Sunday, May 2, 2010
Image by ice.bluess via FlickrAre we drugging ourselves into disability?
Levine: So mental illness disability rates have doubled since 1987 and increased six-fold since 1955. And at the same time, psychiatric drug use greatly increased in the 1950s and 1960s, then skyrocketed after 1988 when Prozac hit the market, so now antidepressant and antipsychotic drugs alone gross more than $25 billion annually in the U.S. But as you know, correlation isn’t causation. What makes you feel that the increase in psychiatric drug use is a big part of the reason for the increase in mental illness?
Whitaker: The rise in the disability rate due to mental illness is simply the starting point for the book. The disability numbers don’t prove anything, but, given that this astonishing increase has occurred in lockstep with our society’s increased use of psychiatric medications, the numbers do raise an obvious question. Could our drug-based paradigm of care, for some unforeseen reason, be fueling the increase in disability rates? And in order to investigate that question, you need to look at two things. First, do psychiatric medications alter the long-term course of mental disorders for the better, or for the worse? Do they increase the likelihood that a person will be able to function well over the long-term, or do they increase the likelihood that a person will end up on disability? Second, is it possible that a person with a mild disorder may have a bad reaction to an initial drug, and that puts the person onto a path that can lead to long-term disability. For instance, a person with a mild bout of depression may have a manic reaction to an antidepressant, and then is diagnosed with bipolar disorder and put on a cocktail of medications. Does that happen with any frequency? Could that be an iatrogenic [physician-caused illness] pathway that is helping to fuel the increase in the disability rates?
So that’s the starting point for the book. What I then did was look at what the scientific literature -- a literature that now extends over 50 years -- has to say about those questions. And the literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness. In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug-- say have a manic episode after taking an antidepressant -- and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic pathway that is helping to fuel the increase in the disability numbers.
Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature -- and this really is a tragic story -- clearly shows that our drug-based paradigm of care is a primary cause.
Levine: I have a clinical practice and I have seen several examples of what you are talking about, and I had previously read several of the scientific studies that you detail in Anatomy of an Epidemic, so I am not exactly a naïve reader. However, in reading your book and seeing the enormity of the problem and just how much overwhelming evidence there is for a horrible crisis, I started getting a little sick to my stomach. I wonder, as you got into the research, did you start drawing comparisons to Rachel Carson and Silent Spring? Specifically, this is such a huge unnecessary tragedy, affecting several million people including children, yet there is virtually no discussion of it in the mass media.
Whitaker: A journalist friend of mine, who was a long-time reporter at the Washington Post and Newsday, said that he too was reminded of Silent Spring when he read Anatomy of an Epidemic. And, in fact, I was stunned by much of what I found when I was researching the book, and I did at times become overwhelmed by the magnitude of the tragedy. Let me give a specific example. When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children. But once psychiatrists started putting “hyperactive” children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants. Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature. And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up “rapid cyclers,” which means they have severe “bipolar” symptoms, and that they can now be expected to be chronically ill throughout their lives. We also know that the atypical antipsychotics [such as Risperdal and Zyprexa] prescribed to bipolar children cause a host of physical problems, and there is pretty good evidence that they cause cognitive decline over the long term. When you add up all this information, you end up documenting a story of how the lives of hundreds of thousands of children in the United States have been destroyed in this way. In fact, I think that the number of children and teenagers that have ended up “bipolar” after being treated with a stimulant or an antidepressant is now well over one million. This is a story of harm done on an unimaginable scale.
So why hasn’t the media reported on this? The answer is that the media, when it covers medicine, basically repeats the narrative fashioned by the academic doctors who are leaders in the particular discipline, and in this case, academic psychiatrists have told a story of new illnesses -- like juvenile bipolar illness -- being “discovered,” and of drugs for those treatments that are safe, effective and necessary. They tell this story to the public even as their own studies find that their juvenile bipolar patients -- who when they first came to a psychiatrist might simply have been “hyperactive” or struggling with a momentary bout of depression -- are ending up with severe bipolar symptoms and can now expect to be chronically ill for life. The problem is that our society trusts academic doctors to tell an honest story, and in this corner of medicine, it's quite easy to document -- and I did document this in Anatomy of an Epidemic -- that academic psychiatry has belied that trust.
