Editorial Note: Two weeks ago we ran Peter Gøtzsche’s Psychiatry Gone Astray. There was a context – a Danish doctor had been found responsible for the suicide of a young man put on antidepressants. This and Peter’s article stirred up debate in Denmark drawing a hard to credit defensive response from senior Danish Psychiatrists.
Peter’s blog was critiqued by George Dawson on Real Psychiatry. An anonymous tweeter @psycrit said “a post about @DrDavidHealy‘s nuttiness turns into an amazing discussion, with unbelievably high-quality comments”. Apparently my nuttiness lies in having anything by Peter G on the site.
There should be new word for this kind of ad hominem attack – which also flavor’s Dr Dawson’s post. It’s ad hominem by association or ad parahominem.
A number of colleagues such as Barney Carroll thought Peter’s piece was over the top. There are major differences between Peter and I - he locates the problem within industry in a way that I don’t. But the correct analysis is not always what carries the day. People like Peter, Ben Goldacre and Bob Whitaker can be effective - the worry then is whether the change they deliver is the right one – are GSK really one of us now?
History will recognize Peter as the man who, among other achievements, prised open the question of access to RCT data, forcing the European Medicines’ Agency to open up their files. His motivation to do this came in part from a discovery of how appallingly bad the state of affairs in psychiatry IS. How almost all trials on which the field depends are ghostwritten, all data withheld and all dissent suppressed. Whatever it is this is not science and there has to be a good chance it’s killing and disabling more people prematurely than it helps.
What you hear from Peter is a howl of horror. The rest of us have got so inured to the situation we can no longer see how bad it is. The Allied troops arriving at concentration camps must have reacted the same way, where many inmates had gotten used to the situation.
It’s quite possible as George Dawson says that psychiatrists could make equivalent comments about other concentration camps in internal medicine. That doesn’t excuse what’s happening in either psychiatry or the rest of medicine. It’s time to Get Real or at least recognize how an outsider from the media or elsewhere would react if they found out what is really going on.
Peter’s response to George Dawson is here.
Unwarranted criticism of “Psychiatry Gone Astray”
Peter C. Gøtzsche Copenhagen
On 6 January 2014, I published the article “Psychiatry Gone Astray” in a major Danish newspaper (Politiken), which started an important debate about the use and abuse of psychiatric drugs. Numerous articles followed, some written by psychiatrists who agreed with my views. For more than a month, there wasn’t a single day without discussion of these issues on radio, TV or in newspapers, and there were also debates at departments of psychiatry. People in Norway and Sweden have thanked me for having started the discussion, saying that it’s impossible to have such public debates about psychiatry in their country, and I have received hundreds of emails from patients that have confirmed with their own stories that what I wrote in my article is true.
Three months earlier, I gave a one-hour lecture about these issues in Danish, which was filmed and put on You Tube with English subtitles: http://www.youtube.com/watch?v=i1LQiow_ZIQ. After only two weeks, it had been seen by over 10,000 people from over 100 countries.
What this tells me is that I must have hit something that is highly relevant to discuss. I therefore translated my article and David Healy uploaded it on his website: http://davidhealy.org/psychiatry-gone-astray/. It also came up on www.madinamerica.com, the website of the science journalist Robert Whitaker, who gives many lectures for psychiatrists and whose recent book, “Anatomy of an epidemic,” was an eyeopener to me, as was David Healy’s “Let them eat Prozac.”
On 8 February 2014, psychiatrist George Dawson wrote “An Obvious Response to ‘Psychiatry Gone Astray“‘ on his blog. Having read Dawson’s blog, I feel the final sentence in my article, which was not translated into English, becomes relevant: It will be difficult when the leaders in psychiatry are so blind to the facts that they will not see that their specialty is in deep crisis. It is also relevant to quote the opening sentences in my acticle:
“At the Nordic Cochrane Centre, we have researched antidepressants for several years and I have long wondered why leading professors of psychiatry base their practice on a number of erroneous myths. These myths are harmful to patients. Many psychiatrists are well aware that the myths do not hold and have told me so, but they don’t dare deviate from the official positions because of career concerns. Being a specialist in internal medicine, I don’t risk ruining my career by incurring the professors’ wrath and I shall try here to come to the rescue of the many conscientious but oppressed psychiatrists and patients by listing the worst myths and explain why they are harmful.”
