Tag Archives: Daniel Carlat

Would Tom Sawyer and Huck Finn be diagnosed mentally ill and drugged?

Imagine if the beloved young characters in Mark Twain’s classic, “The Adventures of Tom Sawyer,” lived today. Based on current psychiatric criteria, Tom and Huck could be designated mentally ill and prescribed mind-altering drugs. Quiet, listless and numb, their legendary adventures would be over.

Describing a day in school, Twain wrote: “The harder Tom tried to fasten his mind on his book, the more his ideas wandered.” His “heart ached to be free, or else to have something of interest to do to pass the dreary time.” That’s a text book so-called symptom of ADHD (attention deficit hyperactivity disorder). A teacher today could refer him to a psychiatrist who would dope him with stimulants. Yet like any typical boy, Tom had no trouble focusing attention on something he found interesting – like finding a hidden treasure.

Tom’s friend Huckleberry might fare worse. An avowed non-conformist, a psychiatric checklist could tag him with ODD – oppositional defiant disorder. And having run away from an abusive father, Huck would land in the hands of Child Protective Services who would sedate him on psychoactive drugs subsidized by government funds.

Although no brain scan, blood test or x-ray had been done, the psych doctors would claim the boys’ mental illness stemmed from a neurobiological disorder involving chemical imbalances in the brain, probably hereditary.

A sugared pill

When Daniel Carlat, a psychiatrist in Massachusetts, was flown to New York with his wife by Wyeth, the “training” weekend he attended in a luxury hotel was topped off with a Broadway show. It was early 2001 and he had just agreed to the US pharmaceuticals company’s proposal that he give talks to doctors about its antidepressant Effexor. During the following year, he was regularly paid fees of $750 a time to drive to “lunch and learn” sessions where he would speak for 10 minutes to emphasise the drug’s advantages to fellow doctors, using slides prepared by the company. “It seemed like a win-win,” he recalls. “I was prescribing it, educating doctors and making some money.” But within a few months, he became disillusioned with his co-option as a marketing representative. He was selectively presenting clinical data that put the drug in a positive light to physicians who had been targeted by the company through “data mining” techniques that identified their individual prescription patterns.Dr Carlat has spoken out as part of a growing backlash against such aggressive marketing tactics, which are leading to significant changes in the relationship between doctors and drug companies. But even as pharmaceuticals executives argue that such problems belong to the past and were always exaggerated, they are bracing for both intensifying penalties and calls for further reform.