INVENTING PSYCHIATRIC “DISEASES” FOR OVER 40 YEARS
Drug Ads Hyping Anxiety Make Some Uneasy
By Shankar Vedantam
Washington Post Staff Writer
Monday, July 16, 2001; Page A01
Abstract of, and Commentary by Fred A. Baughman Jr., MD
About two years ago, newspaper, magazine and television news stories began popping up across the country about a little-known malady called social anxiety disorder (SAD). Psychiatrists and patient advocates appeared on television shows and in articles explaining that the debilitating form of bashfulness was extremely widespread but easily treatable.
The stories and appearances were part of a campaign, coordinated by a New York public relations agency, that included pitches to newspapers, radio and TV, satellite and Internet communications, and testimonials from advocates and doctors who said social anxiety was America’s third most common mental disorder with more than 10 million sufferers.
So successful was the campaign that according to a marketing newsletter, media accounts of social anxiety rose from just 50 stories in 1997 and 1998 to more than 1 billion references in 1999 alone. And about 96 percent of the stories, said the report in PR News, “delivered the key message, ‘Paxil is the first and only FDA-approved medication for the treatment of social anxiety disorder.’ ”
The plug for a drug was no accident. Cohn & Wolfe, the public relations agency coordinating the campaign, did not serve at the pleasure of the doctors and patient advocates who participated in the education campaign. Instead, the agency worked at the behest of SmithKline Beecham, the pharmaceutical giant now known as Glaxo SmithKline, which makes the antidepressant Paxil.
The campaign was supplemented by a multimillion-dollar marketing and advertising blitz that pitched the drug to doctors, audiences of television shows such as “Ally McBeal” and readers of magazines such as Rolling Stone. Sales of Paxil, which had been lagging those of Prozac and Zoloft, jumped, rising 18 percent last year alone.
The education and advertising campaigns have raised concerns that pharmaceutical companies, traditionally in the business of finding new drugs for existing disorders, are increasingly in the business of seeking new disorders for existing drugs. Critics accuse the companies of recruiting patients by teaming up with doctors and patient advocates — with all the attendant conflicts of agenda and conflicts of interest.
“Pharmaceutical companies who are marketing psychopharmacological treatments have gotten into the business of selling psychiatric illness,” said Carl Elliott, a bioethicist at the University of Minnesota, who studies the philosophy of psychiatry. “The way to sell drugs is to sell psychiatric illness. If you are Paxil and you are the only manufacturer who has the drug for social anxiety disorder, it’s in your interest to broaden the category as far as possible and make the borders as fuzzy as possible.”
Blurring the Lines
Blurring the line between normal personality variation and real psychiatric conditions can trivialize serious mental illness, some experts said.
“Some marketing seems to imply that huge proportions of the population need pharmaceutical intervention for relatively common problems, and in the long run [Fred A. Baughman Jr., MD: with no knowledge of what dangers their long term use holds], I am concerned that that may undermine the credibility of the concept of serious mental illness,” said Rex Cowdry, medical director of the National Alliance for the Mentally Ill, a patient advocacy group.
Glaxo Smith Kline did not make company officials available for comment, despite repeated requests. But doctors and advocates associated with the company’s campaign defended the effort, saying it informed thousands of people who previously did not know they were suffering from the disorder, spurring many to seek needed help.
“When I talk to family physicians, I don’t hear them saying I have all these people who are asking for medicines they don’t need,” said Murray Stein, a psychiatry professor at the University of California in San Diego
[Fred A. Baughman Jr., MD: Dr. Stein, thats because all the family physicians are delighted with
the business too, the hand-in-glove arrangement with the pharm industry,
so cozy for one and all]
. “They say this patient said she had social anxiety and I’ve been treating her for years and I never thought to ask about it. What could be negative about that?”
Advocates Hail Attention
Although many of the participants said they served as paid consultants or scientific investigators for the company, they rejected any notion that they were manipulated by the pharmaceutical industry. Most said they had spent years toiling on social anxiety disorder and were delighted when SmithKline offered a way to get their message out.
“I know there’s lots of concern about, ‘Are we medicalizing normative things and is the pharmaceutical industry trying to put SSRIs in the water,’ ” Stein said, referring to the class of drugs known as selective serotonin reuptake inhibitors, which includes Paxil. “The people I see talking about that have not seen these patients.”
Patients with social anxiety disorder aren’t the shy people who hang out at the edges of parties. Those truly suffering from the condition are profoundly debilitated, refusing promotions or taking jobs as night guards because they can’t stand to be around people. Some cannot open the door to a handyman because that would mean conversation.
“Would somebody who is not having problems take a medicine that is costly and has side effects?” Stein asked. “I don’t think too many people would do that. The idea that this is cosmetic psychopharmacology I find offensive.”
