Lancet: Atypical Antipsychotics--Who "Beguiled" Doctors?

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Jan 10, 2009, 1:42:19 PM1/10/09
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The current issue of The Lancet, includes a meta-analysis comparing the efficacy of old and new neuroleptics--a.k.a. first generation antipsychotics and 'atypical' second generation antipsychotics. The findings corroborate the fact that the new drugs are no better than the old antipsychotics.

A Commentary in the same issue, "The Spurious Advance of Antipsychotic Drug Therapy," by Dr. Peter Tyrer, professor of community psychiatry, Imperial College, London, and Tim Kendal, MD, co-director of the Royal College of Psychiatrists' national collaborating centre for mental health, leads one to conclude that doctors have been 'conned' by drug manufacturers:

"The new generation of drugs, known as atypicals, were heralded as safer and more effective than the earlier antipsychotics, and for the past 20 years doctors have been bbeguiledb into thinking they were superior."

bThe spurious invention of the atypicals can now be regarded as invention only, cleverly manipulated by the drug industry for marketing purposes and only now being exposed.b (Source: Lancet, 2009; 373: 4-5; 31-41).

We would beg to disagree: given the active (duplicitous) role of prominent academic psychiatrists, as well the major professional associations in psychiatrybthe American Psychiatric Association, the American College of Neuropsychopharmacology, the American Academy of Child and Adolescent Psychiatry, et albin promoting the second generation antipsychotics, it is unfair to lay blame entirely on the pharmaceutical industry.

Prominent academic-based psychiatrists--or as industry refers to them, key opinion leaders (KOLs)--who were paid by industry are listed as principle investigators of clinical trials testing antipsychotics; they penned their name to dozens--if not hundreds--of published reports in the major medical and /or psychiatry journals claiming "positive" findings ("well tolerated" "effective" "no adverse effects"); they extolled the high efficacy of 'atypical' antipsychotics--without scientific evidence to back up such judgments. Thus, they deserve equal blame for bdupingb clinicians who trusted their reports and treatment recommendations.

Below, an OpEd piece by clinical psychologist, Jacob Azzerad, "How many more Rebecca Rileys?" is a sobering reminder who the victims of psychiatry's "promiscuous prescribing promoters" are.

Before the collusion between drug manufacturers and psychiatry's highly paid influential leaders, studies in the 1970s and b80s concluded bipolar disorder was rare in children. However, once the partnership between organized psychiatry and drug manufacturers was cemented, between 1994 to 2003, there was an astounding 40-fold increase diagnosing bipolar disorder in children. Why?

The answer: industry needed to expand the market for its ineffective, atypical antipsychotics whose high profit margins were underwritten by taxpayers through Medicaid. Children who have no legal voice of their own were targeted as the next market while the drugs were under patent protection.

Industry-funded psychiatrists, "diagnosed" children as young as two with such unlikely diagnoses as bipolar disorder. In rendering such diagnoses, psychiatrists lent industry a hand in legitimizing "promiscuous prescribing practices"--including the prescribing of untested toxic drug cocktails. Children have become the dumping ground for an arsenal of psychoactive drugs that carry Black Box warning labels about potentially lethal hazardous effects.

The toxic drug effect that killed little Rebecca Riley encapsulates this commercially-driven crime committed by psychiatrists who abuse their prescribing license, disregarding children's welfare. In so doing they are also undermining the integrity of medicine as a healing profession.

Contact: Vera Hassner Sharav
Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis
PD Dr Stefan Leucht MD a Corresponding AuthorEmail Address, Caroline Corves MSc a b, Dieter Arbter MD a, Prof Rolf R Engel PhD b, Chunbo Li MD c d, Prof John M Davis MD e f

Because of the debate about whether second-generation antipsychotic drugs are better than first-generation antipsychotic drugs, we did a meta-analysis of randomised controlled trials to compare the effects of these two types of drugs in patients with schizophrenia.

Methods: We compared nine second-generation antipsychotic drugs with first-generation drugs for overall efficacy (main outcome), positive, negative and depressive symptoms, relapse, quality of life, extrapyramidal side-effects, weight gain, and sedation.

Findings: We included 150 double-blind, mostly short-term, studies, with 21 533 participants. We excluded open studies because they systematically favoured second-generation drugs. Four of these drugs were better than first-generation antipsychotic drugs for overall efficacy, with small to medium effect sizes (amisulpride b0B731 [95% CI b0B744 to b0B719, p<0B70001], clozapine b0B752 [b0B775 to b0B729, p<0B70001], olanzapine b0B728 [b0B738 to b0B718, p<0B70001], and risperidone b0B713 [b0B722 to b0B705, p=0B7002]). The other second-generation drugs were not more efficacious than the first-generation drugs, even for negative symptoms. Therefore efficacy on negative symptoms cannot be a core component of atypicality. Second-generation antipsychotic drugs induced fewer extrapyramidal side-effects than did haloperidol (even at low doses). Only a few have been shown to induce fewer extrapyramidal side-effects than low-potency first-generation antipsychotic drugs. With the exception of aripiprazole and ziprasidone, second-generation antipsychotic drugs induced more weight gain, in various degrees, than did haloperidol but not than low-potency first-generation drugs. The second-generation drugs also differed in their sedating properties. We did not note any consistent effects of moderator variables, such as industry sponsorship, comparator dose, or prophylactic antiparkinsonian medication.

