When a loved one dies is your grief a “psychiatric condition” requiring medication? Why is a vial of insulin, once produced for five dollars, now $300? Is the Alzheimer’s amyloid model accurate in light of weak correlations to actual improved cognition—and new treatments so expensive they threaten to raise Medicare premiums? And finally, does early cancer detection have concerning drawbacks?
These volatile questions characterized the 9th conference of PharmedOut, a Georgetown University Medical Center project, held in June.
Created by a two-year grant from Pfizer’s 2004 off-label neurontin settlement—its Warner-Lambert unit pleaded guilty to off-label marketing—PharmedOut’s focus is to educate healthcare professionals about pharmaceutical marketing practices.
June’s conference was funded by conference fees, individual donations and a contribution from Kaiser Permanente. The deans of the Georgetown medical and graduate schools provided support for student registrations and a competitive global engagement grant paid for bringing in foreign speakers, Adriane Fugh-Berman, MD, director of PharmedOut told me. Dr. Fugh-Berman is a professor in Georgetown’s departments of pharmacology, physiology and family medicine.
The conference, attended by nearly 150 physicians, researchers, scientists, healthcare professionals, lawyers and government officials, was titled, “Making Healthy People Sick; Invented Diseases & Overtreatment.”
Psychiatric Diagnoses
“You’re not sick, you are just in love.” So started a presentation by Yulia Chentsova Dutton, PhD, associate professor of psychology at Georgetown University, exploring “cultural scripts of distress and their psychological implications.”
Making sense of complex health symptoms can be overwhelming and people look to their “cultural environment” for answers said Dutton. Because lacking a “story” or explanation for psychiatric symptoms is unnerving, people actual feel “comforted” when they receive a diagnosis. An expert on the panel added that parents can also welcome a psychiatric diagnosis to make sense of their child’s behavior or symptoms.
One young participant who spoke to me after the presentation but did not give her name, said that TikTok overflows with pro-psychiatric disease messaging conferring a sense of illness “belonging” to users.
Are Diseases Really “Invented”?
Few doctors, researchers and lawyers who spoke at the conference said diseases were “invented” but many said disease criteria are being expanded through diagnostic “creep.” For example, Gretchen LeFever Watson, PhD, author of “Your Patient Safety Survival Guide,” and an early critic of the overprescribing of ADHD drugs, pointed out that an ADHD diagnosis, lacking a simple test, generally begins with a visit to a general practitioner, followed by a psychiatric appointment and diagnosis and one or more prescriptions.
“Educational outcomes” for school children using ADHD drugs are not improved by the drugs said Watson and when activists in Virginia lowered the diagnosis in children by 32%, there was a 70% reduction in “discipline referrals.” Watson added that when withdrawal symptoms occur as children discontinue psychiatric medications they can be cast as a return of the illness.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by US mental health professionals and changes and new entries affect the entire mental health landscape. According to Lisa Cosgrove, PhD, a clinical psychologist and professor at the University of the University of Massachusetts and presenter at the conference, grief—such as the loss of a loved one— has appeared in the DSM as “prolonged grief disorder” and a suggested treatment is the opioid antagonist naltrexone, known to lessen social connection further.
Early Treatment of Cancer
Early screening and treatment of cancer was another topic addressed at the conference. Laurence Klotz, MD, former chief of urology at Sunnybrook Health Sciences Centre and former president of the Urologic Research Society, cautioned that early diagnosis, especially of prostate cancer, may appear to represent better survival rates but some cancers, especially indolent ones, may not be clinically significant and “active surveillance” is the preferred treatment.
Patients, afraid of a cancer diagnosis, drive the early treatment trend because they believe they have been “saved” and share their experiences online and with friends. But, pointed out Dr. Klotz, clinically insignificant cancers are so common that 70% of 70-year-olds have some form of prostate cancer.
Peter Whitehouse, MD, a professor of medicine at the University of Toronto who previously held key positions at Case Western Reserve University, noted similar clinically insignificant cases with amyloid deposits in a later presentation at the conference. He referred to an autopsy study of nuns at a Jesuit university that found 40 percent had amyloid deposits yet none had symptomalogy.
Wayne Gao, PhD, associate professor at Taipei University in Taiwan, also addressed early screening. While lung cancer screening has increased, many with the condition do not die from it he told conference participants. Moreover, the very term “lung cancer market” implies there are financial factors behind the rising rates of screening he observed. Interestingly, Gao added that the reason it can appear that lung cancers in non-smokers are becoming more common, is that so many smokers have quit the habit.
Questions About Popular Drugs
Many remember that Lipitor, which led the statin craze in past years, was the best-selling drug of all times. But Paula Byrne, PhD, a researcher at the National University of Ireland whose PhD focused on the use of statins for primary prevention of cardiovascular disease, shared her reservations. First, she noted that patients think statins prevent cardiovascular events which they don’t and secondly, she noted that before statins, high cholesterol was considered a symptom and not a disease unto itself. Perhaps another example of the “creep” cited at the conference.
Colleen Fuller, a Canadian health policy researcher who spoke at the conference, addressed insulin, used by over seven million Americans. According to Fuller, recombinant (synthetic) insulin was introduced in the 1970s because of an apparent shortage of animal pancreatic glands from which insulin had been derived. Not only did insulin “clear the path for biotechnology,” according to Fuller, its price did not go down despite the greater and more reliable supply. According to fuller a vial of insulin used to cost five dollars to produce and a vial now costs consumers $300.
More Standard Treatments Questioned
While the amyloid theory of Alzheimer’s disease has prevailed for decades, Susan Molchan, MD, a former program director of the Alzheimer’s Disease, Clinical Trials, Biomarkers, and Neuroimaging at the National Institute on Aging, who also served as an attending psychiatrist at Walter Reed National Military Medical Center and a clinical officer at the FDA, said she has her doubts.
Because removal of the amyloid plaques does not result in improved cognition, Dr Molchan said the theory has in some respects “distracted” Alzheimer’s research. She said the deficiency of the acetylcholine should be further studied and that the notorious loss of brain volume seen with the disease may be due to drugs that have been given and not the condition itself.
Dr. Whitehouse, MD, also addressed current dementia models. For example, he joked that the currently popular diagnosis of “mild cognitive impairment” (MCI) is an example of “semantic ataxia”—if MCI is pre-Alzheimer’s, is “pre-MCI” around the corner—and said that the Alzheimer’s Association once a local group, has become “one of the greatest travesties that have affected our field” because of its “moral corruption,” apparently through industry ties.
More Questions Raised
The PharmedOut Georgetown conference concluded with thought-provoking presentations about hormones—Viagra and “Low T” marketing (“Ups and Downs of Men’s Health”) presented by Barbara Mintzes, PhD of the University of Sydney and Joel Lexchin, MD of York University and menopause medication.
The latter, called the “Resurrection of Drugs for Menopause,” was presented by Dr. Fugh-Berman, director of PharmedOut and Tony Scialli, MD of George Washington University School of Medicine. While Dr. Fugh-Berman has exposed the problematic marketing tactics of “hormone replacement therapy” which led to its previous popularity through her extensive publishing, the speakers predicted a revival of menopause as a “disease” to be treated with medication.