The advocacy organizations that participated in the campaign — the American Psychiatric Association, the Anxiety Disorders Association of America and a Long Island-based group called Freedom From Fear — said that the only way for nonprofit groups to get out a potent public health message is to team up with a pharmaceutical company with deep pockets. Moreover, the groups demanded and received full control over the editorial content of the education campaign, said John Blamthin, an APA spokesman.
“We have never, ever promoted any drug,” said Jerilyn Ross, the founder of the Anxiety Disorders Association of America. “If you look at our materials and on our Web site, we have never mentioned a drug.” Ross said that she even got into “fights” with SmithKline because she frequently told the company’s marketers, ” ‘We can’t do this, we can’t do that.’ “
But if the experts did not want to be boosters for Paxil, the arrangement with the public relations firm — and the marketing campaign for Paxil, which offered journalists interviews with some of the same experts — made that confusing. Cohn & Wolfe emphasized in its calls to the media that it spoke on behalf of doctors and nonprofits — not the pharmaceutical company that was paying its bills.
The Cohn & Wolfe Web site, however, made no secret of the fact that it is in the business of marketing, not public health: On a previous campaign to promote coverage about the 10th anniversary of Prozac’s launch in Britain, the agency said it successfully helped drug maker Eli Lilly spin coverage. The strategy? Offer journalists interviews with “independent Key Opinion Leaders” — doctors, advocacy groups and patients with “suitable debate.”
Cohn & Wolfe declined to talk about its role in the Paxil campaign, calling the information “proprietary and confidential.”
Business of Educating
Marcia Angell, a former editor of the New England Journal of Medicine, said that pharmaceutical companies could not be expected to act solely in the interest of public health: “They are no more in the business of educating the public than a beer company is in the business of educating people about alcoholism.”
The expensive ad and education campaign paid off in the crowded antidepressant market: Glaxo SmithKline’s 2000 annual report told shareholders the drug “became number one in the U.S. selective serotonin reuptake inhibitor market for new retail prescriptions in 2000.”
Barry Brand, Paxil’s product director, told the journal Advertising Age, “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder.”
Several experts, including some who treat social anxiety disorder, worried whether such marketing was in the public’s best interest.
“When the pharmaceutical companies focus on broadening the market, you miss out on the fact that there is a proportion of people for whom mental illnesses are truly disabling,” said Cowdry, who formerly headed the National Institute of Mental Health. “I have the same reaction when I hear that one in three Americans have a mental illness. The problem with that kind of data is that it undermines credibility — it doesn’t pass the laugh test.”
Sizing Up the Problem
Two experts who were assembled by the American Psychiatric Association to write the definition of social anxiety disorder for the psychiatrist’s manual said they admired the campaign for alerting patients suffering in silence. Still, they had concerns.
“I don’t think the ads make the distinction between social anxiety and shyness,” said Edna Foa, a professor of psychology at the University of Pennsylvania who served on the APA committee. “One gets the impression from the ads that if you are shy and you have some difficulties and you want to be outgoing, then take Paxil. You are promoting medication when it is unnecessary.”
There were other instances where the social anxiety marketing campaign diverted from the message of medical experts — including experts who were part of the education campaign — or quoted the experts selectively.
The campaign said that more than 10 million Americans suffered from social anxiety disorder, making it the most common mental disorder after depression and alcoholism — and that 13 percent of Americans are affected by social anxiety disorder. But the National Institute of Mental Health says only about 3.7 percent of the U.S. population has social anxiety disorder. The American Psychiatric Association says rates vary between 3 percent and 13 percent. Stein of UCSD said he preferred the 3 percent to 4 percent estimate.
Although Paxil has been specifically approved by the Food and Drug Administration for the disorder, many psychiatrists said there is probably little difference between Paxil and similar medicines such as Prozac or Zoloft in treating social anxiety. There are also other types of drugs available for treating other forms of anxiety.
And although the campaign mentioned a psychological therapy called cognitive behavior therapy, it did not stress that the therapy is as effective as medication, has no side effects, such as sexual problems and fatigue, and does not require patients to stay on treatment indefinitely.
“In my opinion, social anxiety is not a chemical problem with the brain,” said Jonathan Abramowitz, a psychologist at the Mayo Clinic in Rochester, Minn., who worked on the psychiatrist’s manual. “I see it as a problem with normal thinking and behaviors that have gone awry.”
Cognitive behavior therapy, he said, takes 14 weeks: “It’s like learning to ride a bike. You are practicing these skills over and over. No one can take them away from you the rest of your life. The long-term benefits of cognitive therapy is better than medicine because with medicine, when you stop, the symptoms come back.”
