TRYING TO MANUFACTURE A PSYCHIATRIC EPIDEMIC IN EAST ASIA Comments of Fred A. Baughman Jr., M.D. regarding: Wall Street Journal WSJ.COM January 11, 2001 Dow Jones Newswires AWSJ: Psychiatric Drugs Hard To Sell In Asia By THOMAS M. BURTON Staff Reporter BANGKOK ] For Western pharmaceutical companies selling psychiatric drugs, East Asia's population of two billion would seem to represent potentially the world's largest market. Yet after more than a decade in East Asia, Eli Lilly & Co. sells a minuscule $5.3 million of the antidepressant Prozac in the area annually, compared with $2.1 billion in the U.S. Lilly's hot-selling antipsychotic Zyprexa chalks up only about $5.5 million in yearly East Asian sales, but $1.37 billion in the U.S. GlaxoSmithKline PLC's antidepressant Paxil (called Seroxat overseas), with more than $1.4 billion in U.S. sales, achieves under $200,000 in annual sales in Indochina, despite the region's population of about 200 million. It isn't that Asians are happier than Americans. Norman Sartorius, former president of the World Psychiatric Association, says the incidence of major depression in Asia is about that in the U.S. -- roughly 3% of adults. But the widespread belief that mental illness is a stigma of the worst sort, coupled with the popularity of shamans
[Fred A. Baughman Jr., MD:
Shamans are indian medicine
men, an apt title for the US psychiatrists dispatched to the region, by
the pharmaceutical companies, to sell emotional/behavioral problems as
diseases, chemical imbalances, needing chemical balancerspills;
were it not an insult to the indian medicine men]
and other alternative healers such as monks and fortune-tellers, have sharply restricted sales of antidepressants throughout the region. In Thailand, for example, hospital referrals for psychiatric treatment rose sharply as Asia's economic crisis smashed businesses and wiped out jobs, although spending on health care abruptly fell. Yet at Bangkok's Bumrungrad hospital, chief executive Curtis Schroeder says that now, as spending on private health care shows signs of recovery from recession, interest in psychiatric care is once again dropping. "There were always expectations that the market could be big, but the reality has proven to be less because of the stigma," says Steve Drew, GlaxoSmithKline's managing director for Indochina. "Companies like ours and Lilly are still struggling to understand it." Starting in the late 1980s, the companies' first job was to assess the prevalence of depression on the continent. Lilly researchers began to interview medical-opinion leaders in Korea and Taiwan and encountered some astonishing results. According to many doctors, there was no mental depression in Asia at all. "It was just fascinating," says William V. Lawson, Lilly's manager of global market research. "It showed that depression just didn't exist there."
[Fred A. Baughman Jr., MD:
Not believing US psychiatrys
inflated, market-friendly view of depression and all mental conditions
as diseases when they are not--seeing them instead, for what they
are, symptoms of lifes ups and downs, coming and going with lifes ups
and downs]
But further examination showed that many of these patients, while showing up complaining of headaches and stomachaches, were depressed. "The incidence of depression really is the same as in the U.S.," says Bangkok psychiatrist Nipatt Karnjanathanalers. "But here, people present (it) with somatic complaints like pain or lack of sexual response. Some even hyperventilate, or their hands and arms become paralyzed, because they can't express their feelings." To grapple with this deep-rooted denial, Western companies launched educational efforts. Lilly has funded a program by psychiatrists and researchers training Asian doctors in the classical definitions of depression and schizophrenia
[Fred A. Baughman Jr., MD:
meaning, no doubt that they are brain
diseases, chemical imbalances, each with a chemical balancer, a pill,
for those believing, for those properly educated.]
, and their varying forms in different societies. Johnson & Johnson, which sells the schizophrenia drug Risperdal, brought officials from U.S. schizophrenia advocacy groups to meet Asian families with schizophrenic relatives. J&J has run seminars in Thailand, arranging for psychiatrists to teach families about schizophrenia, but many who could benefit stay away. "Thai people think a spirit has possessed the patients, and most of the people feel shame," says Somgiat Mahapun, Thailand managing director for J&J's Janssen drug unit. That being the case, small wonder that monks, shamans and fortune-tellers sometimes substitute for psychiatrists in the lives of some Thais. On a back street of this capital, in a room dimly lit by candles, a shaman chants to summon ancient spirits. Making barking noises, she whips a sword around in swooping circles and smacks herself on the back with it. The shaman, Kaek Dabsomdej, believes she is inhabited by spirits of ancient Buddhist hermits. Patients with mental problems and physical illnesses often seek her help in seance-like sessions. Her billing rate is $2 per visit -- or $1.25 plus a pack of cigarettes. "I don't smoke," she says in the deep voice of one of the hermit spirits. "But the other hermits do." Ms. Kaek boasts as many patients as any psychiatrist, dispensing advice along the lines of "Bathe three times with holy water on the day of the week you were born." "I recommend this holy water and it cures the patients," she explains. "We soothe by words, we show people the way, and they get better." In Thailand, Eli Lilly and the Thai government have made efforts to appeal directly to alternative healers to have them refer patients with serious mental illnesses for treatment. The Thai health ministry last fall held a daylong seminar to teach fortune-tellers -- nearly every village in the country has one -- how to recognize depression. Western companies also try to reach the mentally ill by working with Asian psychiatrists. At one recent World Psychiatric Congress in Beijing, Lilly and other companies gave out scientific-magazine subscriptions to many of the 700 psychiatrists attending. They began sending Asian doctors to psychiatric meetings. Lilly funds a regular seminar at Australia's University of Melbourne, where more than 50 Asian psychiatrists at a time gather for postgraduate training. Taking another tack, Lilly has retained Bangkok's Dr. Nipatt as a paid consultant. Under Lilly's auspices, he gives about 20 talks a year to medical groups in East Asia. One recent day, Dr. Nipatt tells 60 medical professionals at Saraburi Hospital, two hours north of Bangkok, that major depression is the leading cause of disability in the world.
[Fred A. Baughman Jr., MD:
Comparing it to bona fide medical
and surgical diseases just as does WHOthe World Heath Organization, to
the liking of the pharmaceutical industry. If you have ever wondered
where epidemics of psychiatric diseases come from, wonder no more.]
The doctor describes the roles of various brain chemicals like serotonin and norepinephrine and describes drugs' side effects
[Fred A. Baughman Jr., MD:
Claims that there are abnormalities of these or other brain
chemicals are fraudulent, but are at the heart of the psychopharm
propaganda campaign. These people, resisting the duplicitous
psychopharm message, are to be seen as more sensible by far than in
enlightened Western countries, particularly the US.]
. "General practitioners are receptive to these ideas, but the people resist," he says. Will his talk make a difference? Saraburi Hospital's chief psychiatrist, Siriritana Sukhawana, says probably not, because most people with depression won't show up at the hospital. Dr. Nipatt realizes as well as anyone just how extensive the Thai belief in alternative healers is: His wife patronizes a fortune-teller. A limitation of companies' efforts to work with psychiatrists is that there aren't enough psychiatrists to influence change. Thailand has about 300 psychiatrists for a nation of 62 million, or five to one million people. The U.S. has about 120 per million -- and New York City, 500 per million.
[Fred A. Baughman Jr., MD:
In the US there are an over-abundance of
psychiatrists, all willing propagandists and pushers thus serving
themselves and their controlling partner, the pharmaceutical industry.]