Thursday, April 20, 2006

Calming Our Nerves Chemically

I know I’m not the only person around that wonders why there has been an astronomical jump in the prescription of psychotropic drugs over the past several decades. I remember as a kid hearing about people taking tranquilizers—you know, better living through legal chemicals—but the number of people on drugs for psychological conditions has skyrocketed since then (see Wash Post article). I remember people talking about stress and anxiety when I was young, but over the past 30 years the American Psychiatric Association (APA) has formally acknowledged an immense cadre of previously unknown psychological disorders.

I have to be careful about how I say this, but a friend of mine that is in a position to know informed me that there are a fair number (he/she quoted a specific range that stunned me) of adults in my very neighborhood that regularly take Prozac or some other mood altering drug. This person says that from his/her interactions with these people, the overall results are not good. Their low points dissipate, but so do their high points. Nothing’s good and nothing’s bad—it just is. They forget how to feel much emotionally.

Then we get to the politically sticky issue of schools and doctors pressuring parents to put their kids (especially boys—see Newsweek article) on psychiatric drugs. Although pediatric prescriptions of these drugs experienced a dramatic drop recently due to concerns about depression and suicide (see Wash Post article), the rate is still drastically higher than it was a few decades ago.

And don’t give me the tripe that parents are not pressured. Pressure was applied to us when our oldest son was in elementary school, but despite the school’s best efforts, he was never successfully diagnosed with ADD or ADHD. Why do kids today have to be drugged up when the previous generation survived without these drugs? What is it about kids (especially boys) today that makes them so much more difficult for schools to handle than they were 30 years ago? (I don’t wish to be insensitive to those that are using these drugs. I know people that swear that Ritalin saved their children’s education.)

Eventually some people started wondering some of the same things I have been wondering. Where have all of these new psychiatric conditions come from? Why have prescriptions of psychiatric drugs skyrocketed? Some people asked so many questions that they decided to study the issue. Lisa Cosgrove of the University of Massachusetts in Boston has found that there are some very shady financial ties between psychiatric experts that develop new psychological diagnoses and drug companies that develop drugs to treat those maladies (see Wash Post article).

Among other findings, Cosgrove and her colleagues found that “100 percent of the experts who served on work groups on mood disorders and psychotic disorders” had “egregious financial ties” with psychiatric drug companies. Some in the psychology field say that this “should not undermine public confidence in the conclusions of its experts.” Oh, really? Even the president of the APA expressed concerns last year that if psychologists “are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised.”

To be fair, some psychologists have called Cosgrove’s study “very flawed.” Of course, these same critics have been beneficiaries of drug company money. Sheldon Krimsky who helped author the study retorts that the criticisms do not reduce the ethical concerns raised by the study. The APA says that it has already implemented plans to require more transparency in the future, but some question whether these efforts are sufficient to protect the public.

Drug companies have a right (perhaps even a responsibility) to do research and development to improve the lot of mankind as well as to improve their profits. They require medical professionals to do much of that R&D. We expect doctors to have altruistic motives, although; many doctors see their Hippocratic Oath as quite irrelevant (see here). We expect doctors to “do no harm,” but many of them see this as no more noble a virtue than making a buck. Some insurance companies and health care companies have practices that don't help matters much either.

Since we cannot trust drug companies or medical professionals to always do what is best for patients, we must require full disclosure and full transparency. And let’s be skeptical the next time somebody shouts, “Eureka! I’ve discovered a new psychological disorder.” Especially if they have also discovered a drug to treat it.


That One Guy said...

AMEN to your last paragraph, Reach. You also note that you wonder how WE ever survived our elementary education years... how did we do that? Are our educational professionals looking for an easy out where behavioral issues are concerned? Are we as parents not doing what we need to be doing? Could these issues be remedied with better parently and more successful behavior monitoring and modification on our parts? I have 8 kids, none of whom have ever been on behavior drugs, to the dismay of some teachers, in a couple of the children's cases... I think the question remains, how did this phenomenon develop? I go back to your last paragraph for the likely answer.

Good thoughts man.

That One Guy said...

ie: "better PARENTING"... it would help if I actually READ my stuff before hitting the button...


steve u. said...

Rep. Mike Morely passed legislation in 2005 restricting schools' ability to recommend psychotropic drugs, but unfortunately it was vetoed. In 2006, he ran HB 299, which passed the House but died in the Senate. It is a good bill, and it could use some citizen support.

Anonymous said...

This is a subject that I take very seriously because I am related to a number of people who take (or have taken) these types of prescriptions. In one case, a case of depression was treated with 6 different drugs with almost daily variances in the doseage. This eventually led to a hospitalization. I am convinced that the hospitalzation was coused by the drugs, not the dpression. I also think that the psychiatrist that was prescribing the drigs and changing the doses so often should have his license revoked.

Apart from that specific case, I have often wondered many of the same things from your post. Some of the increase in psychological disorders comes from our increased ability to recognize problems. Some of it also comes, I am convinced, from having a lower tolerance for variation. That's why so many kids are diagnosed with ADD/ADHD today when the problem was nonexistent 30 years ago.
Your suggestions for full disclosure and full transparency are good measures to start combatting this. Another good measure would be to make it illegal for pharmaceutical companies to market to the public. We should not have commercials telling us to "Ask your doctor if {this drug} is right for you." Doctors should make any prescription based on the symptoms of the patient and not based on the symptom that "I heard about a drug on the TV that can help this kind of thing and I began to notice that I had all those symptoms."

Scott Hinrichs said...

David, I think you're right on the money with respect to a lower tolerance for variation. I think we used to accept some types of idiosyncrasies more than we do today. (But today we accept a lot of abnormality as OK.) We now look at these common variations as failures in our systems: schools, parenting, child welfare services, etc., but especially failings within our government systems.

Our government systems wield so much power that the idea that a system might require changes seems far-fetched. The opposite seems to be true: the people being served require changing. Was the institution made for the people or the people for the institution? Since we revere the institutions above the people, we medicate people to make them fit into what the system defines as the norm.

Psychiatry today assumes a biological base for all psychological conditions. Hence, the answer is always chemicals. If the only tool you have is a hammer, everything looks like a nail. We push (legal) drugs as the answer to everything, and then we wonder why so many people are hooked on drugs (legal or otherwise).

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