Markets and the Mental Illness Epidemic

This isn’t really on topic for our blog, but a recent article in the New York Review of Books by Harvard Medical School faculty member Marcia Angell raises some serious questions about how the pharmaceutical industry goes about its business.

As you may know, the reported incidence of mental illness has skyrocketed in the US in recent decades:

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

Angell reviews several books that strongly suggest that this epidemic has been brought on by the pharmaceutical industry and their regulators.  For example, one book apparently makes the case that many types of mental illness have been defined based upon the symptoms that psychoactive drugs treat, rather than any underlying cause for the disease:

For example, because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine. Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As [author of one of the books, Daniel] Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.

The books being reviewed argue that these drugs are actually completely ineffective against mental illnesses.  Some argue that, by unnecessarily disrupting brain chemistry, these drugs have actually worsened people’s conditions dramatically.  This is all driven by pharmaceutical companies trying to find uses for drugs that they developed for other reasons.  Very disturbing stuff.

You can read Angell’s review here.

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