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Guaranteed from the outset: The failed promise of the 'atypical antipsychotics' "Leading Drugs for Psychosis Come Under New Scrutiny," trumpeted a New York Times headline on May 20, 2003. The story, written by Erica Goode, notes the "excitement" with which the "atypical antipsychotics," drugs that were supposed to offer more benefits with fewer side effects than traditional antipsychotics, were greeted (Read article.) "But 14 years after the first of the drugs entered the market," writes Goode, "researchers are questioning whether they are quite as miraculous -- or benign -- as originally advertised."
Who could have foreseen that? Well, Boston Globe journalist Robert Whitaker -- who recently spoke at the May 17 Freedom Forum & Festival, an event timed to coincide with the American Psychiatric Association's Annual Meeting -- for one. Readers of Ragged Edge's print edition may remember my review of Whitaker's Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Cambridge, MA: Perseus, 2002). Mad in America is a book about psychiatric spin, about the public reputations of psychiatric treatments and how they rise and fall. (It's also a good read, and I strongly recommend it.) "A reputation rises from silence to name recognition," I wrote in that review. "Then the hype shifts: this is the hot new thing that does it faster, cleaner, better than its predecessors. The reputation begins to gleam. At its climax it is the hottest, fastest, cleanest, best! Then the slide: the reputation sinks, until finally its shiny surface tarnishes as the side effects emerge into common knowledge. It is eclipsed by the rising reputation of the next new thing. And finally it crashes to earth; and if the treatment is remembered at all it is as a relic of a barbarous past." Erica Goode doesn't seem to have read Mad in America, because her article gives little historical context. And she doesn't seem to have run into too many psychiatric survivors either, because she concludes that "few psychiatrists -- and perhaps even fewer patients -- would want to lose any of the newer generation of antipsychotics now on the market." I wish she had consulted Robert Whitaker. Or Judi Chamberlin or David Oaks or any of the leaders of the psychiatric survivor movement. Covering the story in bits and pieces -- looking at the hot new treatment without considering all the hot new treatments that have come before, covering an unfulfilled promise without considering how all the promises yet to come may fall by the wayside, even asking hard questions about today's treatment without asking the same questions about yesterday's and tomorrow's -- does her readership a disservice. It allows, even encourages, them to be gulled in exactly the same way next month or next year as the last time and the time before that. But the very appearance of Goode's article in the New York Times suggests that we may be seeing the atypical antipsychotics' reputations starting to slide. Now we're hearing that they aren't much better than the older generation of drugs at what they're supposed to do -- at least one researcher, Oxford's Dr. John Geddes, has suggested that they aren't noticeably better at all -- and while they may be less likely to cause tardive dyskinesia, they appear to have other severe and possibly irreversible side effects. And the newer drugs cost more. Much of the cost of producing pharmaceuticals shows up at the start, in the research and development phases. As a result, new drugs are patented, and sold at a high markup -- the large profits then allow drug companies to recover their R&D costs. When other companies are permitted to produce and sell generic versions, drug prices fall dramatically. As a result, Thorazine and Mellaril cost much less than Risperdal and Zyprexa. People struggling to ensure that patients have access to drugs they find helpful are concerned that reports suggesting the newer drugs have no more bang for a lot more bucks will be used to limit access to them. After all, drugs affect different people in different ways, and even if a drug is no more effective than another in general, a specific patient may prefer it greatly. But those activists working against forced treatment will no doubt be paying close attention to Erica Goode's article and others like it. They will no doubt be attempting to push the mainstream media to cover the whole story. They will no doubt be pointing out that the failed promise of the atypical antipsychotics was guaranteed from the outset. And they will no doubt be working to use this story to debunk the persistent and pernicious myth that psychiatric drugs are an unmitigated benefit and that anyone who chooses not to take them when they are offered obviously needs added "incentives" such as incarceration or its threat. Posted May 21, 2003 Cal Montgomery lives in Chicago. Besides her book reviews in the print edition of Ragged Edge magazine, her articles have included Drugging Dr. Sell and Critic of the Dawn. WHAT DO YOU THINK of what you've just read? Click to tell us.
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