Book Review: Peddling Psychiatry

Peddling Mental Disorder: The Crisis in Modern Psychiatry

Lawrie Reznek, a psychiatrist formerly at Sunnybrook Hospital in Toronto and now in private practice, presents a troubled view of the current state of psychiatry, the infrastructure that supports it and in particular documents the power of pharmaceutical companies in their relentless push to make profits from psychiatric drugs, particularly anti-depressants.

Who is to blame for this situation? You’ll need to read the book to make your own conclusions. Mine is that psychiatrists, governments, pharmaceutical companies and both you and I share the blame.

Peddling-book-coverReznek makes the startling conclusion that modern psychiatry is often no better than quackery because psychiatrists claim to have identified real mental disorders when in fact they have only invented them. The scientific method prized by the medical profession is often on very unsound and unscientific grounds and this is all worsened by pharmaceutical company marketing, the role it plays in regulating drugs and the funding of psychiatric journals and continuing medical education.

Reznek states, “A plethora of disorders have been “discovered”, and an army of epidemiologists tell us that these are widespread. We are being informed that countless lives are being blighted by these disorders, and that we have a responsibility to communicate this to the public, seek such patients out, and give them all the needed treatments. As I will argue, all of this is a lie- “a false or idle tale told to deceive {and} cheat.

Reznek argues we are in an era of “disease mongering” which consists of convincing well people they are ill. In the span of some 130 years there has been an 8,000 percent increase in the number of mental disorders recognized.

Reznek prevents compelling evidence pharmaceutical companies have a pervasive influence on prescribing habits by physicians. Pharmaceutical companies spend a whopping $22 billion a year on marketing drugs directly to physicians and $60 billion in marketing.

Pharmaceutical companies are also well represented in influencing the guidelines of medical self regulatory organizations. It spends vast sums of money presenting its clinical trials and advertising in medical journals and its paid representatives are heavily involved in regulatory agencies that approve the selling of drugs. In 2002 pharmaceutical companies in the United States funded 90% of drug research therefore controlling what gets researched.

Pharmaceutical companies also appear to be cherry picking data from its studies. Reznek states, “There is evidence that pharmaceutical companies deliberately restrict access to information about their drugs from treating psychiatrists (and the public). This is alarming because scientific medicine cannot be practiced on the basis of cherry picked data. The ugly truth is that pharmaceutical companies have been reluctant to publish their negative studies showing that drugs don’t work, or publish studies showing their drugs have serious side effects. This cherry picking of the data made available to practicing physicians undermines medicine as an evidence based and scientific discipline.”

Increased funding for continuing medical education is coming from pharmaceutical companies influencing the discussion of the latest drugs being produced. Research has demonstrated prescribing habits rise for a drug after a continuing medical education (“CME”) session promoting that drug. Pharmaceutical companies pay key opinion leaders in the medical community give “educational sessions” on the latest drugs.

As a last jab to pharmaceutical companies Reznek questions the validity of their clinical studies suggesting they can be easily manipulated as in essence they are not truly scientifically structured.

In 1980 DSM-III (“Diagnostic and Statistical Model”) was issued by the American Psychiatric Association (“APA”) which defined numerous psychiatric diseases. Reznek points out DSM- III tremendously expanded the category of mental illnesses to the extent it allowed the medicalization of ordinary problems by allowing psychiatrists to define a new disorder into existence by simply producing a list of undesirable behaviours. DSM-III described existing disorders defined by symptoms that could be easily broadened as to allow more and more people to qualify for that diagnosis.

Reznek’s take on DSM-III is that, “We are lured into a crude medical model, obscuring the fact that the distress reflects understanding the problems and not some disease entity. Only if we step aside from the classification and try to see why this patient developed these symptoms, only if we examine the patient’s narrative, will we have a better chance of both understanding and helping our patients.

Reznek argues this easy classification tool in DSM-III basically downplays the painstakingly learnt skill of clinical diagnosis. There is a focus on symptoms rather than signs which is a mistake as psychiatric symptom can often appear in patients when there is no disorder. And the more the symptoms then the more the medications can flow to the delight of pharmaceutical companies.

As a last windfall to pharmaceutical companies DSM -V is now in place and it has eliminated “Criterion E” which excluded ordinary grief from being a mental disorder. On this point Reznek says “In a stroke, it has turned ordinary grief into a major depressive disorder, and to the delight of the pharmaceutical industry, has increased the lifetime of major depression to close to 100%.” Reznek notes that 8 of the 11 members of the DSM-5 Mood Disorders Work Group had (at times) ties to pharmaceutical companies.

So some of psychiatry and big Pharma are not very good for patients!

What does Reznek recommend to overcome this problem?

  1. All those involved in the DSM classification manual issued by the American Psychiatric Association should act free of any conflict of interest particularly not having any ties to pharmaceutical companies.
  2. More education is needed particularly for residents with an emphasis on the pitfalls of the DSM classification method.
  3. Changes to legislation are required to compel drug companies seeking approval to license their new drugs that such a new drug is shown to be superior to existing treatments not simply to placebos. Furthermore, drug company studies should not be to cherry picked to focus on positive effects All results must be made public.
  4. Government funding for regulatory bodies should be increased and that by pharmaceutical companies be decreased. It is in the interests of governments to keep costs under control in the health field.
  5. Direct to consumer advertising should be prohibited to relieve the pressure on physicians to prescribe the latest drugs.
  6. There should be a threshold on amounts paid by pharmaceutical companies to physicians and such amounts must be reported.
  7. Cash gifts by pharmaceutical companies to physicians should be made illegal.
  8. In order to reward drug companies for creating effective new drugs the patent life for such drugs should be increased.
  9. It should be illegal for practicing physicians to act as consultants for drug companies. To go on paid speaking tours for drugs, to accept payment to do drug studies and to accept money for undergraduate and continuing education. According governmental bodies must pony up more money for drug testing.
  10. Reliance on DSM lists of symptoms should be replaced by more clinical evaluation.

In conclusion Reznek says, “To climb off the tiger, we need a sufficiently large incentive to do so. It has been financial incentives that have kept psychiatry on in the first place, and so it will take financial incentives to get psychiatry off. Very soon, health care in the developed world will be unaffordable. Health care costs are on the rise, and are ballooning out of control. Nations will go massively into debt. Economies will collapse. This is happening in no small measure because pharmaceutical companies are being allowed to make billions of dollars annually for drugs that do not work, or when they do, don’t work better than cheaper alternatives.

Reznek starts his book by advising us that many of our answers can be found by “following the money.”

(Peddling Mental Disorder, The Crisis in Modern Psychiatry, Lawrie Reznik, McFarlan & Company Inc, Jefferson, NC, 2016)

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About the Author

Robert Stephen (CSW)
Robert K Stephen writes about food and drink, travel, and lifestyle issues. He is one of the few non-national writers to be certified as a wine specialist by the Society of Wine Educators, in Washington, DC. Robert was the first associate member of the Wine Writers’ Circle of Canada. He also holds a Mindfulness Certification from the University of Leiden. Be it Spanish cured meat, dried fruit, BBQ, or recycled bamboo place mats, Robert endeavours to escape the mundane, which is why he loves The Square. His motto is, "Have Story, Will Write." Email Robert Stephen