I listed 10 myths in my article, which I shall repeat here, and will now rebut Dawson’s criticism of them. Dawson says that the myths I describe “are mythical in that they are from the mind of the author – I know of no psychiatrist who thinks this way.” As I have just indicated, there is no person as blind as he who will not see and no psychiatrist as deaf as he who will not listen. Everything I wrote in my article has been documented, most of it in my book “Deadly Medicines and Organised Crime,” and many responses on his own blog shows Dawson to be wrong.
Myth 1: Your disease is caused by a chemical imbalance in the brain
Dawson: “This is a red herring that is frequently marched out in the media and often connected with a conspiracy theory that psychiatrists are tools of pharmaceutical companies who probably originated this idea. What are the facts?”
The facts are abundant. Many papers written by psychiatrists have stated this, and it is also what most patients say that their psychiatrists tell them. I have lectured for patients and asked them, and every time most patients say they have been told exactly this hoax about a chemical imbalance. The drugs don’t cure a chemical imbalance; they create one, which is why it is difficult to get off them again.
Myth 2: It’s no problem to stop treatment with antidepressants
Dawson: “Another red herring.”
Dawson agrees that there may be “difficulty discontinuing antidepressants” but then tries to get off the hook by noting that this can also be seen with other drugs than psychiatric ones. Allow me to say that one illegal parking doesn’t make the next one legal. Dawson agrees with me but tries to say he doesn’t. Pretty weird.
Myth 3: Psychotropic drugs for mental illness are like insulin for diabetes
Dawson invents strawmen here, e.g. by saying “Am I getting prednisone for my asthma because I am deficient in prednisone?”
That’s totally off the point, as no asthma specialist would be as silly as many psychiatrists are. Again, most patients have told me that this is what their psychiatrists tell them, and professors of psychiatry have also propagated the myth publicly, e.g. in numerous interviews and in articles written by themselves.
Myth 4: Psychotropic drugs reduce the number of chronically ill patients
Dawson: “I don’t know of anyone who has actually suggested this.”
Pardon me, but Dawson must be both blind and deaf to have escaped this, which psychiatrists say and write all the time. Dawson finds the argument “demeaning to anyone with a severe psychiatric disorder who is interested in staying out of hospitals and being able to function or trying to avoid a suicide attempt. Being able to adhere to that kind of plan depends on multiple variables including taking medications,” and he furthermore says that, “It is reckless to suggest otherwise and any psychiatrist knows about severe adverse outcomes that have occurred as a result of stopping a medication.” Whitaker has documented at length in his book that the increased use of psychotropic drugs has led to an explosion in the number of chronically ill patients on lifelong disability pension and he has also explained and documented the mechanisms behind this.
Myth 5: Happy pills do not cause suicide in children and adolescents
Dawson believes that I reveal my “antipathy to medication used by psychiatrists” by referring to antidepressants as “happy pills.”
Dawson plays the antipsychiatry card here, which is the ultimate trump card psychiatrists use when they have no valid arguments. I consider the term happy pill extremely misleading, as, for example, half of those treated get their sex life disturbed, which has led me to call them unhappy pills whose main action is to ruin your sex life. However, since everybody uses the term (instead of the cumbersome “selective serotonin reuptake inhibitors”), including many psychiatrists, I also use it. Dawson says he has never met a psychiatrist who calls antidepressants “happy pills,” but what can you expect of a man who seems to be both blind and deaf? Dawson claims that “saying that happy pills are a cause of suicide is the equivalent of saying that “sugar medicine” (insulin) is a cause of hypoglycemia that harms children and therefore it should not be prescribed.” What exactly does Dawson mean by this smoke and mirrors? It is a fact, which the FDA has demonstrated, that SSRIs increase suicidal behaviour up to age 40, and package inserts warn about the risk of suicide and recommend not using SSRIs in children and adolescents. Then why do psychiatrists use them in this age group? To use Dawson’s allegory, we wouldn’t use insulin if it increased blood glucose and the risk of dying in a diabetic coma.
Myth 6: Happy pills have no side effects
Dawson’s naivity with respect to the drug industry is heartbreaking. About the incidence of sexual problems caused by SSRIs, he refers to FDA data. But what is buried in FDA archives is not what the companies tell doctors. It is true when I write that companies have said that only 5 % get sexual problems. The true rate of sexual problems is above 50%, and there are reports that these disturbances might become permanent, which agree with rat studies where the rats showed less interest in sex long after they had come off the drugs.
