It's also, by the way, associated with some other things including worsening psychosis, etcetera. And by the way, that set in at the rate with these old drugs at about 5 percent per year. So after one year on the drugs, 5 percent had Tardive Dyskinesia; after 2 years, 10 percent; and after 10 years maybe 40, 50 percent; and that means that once you got on the old standard neuroleptics, you were really on a path towards having your basal ganglia damaged and this physical disability. Well the thought was that when the atypical antipsychotics came in -- this was a new class of antipsychotics, drugs like Risperdal and Zyprexa -- and what happened is when they were brought in, the academic psychiatrists, who were being paid by the pharmaceutical companies to act as speakers and advisers...in other words they really were paid spokesmen -- they painted this story (and this is in the mid-1990s in the Wall Street Journal, The New York Times) of how these drugs were so safe and effective....so much more effective than the old drugs, so much safer than the old drugs, they didn't cause Tardive Dyskinesia, and, in fact, if you go back to the stories that appeared in the newspaper, it almost sounds like they didn't cause problems at all. Well it was complete nonsense. I mean, if you actually looked at the trials, there were a number of people who had died in the trials. There were...diabetes showed up in the trials. Weight gain showed up in the trials. I'm talking about in the short term trials. And they weren't really any better than the old drugs even in those trials -- so we just heard this false story. Now because of that false story the drugs began to be prescribed for all sorts of things -- kids, people "with bipolar illness" and we can talk about how that became so popular; we even have...you can go and watch your TV now and they'll say if you're antidepressant doesn't work add Abilify -- well Abilify is an antipsychotic. So because of this false story about how safe and effective the atypicals were, the use of these drugs exploded and in 2000...I think it was 2008, antipsychotics -- now these are problematic drugs, these are drugs that can...you go on Zyprexa and you can gain 60 pounds in, you know, 4 months...you're at risk for diabetes...all sorts of things -- they were the leading generator of revenue in the United States of any class of medications...antipsychotics. It's extraordinary. And these are the...these are drugs that are so, so problematic and by the way, I did an initial study of Zyprexa in the clinical trials and it was something like -- I don't know 1 out of every 145 people in the trials died. I mean, it's just...the idea that these are very safe and effective drugs is just extraordinary that such an idea could have taken hold, I mean, especially on the safety part of the thing...that they're so extraordinarily safe without side effects; and yet because of that we give these antipsychotics....the atypical antipsychotics to kids, including 2 year olds, 4 year olds...and now that you've already got me warmed up, you know, a recent study came out and said that within a year on Zyprexa you have some sort of notable shrinkage of the frontal lobes -- well, why would you give that drug to a kid? So that's what atypical antipsychotics are -- they were advertised to the public as very safe and effective when in fact if you look at the clinical trials they were...the adverse events with these drugs was pretty extraordinary.
Rob: Now I want to take a step back for a second because you're very tough on the pharmaceutical companies here, and on modern psychiatry; and in your book, you write a history of modern psychiatry that looks like they're monsters in many ways. And you point out something very interesting that probably the biggest group that has opposed the use of psychiatric medications is the scientologists.
RW: Right.
Rob: And that actually this has helped the psychiatrists and the pharmaceutical companies. How's that?
RW: Okay, so what you're talking about here is the storytelling forces within our society, and that's one of the things that I do do in the last part of the book. So, and just sort of to set the stage for why we're so interested in the storytelling forces -- our society now believes, for example, that these drugs fix a chemical imbalance in the brain, that they are antidotes to known diseases. So you can read things like, well why would you give your kid a stimulant? Well because wouldn't you give your kid insulin for diabetes? -- that sort of metaphor is said. And of course we believe, and you can see the extraordinary embrace of these medications, that, you know, how helpful they are; and there has been an extraordinary success in marketing these medications.
But what you have to go back to is how did we as a society come to believe this story? Because it's false in so many dimensions. When you look at the chemical imbalance theory of mental disorders that arose in the 60s and 70s, it was investigated...really in the 70s and early 80s, and found not to be true. So in other words, Prozac comes to market in 1987...we start hearing about how people with depression have low serotonin and the drugs...Prozac, by upping serotonin is fixing that much like insulin for diabetes. Well 3 years earlier the NIMH had concluded after investigating the serotonin theory of depression and it wasn't so. So that's an example of how, in essence, a false story was told.
So what happens? How did we get to this false storytelling? You've got to go back to 1980. Prior to that time, in the 1970s, psychiatry as a profession felt that it was fighting for its survival, and really fighting for its survival in the marketplace, and in 2 ways -- one, the use of psychiatric drugs was actually declining in the 1970s and that was because the first generation of drugs was being found to be so problematic...so you had Tardive Dyskinesia showing up with the first generation antipsychotics, you had a lot of addiction showing up with the use of Valium and the Benzodiazepines, the Tricylics -- there was a big problem with those drugs inducing mania; so actually, use of psychiatric drugs was declining in the 1970s.
