NYT Editorial: comparing schizophrenia drugs
Wed, 21 Sep 2005
Today’s New York Times Editorial acknowledges:
“A government-financed study has provided the strongest evidence yet that the system for approving and promoting drugs is badly out of whack. The study compared five drugs used to treat schizophrenia and found that most of the newest, most heavily prescribed drugs were no better than an older drug that is far cheaper. The nation is wasting billions of dollars on heavily marketed drugs that have never proved themselves in head-to-head competition against cheaper competitors.”
Finger wagging isn’t enough.
Those billions of dollars that have depleted health care budgets, have enriched both drug manufacturers and the leaders of psychiatry who have promoted these not only ineffective, but harm producing drugs. Empirical evidence from government documents suggests a startling correlation between the introduction of currently prescribed psychoactive drugs (1989) and an unprecedented increase in persons diagnosed with disabling mental illness.
Robert Whitaker, author of the prize winning book, Mad in America (2002), brought to light evidence showing that the best selling atypical antipsychotic drugs were the product of bad science, bad medicine and hype. Three years later, the NIMH CATIE study validates that assessment.
Whitaker, an investigative reporter who is writing his third book (this one about a 1919 racial massacre that gave rise to a precedent-stting U.S. Supreme Court decision that expanded federal intervention in state criminal trials, Crown Publishers), has just published a follow-up to Mad in America.
*Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, is an original analysis of government data that tracks the unprecedented increase in the number of people diagnosed with a disabling mental illness in the US since the introduction of currently used psychotropic drugs–SSRI antidepressants and atypical antipsychotics.
As use of these drugs increased to blockbuster sales levels, so did the number of people who became severely disabled. Between 1987 and 2000, the number of disabled mentally ill in the United States who receive Supplemental Security Income or Social Security Disability Insurance, increased from 3.331 million people to 5.726 million.
A century ago, fewer than two people per 1,000 were considered to be “disabled” by mental illness and in need of hospitalization. By 1955, that number had jumped to 3 .38 people per 1,000, and during the past 50 years, a period when psychiatric drugs have been the cornerstone of care, the disability rate has climbed steadily, and has now reached around 20 people per 1,000. (Table 2). As with any epidemic, one would suspect that an outside agent of some type-a virus, a bacterial infection, or an environmental toxin was causing this rise in illness. That is indeed the case here. There is an outside agent fueling this epidemic of mental illness, only it is to be found in the medicine cabinet. Psychiatric drugs perturb normal neurotransmitter function, and while that perturbation may curb symptoms over a short term, over the long run it increases the likelihood that a person will become chronically ill, or ill with new and more severe symptoms. A review of the scientific literature shows quite clearly that it is our drug-based paradigm of care that is fueling this modem-day plague.
The article is available at: http://psychrights.org/Articles/EHPPPsychDrugEpidemic(Whitaker).pdf See:* Ethical Human Psychology and Psychiatry, Volume 7, Number I , Spring 2005
AHRP offers the following recommendations to stem the tide of drug-induced disability and waste of public funds:
- The Texas Medication Algorithm Project (TMAP) guidelines which recommend these expensive drugs as first line treatment should be declared invalid.
- State policies that supported coercive measures to force patients to take antipsychotics must be rescinded.
- The FDA must issue a public advisory at once warning physicians against prescribing atypicals off-label.
- Doctors who prescribe an atypical must be required to monitor patients metabolic functions on a regular basis.
- No child under 18 should be exposed to atypical antipsychotics – which are mainly used to control bad behavior. Chilldren in foster care should not be subjected to antipsychotic drugs.
- Suspend the so-called schizophrenia prevention study conducted at Yale University, in which healthy adolescents are exposed to olanzapine for a year. The stated rationale for selecting these adolescents is that they have a sibling diagnosed with schizophrenia, and by extension the researchers speculate – without evidence – that the drug could prevent schizophrenia.
Contact: Vera Hassner Sharav
THE NEW YORK TIMES
September 21, 2005
Comparing Schizophrenia Drugs
A government-financed study has provided the strongest evidence yet that the system for approving and promoting drugs is badly out of whack. The study compared five drugs used to treat schizophrenia and found that most of the newest, most heavily prescribed drugs were no better than an older drug that is far cheaper. The nation is wasting billions of dollars on heavily marketed drugs that have never proved themselves in head-to-head competition against cheaper competitors.
The whole class of antipsychotic drugs has had undeniable value in blunting the symptoms of schizophrenia, enabling many patients to leave mental hospitals and move into the community. But the first generation of these drugs fell into disfavor because they often caused neurological side effects, like tremors and other involuntary movements.
That spurred the development of a new generation of drugs known as atypical antipsychotics, which now dominate the market and rake in some $10 billion in annual sales. The trouble is that these new drugs were approved largely on the basis of short-term clinical trials that compared them primarily with placebos, so there was little if any evidence that they were any better than many of the older drugs.
That gap has been filled by an 18-month clinical trial involving more than 1,400 adults around the nation. The study, sponsored by the National Institute of Mental Health, measured how long patients were able to keep taking their assigned drugs before deciding to change, usually because a drug wasn’t working or had intolerable side effects. Three-fourths of the patients, a shocking number, stopped taking the drug they had been given, suggesting that there is a clear need for better treatments.
The study found that the oldest drug, perphenazine, was as effective and caused no worse side effects than three of the newer drugs. Zyprexa, a new drug made by Eli Lilly, helped patients control symptoms slightly better than the others, but at the cost of serious side effects.
Doctors should find a trove of useful data in the study to help them decide which drug might be best for a particular patient. But Congress and the Bush administration ought to pay attention as well. Surely it would make sense to force manufacturers to test their drugs not just against placebos, but against existing drugs that they are seeking to displace. And surely it would be cost-effective for the government to sponsor large studies comparing a slew of expensive drugs with their cheaper alternatives.
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