The Huffington Post – August 17, 2011

by Martha Rosenberg

Before “Ask Your Doctor” ads on TV, all you knew about prescription drugs were creepy ads in a JAMA at the doctor’s office with a lot of fine print. Even if you knew the name of a drug, you’d never ask your doctor for it because that would be self-diagnosing and cheeky for a patient.

Flash forward to the late 1990s when direct-to-consumer (DTC) drug advertising, drug websites and online drug sales came on board and self-diagnosing and demanding pills became medicine-as-usual for many doctors and patients.

The DTC/web perfect storm didn’t just sell drugs like Claritin, Prozac and the purple pill. It sold the diseases to go with them like seasonal allergies, GERD and depression. It sold risk of diseases like heart events for which you’d take a statin like Lipitor, osteoporosis for which you’d take a bone drug like Boniva and asthma attacks for which you’d use a second asthma drug like Advair. Of course, by the very definition of prevention, you didn’t know if the drugs were working but you weren’t paying out of pocket anyway so what the hay.

Thanks to DTC advertising, people began taking seizure drugs like Topamax and Lyrica for everyday pain or headaches and antipsychotics — hello? — for everyday blues or mood problems. They started taking monoclonal antibodies made from genetically engineered hamster cells like Humira when they didn’t have to. And even though FDA mandated risk disclosures — brain bleeds, sudden death, difficulty breathing, stomach bleeding, liver failure, kidney failure, muscle breakdown, fainting, hallucinations, the drugs perversely sold more either because ad frequency itself sells or because people like the identity in having a disease.

Soon anxiety graduated to depression which graduated to bipolar disorder. Children got schizophrenia and depression like adults, and adults got ADHD like kids. And it didn’t stop there. If the depression you or your kid had didn’t go away — maybe because it wasn’t depression in the first place, but a thing called “life” — you needed to add a drug like Abilify or Seroquel on to the original drug(s) because your depression was “treatment resistant.”

Of course if people were paying for the drugs out of their pocket and you told them to add a drug that costs almost $500 a month because the first one isn’t working, they would say the only thing “treatment resistant” is your sales pitch — go find another sucker. But if third party payers get stuck with the bill, no one seems to mind pharma’s double-(and triple)-its-money plan — or even notice it.

In fact psychiatric drug cocktails of eight, 10 and 12 drugs are now fairly common for “treatment resistant” depression and PTSD (often paid by government entitlement health plans) even though the drugs have never been tested when taken together. Unless you count the patients taking them now!

Pharma also adds an urgency pitch to the sell in case you think you can wait to take you or your child’s treatment resistant drug cocktail until symptoms worsen. Depression is now a “progressive” disease, say pharma-paid doctors after being known for decades as a self-limiting disease. (The one good thing you could say about depression; it would go away.)

And don’t think kids will outgrow mood problems either, says pharma. That erratic behavior is no doubt early mental illness that will become worse if you’d don’t nip it in the bud. Even mothers of 1-year-olds with the sniffles are told serious asthma is just around the corner if they don’t treat their toddler now.

Pharma is also having a field day with sleep because everyone is in the demographic. In fact comedian Chris Rock riffs about hearing a DTC ad that asks, “Do you fall asleep at night and wake up in the morning?” and recognizing himself. “Yeah, I got THAT,” he says.”

Not falling asleep soon enough of course is the disease of insomnia which can have “strains” like “middle-of-the-night” and “terminal” insomnia. But it also sets you up for — what’s the pharma euphemism — wakefulness problems the next day. And once you’re using a wakefulness aid like Adderall or Nuvigil, what do you bet you’ll have sleep problems?

Because of pharma-paid doctors, PR firms and industry subsidized medical journals and websites like WebMD, pharma is able to create new diseases (osteopenia, the “risk” of osteoporosis), perimenopause and Low T), “humanize” others by giving them nicknames (ED, RA, RLS, Hep C) and elevate others to public health problems like HPV/venereal warts. (It doesn’t hurt that Julie Gerberding, M.D., former CDC head resurfaced as head of Merck vaccines after she left the government.)

But a more insidious sell are pharma subsidized “patient groups” that lobby FDA and state agencies about expensive drugs, often psychiatric. While these “patients” — often flown by pharma to testify at FDA hearings — pretend they can’t get needed drugs like terminal cancer patients, the issue is seldom availability but money: Either they want a new use covered by insurers or they don’t want an older, cheaper drug substituted.

The same patients appear on website testimonials and phony grassroots PSAs (public service messages) about the epidemic of depression or childhood mental illness. How can you tell they’re not real patients but pharma plants? The websites and PSAs look exactly like direct-to-consumer ads.

