Pharmageddon (2012)

By David Healy - 30 Q&As - Book Review and Summary

The 1962 amendments to the US Food and Drugs Act, passed in the wake of the thalidomide disaster to protect the public from pharmaceutical harm, are the reason modern medicine is captured. Prescription-only status, mandatory controlled trials, and the requirement that drugs be marketed for specific diseases were each installed as safeguards. Each became indispensable to the industry the safeguards were meant to constrain. Prescription-only status made a small group of untrained consumers, doctors, the target of the most concentrated marketing on the planet. Controlled trials, designed to weed out useless treatments, became the primary tool for making useless treatments look essential. The requirement to market for diseases meant companies started marketing diseases. This is the argument at the center of Pharmageddon, published by David Healy in 2012 through the University of California Press. What almost every other critic of the pharmaceutical industry misses, Healy demonstrates through case after documented case, is that the machinery of exploitation was installed by the reformers themselves.

Healy is a practicing psychiatrist who has served as an expert witness in drug injury cases for over fifteen years and has published extensively on the history of psychopharmacology, including Let Them Eat Prozac and The Antidepressant Era. He has direct experience treating patients caught in the machinery he describes: Cora, the young woman with textbook catatonia misdiagnosed as schizophrenia elsewhere and given antipsychotics that made her worse before she laid her neck on a railway track; Sheila, whose two decades of recovery were destroyed by hospital-mandated statins and SSRIs that her primary care doctor would not countermand; Bill, whose hacking cough from an ACE inhibitor and weakness from a statin were both prescribed by guideline after a stroke. Healy was the person who made public the internal GlaxoSmithKline document showing the company had known in 1998 that Paxil failed in depressed children and had decided to publish only the good bits. That document reached the New York Attorney General’s office and became the basis of the successful fraud action against GSK. He was blocked from consulting on the British NICE antidepressant guidelines on the grounds that he was too critical of the pharmaceutical industry, while pharmaceutical companies themselves were happy to invite him to their consensus conferences. The asymmetry is documented in the book.

The book appeared eight years after the FDA finally issued black-box warnings on pediatric antidepressants following the deaths of children like Candace Downing and the testimony of mothers like Mary Ellen Winter. Vioxx had been withdrawn in 2004 after Merck’s own trial data pointed to tens of thousands of avoidable heart attacks. Steve Nissen’s 2007 meta-analysis on Avandia had triggered a Senate investigation that would issue a damning report on GlaxoSmithKline’s concealment. The 2009 Supreme Court decision in Wyeth v. Levine had, for the moment, blocked the preemption doctrine that pharmaceutical companies had used to make failure-to-warn lawsuits impossible. Against this background, most published critiques settled on the same diagnosis: rotten apples in the barrel, undisclosed conflicts of interest, a few too many free lunches. Senator Chuck Grassley’s Sunshine Act proposed disclosure as the solution. Pharmageddon was published to argue that the diagnosis was wrong. Every reform aimed at the industry, Healy shows, has reinforced the very structures the industry depends on. Ban ghostwriting and ghostwriters comply with disclosure rules better than academics do. Require conflict of interest declarations and companies happily comply while raw trial data remain sequestered. This is why the industry welcomes the attacks. Muhammad Ali-like, they settle back on the ropes.

Pharmageddon stands alongside Whitaker’s Anatomy of an Epidemic, Gøtzsche’s Deadly Medicines and Organised Crime, and Moncrieff’s work on psychiatric medication as convergent witness testimony from establishment-credentialed practitioners whose findings converge on conclusions the establishment cannot afford to accept. The full summary works through the mechanics: how Lilly’s Zyprexa patent was granted in 1991 on the basis of a single dog study showing lower cholesterol, for a drug that turned out to be one of the greatest cholesterol-raising agents in medicine and cost the company over two billion dollars in settlements for the diabetes it caused; how Sally Laden of Scientific Therapeutics Information transformed a failed pediatric Paxil trial in which children became suicidal at over triple the placebo rate into a published landmark endorsing the drug as safe and effective, an article that remains in print unretracted; how thirteen-year-old Aliah Gleason ticked a suicidality box on a school psychological screening in Pflugerville, Texas, in 2004, was removed from her family within hours, and spent nine months in Austin State Hospital on cocktails of up to five medications mandated by the industry-funded Texas Medication Algorithm Project. The document is publicly available. The signatures are on it. The dog study is on it. The date is 1991. Whatever word you choose for that, the document exists and says what it says.

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