Image via Wikipedia
. . . Disturbing evidence that honeybees are in terminal decline has emerged from the United States where, for the fourth year in a row, more than a third of colonies have failed to survive the winter.UPDATE: The Oregonian runs a story on this with a little new stuff about OSU response.
The decline of the country's estimated 2.4 million beehives began in 2006, when a phenomenon dubbed colony collapse disorder (CCD) led to the disappearance of hundreds of thousands of colonies. Since then more than three million colonies in the US and billions of honeybees worldwide have died and scientists are no nearer to knowing what is causing the catastrophic fall in numbers.
The number of managed honeybee colonies in the US fell by 33.8% last winter, according to the annual survey by the Apiary Inspectors of America and the US government's Agricultural Research Service (ARS).
The collapse in the global honeybee population is a major threat to crops. It is estimated that a third of everything we eat depends upon honeybee pollination, which means that bees contribute some £26bn to the global economy.
Potential causes range from parasites, such as the bloodsucking varroa mite, to viral and bacterial infections, pesticides and poor nutrition stemming from intensive farming methods. The disappearance of so many colonies has also been dubbed "Mary Celeste syndrome" due to the absence of dead bees in many of the empty hives.
US scientists have found 121 different pesticides in samples of bees, wax and pollen, lending credence to the notion that pesticides are a key problem. "We believe that some subtle interactions between nutrition, pesticide exposure and other stressors are converging to kill colonies," said Jeffery Pettis, of the ARS's bee research laboratory.
A global review of honeybee deaths by the World Organisation for Animal Health (OIE) reported last week that there was no one single cause, but pointed the finger at the "irresponsible use" of pesticides that may damage bee health and make them more susceptible to diseases. Bernard Vallat, the OIE's director-general, warned: "Bees contribute to global food security, and their extinction would represent a terrible biological disaster."
Dave Hackenberg of Hackenberg Apiaries, the Pennsylvania-based commercial beekeeper who first raised the alarm about CCD, said that last year had been the worst yet for bee losses, with 62% of his 2,600 hives dying between May 2009 and April 2010. "It's getting worse," he said. "The AIA survey doesn't give you the full picture because it is only measuring losses through the winter. In the summer the bees are exposed to lots of pesticides. Farmers mix them together and no one has any idea what the effects might be."
Pettis agreed that losses in some commercial operations are running at 50% or greater. "Continued losses of this magnitude are not economically sustainable for commercial beekeepers," he said, adding that a solution may be years away. "Look at AIDS, they have billions in research dollars and a causative agent and still no cure. Research takes time and beehives are complex organisms." . . .
WHY BEES MATTER
Flowering plants require insects for pollination. The most effective is the honeybee, which pollinates 90 commercial crops worldwide. As well as most fruits and vegetables – including apples, oranges, strawberries, onions and carrots – they pollinate nuts, sunflowers and oil-seed rape. Coffee, soya beans, clovers – like alfafa, which is used for cattle feed – and even cotton are all dependent on honeybee pollination to increase yields.
Researchers have discovered that a unique strain of the bug has emerged recently in Oregon and already spread widely there, sickening humans and animals.
So far, over the past 11 years there have been about 220 cases reported in British Columbia. Since 2004, doctors in Washington and Oregon have reported about 50 cases. Among the total 270 cases, 40 people have died from overwhelming infections of the lungs and brain.
Public health officials aren't calling it a public health emergency. The fungus can't be spread from person to person, and there doesn't seem to be any prospect of an explosive epidemic. But they do want doctors to be on the lookout for cases, because early diagnosis and proper treatment is vital to prevent deaths.
The most striking thing about this fungus is that it's popping up and establishing itself far afield from its usual range — possibly because of climate change.
"The disease was almost exclusively seen in tropical and subtropical areas of the world," says Dr. Julie Harris, a specialist in fungal diseases at the Centers for Disease Control and Prevention. The hot spots were Australia and Papua New Guinea, along with Egypt and parts of South America. . . .
(The map shows human and animal cases of Cryptococcus gattii infection from 2005 to 2009.)