Martha Rosenberg’s first book, tentatively titled “Born with a Fritos Deficiency: How Flaks, Quacks and Hacks Pimp the Public Health,” will be published by Amherst, New York-based Prometheus Books next year.

http://www.huffingtonpost.com/martha-rosenberg/does-anyone-remember-life_b_921361.html

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The Huffington Post – August 16, 2011

by Leonard Rubenstein

One of the most disturbing legacies of the use of torture against national security detainees in US custody has been participation of psychologists in interrogation. That role has been endorsed by the American Psychological Association, adding a veneer of professionalism to the infliction of horrific abuse on detainees.

But now the very foundation of the APA’s position has been undermined with the release this month of its own Specialty Guidelines for Forensic Psychology. Though directed principally toward psychologists who engage in evaluations for courts and administrative bodies, such as for child custody and competency to stand trial, the new guidelines’ emphasis on integrity, truthfulness, disclosure, prevention of harm and avoidance of conflicts of interest repudiates central features of psychologists’ participation in interrogation.

Psychologists were instrumental in designing and promoting the use of sleep deprivation, isolation, painful and contorted shackling, waterboarding, sensory deprivation, and other forms of torture on detainees in military and CIA custody. They employed these methods to induce anxiety, disorientation, fear, cognitive impairment and feelings of vulnerability — in the CIA’s words, “debility, dependency and dread” — toward seeking to break the detainee’s resistance to yielding intelligence. At Guantanamo Bay, special units of psychologists (and sometimes psychiatrists), called Behavioral Science Consultation Teams, were charged with helping interrogators identify detainee vulnerabilities, advise on strategy before and during the interrogation and tell interrogators when to push the detainee harder to seek intelligence. It is likely that thousands of detainees held in Afghanistan, Iraq and Guantanamo Bay suffered acute and enduring pain and suffering as a result.

Even after the Department of Defense repudiated the use of torture, these units have persisted. Current policy assigns psychologists the duty to assess detainees for personal strengths and vulnerabilities and advise interrogators how to exploit those vulnerabilities in interrogation. Psychologists also advise commanders on creating conditions of confinement that they think will maximize intelligence collection. At the same time, psychologists are supposed to exercise another, incompatible role, protecting the safety of the detainee, including stopping “behavioral drift” toward abuse by interrogators.

All medical groups have determined that direct participation in interrogation is unethical, a severe breach of the professional duty to avoid harm. But the APA’s 2005 Presidential Task Force on Psychological Ethics and National Security (PENS), a majority of whose members were involved in intelligence work, argued that psychologists have a responsibility to advance national security and additionally claimed that they could make interrogation safer. The PENS conclusions have remained APA policy and have been cited by the Pentagon to justify the use of psychologists in interrogation.

The newly released Specialty Guidelines demonstrate why the PENS position is ethically untenable, little more than a shabby rationalization for severe ethical violations. For example, the guidelines require transparency to the person subject to examination: The psychologist must disclose the nature and purpose of examination, explain who will have access to the information, what limits on confidentiality exist, the consequences of participation in the examination, and results of the examination. Department of Defense practice not only eschews transparency but prohibits it. Deception, which is rejected by the guidelines, lies as the heart of the interrogation assessment; the psychologists involved are not even identified as such to the detainee.

The guidelines also render intolerable the conflict of interest at the heart of the psychologists’ role — at once to advance intelligence gathering and to act as a “safety officer.” The conflict, moreover, is likely to be resolved in favor of pressing for information, since the psychologists involved are classified as combatants, not clinicians (though they must be licensed to practice), and assigned to an intelligence chain of command. Whereas PENS sought to fudge the conflict by urging a “delicate balance of ethical considerations” the Specialty Guidelines insist on adherence to core obligations of integrity and fairness and avoidance of involvement in roles with conflicts of interest.

Finally, and most critically, the guidelines join the medical community in allowing no room for compromise in exposing individuals to harm, so that typical roles of psychologists in interrogation, such as stimulating stress, anxiety, and fear in the detainee, are impermissible. Their function of weighing harms to the detainee against intelligence needs is grossly inappropriate under the guidelines.

The content of the guidelines should not be surprising, as they are based squarely on core values reflected in the profession’s binding code of conduct. The question now is whether the American Psychological Association and Department of Defense are going to recognize the impossibility of any ethical role for psychologists in individual interrogations and end this destructive and conflict-ridden practice.

http://www.huffingtonpost.com/leonard-rubenstein/an-end-to-psychologists-r_b_928685.html

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