Aldous Huxley's Brave New World is a dystopian-or anti-utopian-novel. The story is set in a London six hundred years in the future. Standardization and progress are valued above all else. Powerful people that resemble today's corporations create human beings in factories, and condition them for their future lives. Children are raised together and subjected to mind control through sleep teaching to further condition them. All is done in the name of keeping people happy and healthy and free of worry.
In many chilling ways, drug companies promise us a utopian future without pain, without disease and illness, thanks to prescription drugs. But is the cost more than we bargained for? This article will be in three parts. Part One will address the power and control that pharmaceutical companies have over our medical system; Part Two will examine how the profession of psychiatry is driven if not controlled by pharmaceutical companies; and Part Three will present evidence that questions the effectiveness claims of psychotropic drugs.
Dr. Joanna Montcrieff is a Senior Professor at the Department of Mental Health Sciences at University College in London and co-founder of the Critical Psychiatry Network. Some of the following material is adapted from her book, The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment, and a paper presented to the Institute of Psychiatry.
It's no small accident that pharmaceutical companies have grown so large-their profitability is astounding. In 2001, US pharmaceutical company profits averaged 18.5% of revenue compared with 2.2% for the rest of the Fortune 500 companies (Fortune magazine, April, 2002). Imagine what the figures are today.
Drug manufacturers spend billions yearly on marketing and advertising, far beyond what they spend on research. Billions go into direct to consumer advertising which drums a mantra to the masses: "ask your doctor if (___ medication) is right for you." Billions are poured into marketing to doctors, including via drug sales reps - one of the most lucrative sales jobs in the U.S.
One ex-drug sales rep, Shahram Ahari, told a Senate Aging Committee that on top of a base salary for starting reps of $50,000, "there were four quarterly bonuses, an annual bonus, stock options, a car, 401k, great health benefits, and a $60,000 expense account." He said his job involved "rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate." Another former drug sales rep and author of Confessions of an RX Drug Pusher, Gwen Olsen, says it's all about the money. She described her hiring process. When asked why she wanted to become a pharmaceutical sales rep, she said she wanted to help people. The regional manager replied, "If that's the case, you might want to join the Peace Corps...But if money is what motivates you, young lady, let me tell you how you can retire a millionaire." Gwen reports that every manager she worked for told her that children are their biggest and most profitable expansion market.
Psychiatric drugs are notoriously high-priced. A year's supply of one top antipsychotic is $7,000. A journal article in Biosocieties, entitled, "Demythologizing the high costs of pharmaceutical research," exposes that drug companies widely exaggerate research costs to justify these prices. These companies typically cite a 2003 industry-funded study to claim a tag of over $1 billion to research and bring a drug to market. A new independent analysis indicates the figure is closer to $55 million.
The drug companies leave nothing to chance in their marketing plans however, making pitches directly to consumers. Of all western nations only in the United States and New Zealand, are drug companies are permitted to advertise their products directly to consumers. In the year 2000 alone, 2.5 billion dollars was spent on advertising prescription drugs to consumers in the United States (Public Citizen, 2002). In 1999, it was estimated that the average American saw nine advertisements for drugs every day.There is no doubt that direct to consumer advertising leads to increased prescription of drugs. A recent survey showed that one in five Americans was prompted to call or visit their doctor to discuss an advertised drug (BMJ, News, October, 2002).
And what is the most profitable area of drug sales? Psychotropic drugs. Mood altering and behavior modifying drugs aimed at brain chemistry. Worldwide sales of antidepressants, stimulants, antianxiety and antipsychotic drugs exceed $82 billion a year as of 2003.
Drug company corporate websites tell us of their integrity and utmost commitment to people's health and well-being. The American Psychiatric Association's website begins with "Healthy Minds. Healthy Lives" and asserts the "highest ethical standards of professional conduct." Yet a mountain of evidence points to an entirely different picture.
Most recently, thirty-eight state attorneys won a $68.5 million settlement with pharmaceutical titan AstraZeneca for unlawful marketing of antipsychotic Seroquel for unapproved use. These states also charged this company with failing to disclose the drug's harmful side effects and concealing negative information about its safety and efficacy. "The company's illegal practices put our most vulnerable populations at risk, including children and older patients with dementia and other debilitating diseases," states Illinois Attorney General. U.S. sales of Seroquel brought in $5.3 billion for AstraZeneca last year.
Looking further, it's evident that the pharmaceutical industry is fraught with fraud. For instance, the new generation of antipsychotics is the single biggest target of the False Claims Act. Every major drug company selling the drugs has either settled recent government cases for hundreds of millions of dollars or is under investigation for health care fraud. Currently, U.S. federal prosecutors are seeking about $1 billion to resolve a long-running probe into Johnson and Johnson's marketing of the antipsychotic drug Risperdal, for off-label marketing of the drug. In 2009, Pfizer reached the drug industry's biggest settlement, agreeing to pay $2.3 billion to resolve an investigation into the marketing of now-withdrawn painkiller Bextra. Since 2001, drug makers have paid more than $11 billion in off-label marketing and other whistleblower fraud cases.
Drug companies also have an impact on governments and social policy. The industry seeks direct influence at a government level by employing political lobbyists and contributing large sums of money to political parties and campaigns. In the United States, there are more pharmaceutical industry lobbyists than Congress members. The lobby budget for 1999 and 2000, at $197 million dollars, was $50 million dollars larger than the drug industry's nearest rivals, the insurance and telecommunications industries. On top of this, the industry makes generous contributions to election campaigns, mostly to Republican Party candidates (New York Times, 4th November, 2001). Imagine what the figures must be like today.
A survey in 2006 reported the number of Americans taking antidepressants had doubled in a decade from 13.3 million to 27 million. The use of antipsychotic drugs to treat children and adolescents for problems such as aggressive behaviors and mood changes increased five fold from 1993 to 2002. A 2009 survey found that 73% more adults and 50% more children were using psychiatric drugs than in 1996.
In short, while the biological revolution in psychiatry shows little evidence of being beneficial for patients, it has been very good for business for psychiatrists and extraordinarily profitable for the pharmaceutical industry. The situation is analogous to the alliance of Wall Street bankers and traders, who with the help of some esteemed economists, established acceptance of a rationale for a financial system of great benefit to them personally. In the end, the one-sided nature of the transactions led to an economic crash causing great financial losses for the public. Similarly, psychiatry and drug companies have perpetrated a utopian pharmaceutical mythology that serves their interests very well but has served the public very poorly.
Part Two of this article will deal how the profession of psychiatry has been co-opted by the drug companies.
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