At the same time, there were a lot of other therapists springing up so psychiatrists found themselves in competition with social workers, counselors, psychologists, etcetera, and they basically started having meetings and saying -- How are we going to revitalize our discipline? How are we going to save our discipline? How are we going to save psychiatry? And what they said is, we need to wrap ourselves in the white coat -- we need to present ourselves as people like internal medicine doctors...and, what do internal medicine doctors do? They prescribe pills more regularly for known diseases. So they...as a financial point of view, as a way to save their image, they set forth DSM-III -- this is the Diagnostic and Statistical Manual in 1980, and under a medical model; they said these are known diseases in essence, and the drugs are, sort of, specific treatments for those diseases. But that wasn't a scientific story, that was a marketing story to (a) revitalize the image of psychiatrists as physicians who are treating known diseases just like their brethren in the internal medicine, and (2) it was to also provide a value to the medications in the marketplace because what separated psychiatrists from psychologists or psychiatrists from social workers is they could prescribe drugs and the others could not....so that was their competitive position in the marketplace, so they needed to have drugs that were seen as quite helpful and drugs for diseases, so to speak. And as they -- and this is real interesting -- in 1980, as they launched this new manual, DSM-III, they also launch an internal...not an internal, they launch a PR campaign and basically...in other words, they set up the American Psychiatric Association Press to start promoting those notions. They start running training schools for psychiatrists, sort of, leading psychiatrist around the country, on how to tell this story to the press. They began holding press conferences to say -- Ah, we're making these great leaps and understanding the brain and now we understand that these drugs are like....we now have drugs that are, sort of, fixing these problems in the brain -- and it was all this story of great medical progress, and frankly it wasn't true.
And then when they...in going forward with the storytelling, let's say with Prozac...when Prozac comes to market, you get this extraordinary story about how the drug is so safe, so much more efficacious -- it can make you better than well, and you even start getting this story about how psychiatrists have learned the inner workings of the brain so finely they can almost give you a designer personality -- whatever you want, and it was like this sort of magical time, etcetera. Well, if you actually look at the Prozac trials, they were having so many problems when they...they first tested it in large trial in Germany -- the German authorities said this is not a safe nor effective drug, and so the German authorities weren't even going to allow Prozac to even come to market. You were also seeing people going psychotic on Prozac; you were seeing people...there was an increased risk of suicide, and all of that got hidden -- it got washed out...it got hidden from the public -- and that's what I'm talking about in, sort of, psychiatry's extraordinary betrayal of the American public in terms of -- and I'm talking not at maybe...I'm not talking about individual psychiatrists, I'm talking about the profession as a whole -- it presented a known false story to the American public, it hid dangers from the drugs, and that's just not how we believe medicine is supposed to operate.
Now you raised Scientology -- why is Scientology...why has it been so helpful to psychiatry in order to tell this story? Well we can go back to the Prozac story. So actually it was Scientologists who began complaining about the fact that Prozac was causing, you know, some people to become suicidal, homicidal, etcetera. Now scientifically that was true...okay...that was indeed showing up in the clinical trials. But because it was being brought to the public by Scientologists -- and most people see Scientology as this sort of odd cult, weird cult, and you know, who the hell are these people?...and they are seen as a group with an agenda -- they have their own way to treat psychological distress -- so they were seen as, basically, they have their own competing form of therapy, they're seen as this crazy cult, so psychiatry and the pharmaceutical industry together said -- Aha, this is fantastic, thank God for the Scientologists because now what we can say, and we can say to the media...and you see this -- what's really interesting...if you get the documentation...so when the Prozac thing happens and this worry about this drug happens, what does Eli Lilly do? It begins coming up with a strategy to tell the press. Oh, they'll say -- this is a problem being sort of...this is a fantasy being brought to the public by Scientologists, okay, it's not real. These drugs actually prevent suicide. And they would bring their fancy doctors in and these doctors/psychiatrists came from places like Harvard Medical School, etcetera, and they would bring them in for training sessions and they would say -- here's the message we want you to say to the Wall Street Journal -- we want you to say is that these drugs reduce suicide and that Prozac reduces suicide, and the real risk is that they won't be treated with Prozac; and we want you to say, oh, and this whole thing is being brought up by Scientologists...so blame the Scientologists. So they would have these PR sessions -- and you can even see at one point the Eli Lilly people complaining that the doctors aren't getting the message that they're supposed to say exactly down. In other words, they're not being the exact spokespeople they're supposed to be and we're going to have to have more training sessions to get them to, sort of, hue to the message...stay tuned to the message -- anyway, then what happens? The Wall Street Journal articles come out, other articles come out, and it's exactly what they plotted in these PR campaigns and the pharmaceutical companies/the doctors say -- Ah, this is not a real problem; we've looked at the data -- the data actually reduces the suicide risk; this whole thing is being brought up by those crazy Scientologists....and, so that became a way for the public...in the public mind to go 'Aha, this isn't the real issue; these drugs are very safe and effective; there's no increased risk of suicide when you go on Prozac; and this whole thing where you question American psychiatric drugs...that's a Scientology thing'....and so it became a way, thanks to Scientology, to diffuse any sort of real critical look about what was happening to people on these drugs long term -- what was the science really showing. And even really, what was the data in the short term.
Rob: So actually in a sense this is kind of like what politician are doing nowadays. If somebody...if a politician gets attacked they'll go out and they'll ask for contributions, and they'll get a half a million or a million dollars in contributions because the other side attacked them. The pharmaceutical companies used this to beef up their promotion of the efficacy of the drug when they were attacked by a group that was not trusted by the American public.
RW: Yeah, yeah, even more than not trusted -- mistrusted. So it became a way to continue to maintain the false story and to keep the press convinced that to write critically of psychiatric drugs was to, sort of, throw your lot in with the Scientologists -- God knows no one wants to do that -- so it became a way, really to, not only maintain a story, but prevent even, sort of, any critical look at what the data might actually show and to completely delegitimize those who would look critically at the medications.
Rob: Now you don't have any connection with Scientology do you?
RW: Good God no, man.
Rob: Okay. I...because you know, you're very strong on attacking and I now, having read the book, I know that. But I just want to make it really clear that what you're talking about is a problem here where this history is that the American Psychiatric Association and the pharmaceutical companies tend to vilify and in character attack people who show them for what they are and what they're doing, and what their drugs do.
RW: Yeah, and this is....
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