Interpretation: Second-generation antipsychotic drugs differ in many properties and are not a homogeneous class. This meta-analysis provides data for individualised treatment based on efficacy, side-effects, and cost.
Funding: National Institute of Mental Health.
The Lancet, Volume 373, Issue 9657, Pages 4 - 5, 3 January 2009
The spurious advance of antipsychotic drug therapy
Peter Tyrer aEmail Address, Tim Kendall b

Clinicians are familiar with studies that claim to show major advances in therapy. They tend to greet early reports of such advances with a touch of scepticism and wait, usually for at least 10 years, for a raft of independent studies that show that the advance is genuine and not just another minor ripple in the treatment stream. In The Lancet today, Stefan Leucht and colleagues 1 deviate from this pattern by suggesting that what was seen as an advance 20 years agobwhen a new generation of antipsych ...

The Patriot Ledger
How many more Rebecca Rileys?
To diagnose a 2-year-old as bipolar by adult standards is crazy
By Jacob Azerrad
Jan 10, 2009

QUINCY b In a 2007 b60 Minutesb episode, Katie Couric focused on the short life of 4-year-old Rebecca Riley of Hull. Diagnosed with bipolar disorder at age 3, she was dead one year later from an overdose of a psychotropic drug cocktail. At one point, Couric asks Rebeccabs mother, who has been charged with her daughterbs murder, if she thinks her childbs behavior might have been normal. That in fact, maybe little Rebecca was just exhibiting Terrible Twobs behavior.

Couric might well ask mental health professionals: Whatever happened to the Terrible Twobs?

We use a medical model developed by Freud, not a behavioral model, to measure behavior. Freud believed that if a behavior works, itbs healthy, and if it doesnbt, itbs sick. So if a 3-year-old is drawing inside the lines of the coloring book, parents donbt have a thing to worry about, but if he or she is drawing on the wallpaper, the stage is set for a clinical diagnosis.

And therebs a pill to fix it. There are pills for yelling, biting, throwing, kicking, cursing, punching, name-calling and lying. There are pills for whispering in class, for when grandma dies and for bad habits. There are pills for daydreaming.

Therebs a big difference between using medicines to treat genuine mental illness and designing new drugs to medicate perfectly healthy children. Today, as the mental health industry systematically pathologizes more and more childhood behavior, we see a raft of drugs aimed at bcuringb them.

But the medical model of behavior overshot its target. Now itbs treating learned responses as though they were diseases, and almost all human behavior is based on learned responses.

Studies in the 1970s and b80s concluded bipolar disorder was rare in children, but between 1994 to 2003, there was an astounding 40-fold increase diagnosing bipolar disorder in children. Children as young as Rebecca are now given powerful drugs not approved for children.

In Massachusetts alone, from 1988 to 2003, the prescription of stimulants, antidepressants and anti-psychotics given to children rose more than 300 percent, and the number of teenage users is even greater.

From 1993 through the first three months of last year, 1,207 children who were given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old who suffered a fatal stroke 12 days after starting therapy with Risperdal.

A key issue is the misuse of psychiatric diagnostic labels to explain bad behavior in children. This has resulted in the drugging of young children to a degree unprecedented in our history. To diagnose a 2-year-old as bipolar by adult standards is crazy.

The behavior of a 2-year-old is filled with curiosity about everything and anything. The young child has extraordinary ability in terms of emotions and cognitions. They can be very upset very quickly, very angry, very depressed, because their emotions are so fluid, so available. When a guy in the Terrible 50s tries to diagnose the Terrible Twobs on an adult level, that is craziness and dangerous.

By prescribing strong medicines instead of teaching children new choices using proven behavioral methods, we short-circuit a childbs learning process and, even worse, lay the tracks for a lifetime habit of responding to challenge and disappointment with avoidance, denial and chemical dependency.

Growing up is not a condition. Childhood is not a disease. Children act up and defy authority and they need adults to teach them how to manage difficult feelings and handle disappointment appropriately.

There are ways for parents to do this that are quite effective and donbt involve drugs, but they do involve parents being teachers. Our preschool children are far too young to defend themselves. Itbs up to parents to bsay no to drugsb and teach their children that life is meant to be learned and experienced b itbs not just a pill to be swallowed.

Jacob Azerrad, a clinical psychologist in Lexington, is the author of bFrom Difficult to Delightful in Just 30 Days,b published by McGraw-Hill.

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Jan 12, 2009, 12:30:55 AM1/12/09
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