I could use her last name, her mother and stepfather, who have legal guardianship, requested that I use her first name only.
* During Biederman’s February 26, 2009, deposition, an attorney asked him about his rank at Harvard Medical School. “Full professor,” he replied. “What’s above that?” the attorney asked. “God,” Biederman replied.
* In a similar vein, pharmaceutical companies have pounced on the fact that many of the drugs initially prescribed for a target symptom don’t work very well. “Two out of three people treated for depression still have symptoms,” a Bristol-Myers Squibb commercial informed television viewers in 2009. The solution? Add an atypical antipsychotic, Abilify, to the mix.
* Biederman here is describing the course of children who are diagnosed with bipolar illness and then medicated; those children do tend to become chronically ill in the way he describes. But there is no medical literature showing that there is a disease that takes this course in unmedicated children.