© 2001 The Washington Post Company
Commentary on Psychiatry's Invented Diseases/Epidemics by Fred A. Baughman Jr., MD When I graduated from medical school in 1960, psychiatry was about Freud, psychoanalysis, our/your rearing/upbringing, adapting and coping. Neurology, my field dealt with the diagnosis and treatment of organic/physical abnormalities/diseases of the brain, psychiatry with all that remained-with all having symptoms (subjective), but no signs/physical abnormalities--symptoms with which they need behavioral therapy. But such is not the case today as a perusal of Mr. Vedantam's article from the Washington Post tells us. Reading this article one gets the distinct impression that psychiatry in league, in fact bought and paid for by Big Pharma had just begun to invent mental/psychiatric disorders, by which they mean diseases, which, to be diseases, must have a detectable/diagnosable physical abnormality. In fact, psychiatrists from the APA leadership of the profession and their research cadre began inventing psychiatric disorders/diseases/epidemics/markets as long ago as the late 60's when the fledgling psychotropic drug market was just getting under way. In a letter to Elliott Richardson, Secretary Department of Health Education and Welfare October 12, 1970, Congressman, Cornelius E. Gallagher, Chairman of Right to Privacy Inquiry of the Special Studies Subcommittee, wrote: "A preliminary general accounting office report showed that the NIMH had granted at least three million dollars for studies in this area, and a NIMH witness testified that at least one hundred fifty thousand children around the nation were receiving drugs. .I have received letters from people..highly critical of the focus of the medical side of minimal brain dysfunction, which is, incidentally, one of at least thirty-eight names attached to this condition. They confirmed..that the medically oriented studies do not adhere to high scientific standards. In addition, representatives of other disciplines have indicated to me that MBD may not be an abnormality. Such a high incidence in the population- as high as thirty percent in ghetto areas.may not be pathological at all." MBD, AKA, minimal brain damage, "hyperactivity," "hyperactive child syndrome," etc., etc., etc.-one of at least thirty-eight names Congressman Gallagher heard appended to the behavioral entity, became, by vote, in the DSM Committee of the American Psychiatric Association, attention deficit disorder-ADD for the 1980, DSM-III, then ADHD, DSM-III-R brand in 1987, and, most recently, and without disease-validation (finding a characteristic, diagnosable abnormality), ADHD, DSM-IV, 1994 variety. Just as for social anxiety disorder, spoken of in the article below, all of psychiatry and their already-in-bed-with pharm industry partners, their was no hesitation at the Gallager, 1970 Congressional hearings to insist to the Congressmen and to their patients and the public that all of the school-based psychiatric disorders they sought, even then to drug for, were real, actual diseases, due, they swore to abnormalities/pathologies/chemical imbalances within the brains of the children, even then, being blamed for their own educational failure and frustration and unhappiness--that surely followed it. It was probably sometime in the early 60s', possible as early as in the late 50's that after a sumptuous dinner in a smoke-filled room, cognac flowing, captains of industry met with leading, pure-as-the-driven-snow, all-expenses-already-paid-for leaders of the APA and academic psychiatry and decided that if they were going to sell all of the "chemical balancers"--pills they could make, they had better hurry up and start inventing chemical imbalances/psychiatric disorders/diseases. And that is just what they did, and, starting with MBD, then ADD, then ADHD they got better and better and faster and faster inventing and marketing disease. ADHD has been the model the prototype and it remains so today-invented out of thin air, never a disease, not even in part, the "epidemic" -as ADD soared to 150,000 in 1970 to 500,000 in 1987 when refinements were edited (for the DSM-IIIR), to 1,000,000 as ADHD by 1990, and to 6-7 million today as-you guessed it, the DSM-IV rendition, no longer ADHD, but AD/HD! And not one of them, not a single solitary psychiatric disorder/disease/chemical imbalance, real, demonstrable/detectable/verifiable/diagnosable, which means that every psychiatric patient in the country, every citizen has been and is being lied to as to the nature of the mental condition by way of "disclosure" meant to ensure them their informed consent rights. Rex Cowdry, MD, now of NAMI, a bought-and-paid-for pharm industry mouthpiece/cheer-leader, formerly of the National Institute of Mental Health (author of all of the fraudulent disease descriptions for psychiatry and Big Pharm). "I have the same reaction when I hear that one in three Americans have a mental illness. The problem with that kind of data is that it undermines credibility -- it doesn't pass the laugh test." WAKE UP AMERICA! Nothing that Big-pharma with psychiatry attached to it's hip says or does today, passes the laugh test -certainly not their drugging, courtesy of the US Congress, of millions upon millions of normal children where ever children are found in a government program, most of all, in every, single classroom, in every single public school; over half of them in some of those classes, and it is not funny. ###