Myth 7: Happy pills are not addictive
Dawson’s says that ‘antidepressants aren’t addictive’.
They surely are, as half of the patients have difficulty coming off them again even with slow tapering and experience similar symptoms as patients who try to come off benzodiazepines.
Dawson claims that SSRIs have no street value and will not make you high, and that my comparison with amphetamine is completely off the mark and consistent with my general lack of knowledge of addiction. Allow me to say that there are striking similarities between the effects of amphetamine and SSRIs and also to quote a few sentences from my book:
“In 2004, the FDA issued a warning that antidepressants can cause a cluster of activating or stimulating symptoms such as agitation, panic attacks, insomnia and aggressiveness. Such effects were expected, as fluoxetine is similar to cocaine in its effects on serotonin (73). Interestingly, however, when the EMA in 2000 continued to deny that the use of SSRIs leads to dependence, it nonetheless stated that SSRIs ‘have been shown to reduce intake of addictive substances like cocaine and ethanol. The interpretation of this aspect is difficult’(77). The interpretation is only difficult for those who are so blind that they will not see.”
“Until 2003, the UK drug regulator propagated the falsehood that SSRIs are not addictive, but the same year, the World Health Organization published a report that noted that three SSRIs (fluoxetine, paroxetine and sertraline) were among the top 30 highest-ranking drugs for which drug dependence had ever been reported (62).”
Myth 8: The prevalence of depression has increased a lot
Dawson and I seem to agree that there is hardly any true increase in the prevalence of depression. The apparent increase is caused by lowering the criteria for what is considered a depression. I also agree with his argument that since 80% of antidepressants are prescribed by primary care physicians we might call this “Primary care gone astray.”
Myth 9: The main problem is not overtreatment, but undertreatment
Dawson’s main argument is that we should not blame psychiatrists for the overtreatment but the primary care prescribers. Well, they are certainly to blame but so are the psychiatrists. Although the Danish National Board of Health recommends that only one antipsychotic should be used at a time, this is not the case. According to a report by the Board of Health, only half of patients with schizophrenia received one antipsychotic drug, one third got two drugs, and the rest got three, four or even more drugs.
Myth 10: Antipsychotics prevent brain damage
Dawson calls my arguments “More rhetoric.”
They are not. Leading psychiatrists have written this and tell their patients that they need to take the drugs in order to prevent brain damage, although it has been documented that antipsychotics cause brain damage in a dose-dependent manner. Dawson continues his futile attempts at killing the messenger: “He also talks about antipsychotic medication with the arrogance of a person who does not have to treat acutely psychotic people and incredibly talks about these drugs killing people.” These drugs do kill people. Doesn’t Dawson know this? I have estimated that Eli Lilly has killed 200,000 people with Zyprexa, and that is just one of the many antipsychotic drugs.
Dawson ends by saying: “At the end of this refutation what have we learned? I am more skeptical than ever of David Healy and his web site.” Dawson is very much against that Healy put my article on his website and he seems to suggest again that one illegal parking makes the next one legal: “It is well known in the US that the 20 year CDC initiative to control antibiotic overprescribing is a failure.” So what? That doesn’t let the psychiatrists off the hook, does it? I think a dose of self-criticism would help not only Dawson, but many other psychiatrists, and their patients.
Dawson finally says that:
“internists have enough to focus on in their own specialty before criticizing an area that they obviously know so little about. The author here also states that he is affiliated with the Nordic Cochrane Center and I think that anyone who considers the output of that Institute should consider what he has written here and the relevant conflict of interest issues.”
These are the words of a desperate man. Short of good arguments, Dawson shoots in all directions. I have done research on SSRIs for several years; had a PhD student who defended her thesis on SSRIs in 2013; have access to unpublished clinical study reports on SSRIs from the European Medicines Agency that no one else outside the agency have access to, and which tells a completely different story to that in published trial reports; and I therefore know more about these drugs than most psychiatrists do. I don’t have a clue what my relevant conflict of interest should be about. I have none! Finally, the Nordic Cochrane Centre, which I established 20 years ago when I co-founded the Cochrane Collaboration and whose director I have been ever since, is highly respected for its research. As an example, I have published more than 50 papers in the big five (BMJ, Lancet, JAMA, NEJM, Annals), which very few people in the world have done. So I think my credentials and my centre are okay.