Drug consumption in psychiatry is harmful

Translation of two articles published in Danish newspaper Politiken 30 August 2015

Politiken

Sunday, 30 August 2015

Front page

By Lars Igum Rasmussen

Professor: Drug consumption in psychiatry is harmful

The consumption of drugs is “insanely high,” warns known professor. It should be substantially reduced since the drugs do more harm than good, he says.

Drugs used to treat mental illnesses such as schizophrenia, depression and anxiety should – virtually – be dropped. The medicine is harmful, injures and destroys more than it helps, according to the respected but controversial professor of clinical research design and analysis at the University of Copenhagen, Peter Gøtzsche:

‘The use of psychotropic drugs in psychiatry is insanely high. The drugs kill people and create disease; they do not solve problems.’

In his book “Deadly psychiatry and organised denial,” which will be released tomorrow, he argues that the use of drugs to treat mental disorders should be reduced by 98 per cent.

Instead, there should be a greater focus on psychotherapy, and all forced treatment must be stopped. Medication should only be used in acute, severe psychosis, and only in short-term treatment.

440,000 people received a prescription for antidepressants in 2013. According to Gøtzsche, 1 in 7 Danes can be in lifelong medical treatment with the current total consumption of psychotropic drugs.

The Danish Health and Medicines Authority is ‘indeed aware of the challenges of a high consumption of psychiatric drugs,’ says Søren Brostrøm, head of Hospital Services and Emergency Management, in a written comment:

‘For example, for groups such as young people, the elderly and people with dementia, where there is no good evidence that antidepressants work, and where the consumption of drugs has probably been too high. ‘

However, he adds that the solution is not ’a strong reduction in the use of the drugs, as suggested by Gøtzsche. There is a need for both pharmacological and non-pharmacological drugs.’

Knud Kristensen, National Secretary of MIND – the national association for the mentally ill – calls it a ‘relevant and welcome debate.’

‘But it is problematic when the style becomes so bombastic that it is said that the drugs kill people. We have many members who say they would not have been alive were it not been for the medication,’ he says.

Thorstein Theilgaard, Secretary General for Better Psychiatry – an association advocating for relatives and families of persons with mental illness – believes that medicine cannot and should not stand alone:

‘Unfortunately, it stands alone a little too often in psychiatry today. We need more tools in the psychiatric toolbox.’

According to professor of psychiatry Poul Videbech, it is frivolous only to talk about overtreatment. He is convinced that some people who get antidepressants, for example because of stress and temporary crises, shouldn’t have them:

‘But I also know from good, solid studies that very sick people who should take antidepressants don’t get them.’

He doesn’t like the bald statements from Professor Peter Gøtzsche: ‘There are sick people who get confused about what is right and wrong when the discussion becomes so bald.’

In his book, Peter Gøtzsche writes that antidepressants ‘probably don’t work,’ are harmful to many and cause deaths. Antipsychotics ‘kill and destroy lives.’ Drugs for dementia don’t work. ADHD drugs only work on a short-term basis, but ‘are directly harmful when used long-term.’

‘We no longer beat our children but destroy their brains with these drugs. There will always be inevitable conflicts between children and adults. And there are children who are not as well adjusted as others think they should be. But they should not be put in a chemical straitjacket. ADHD medication is today’s cane,’ says the professor.

lars.i.rasmussen@pol.dk Interview with Peter Gøtzsche

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Politiken

Sunday, 30 August 2015

Pages 8 and 9 in PS

By Lars Igum Rasmussen

‘The industry’s marketing is very, very effective. For example, it has led doctors to believe that antidepressants are effective drugs. It is not the case at all.’

The mentally ill should hardly be treated with psychotropic drugs. The drugs are far more dangerous than acknowledged. And the psychiatrists’ diagnoses are pretty arbitrary. We should adopt a totally new view on people with mental disorders, says the controversial professor Peter Gøtzsche who publishes a new book tomorrow.

Psychotropic drugs interview

‘An infinite number of bodies are buried in healthcare that people hope will never be discovered. That is why it is very, very unpopular when I dig the bodies up.’

Says one of the most controversial, but also academically respected, contemporary Danish physicians, Peter Gøtzsche, Doctor of Medical Science and professor of Clinical Research Design and Analysis at the University of Copenhagen.

In his new book, “Deadly Psychiatry and Organised Denial,” which is released at the same time in Danish and English, Peter Gøtzsche makes a confrontation with the whole of psychiatry. He criticises psychiatric diagnoses, which are being made by using ‘simple checklists.’ According to the professor, the arbitrariness leads to a huge consumption of psychotropic drugs, which often harm the patients and don’t work at all, as doctors otherwise say.

In 2013, for example, 440,000 Danes redeemed a prescription for an antidepressant drug. According to Peter Gøtzsche, the total Danish consumption of psychotropic drugs is so high that one in seven Danes could be in treatment every day from cradle to grave.

In the United States, antipsychotic drugs were the most sold drugs in 2009 while antidepressants came at the fourth place.

Although Peter Gøtzsche’s scientific arguments about the effects of the drugs and their side-effects are in direct conflict with the established attitude to psychotropic drugs shown by respected Danish and international psychiatrists, the book is really intended to be an invitation to a scientific debate with the established psychiatric community, both in Denmark but primarily in the United States, which sets the tune in relation to how the psychiatry community perceives patients and how they use drugs.

The fact is that psychiatric diagnoses often comply with the American Psychiatric Association’s diagnostic manual ‘DSM,’ ‘Diagnostic and Statistical Manual of Mental Disorders.’ The controversial checklist system where doctors tick boxes to see if the patient has a psychiatric disorder published a third diagnostic manual in 1980. The fourth edition was published in 1994 and had 374 – or 26 per cent more – mental disorders listed. The fifth edition was published a couple of years ago.

‘I have now provided my documentation in the book. I do not expect that everyone will agree with the way I interpret the scientific literature. But I hope that we can have a serious scientific debate about these things,’ he says and continues:

‘Because no matter how you turn and twist the scientific literature and at the same time look at the gigantic consumption of psychotropic drugs, you should come to the conclusion: the way in which we use psychotropic drugs today does more harm than good. We should react very differently to citizens with mental health problems. Drugs are not the solution but part of the problem.’

Broadly, the conclusion is the same for each disease area: scientific research – he calls it ‘mainly pseudoscience’ – does not find that these various drugs are efficient such as psychiatrists otherwise say to their patients.

Gøtzsche believes he has documented that psychiatric drugs generally do more harm than good. And both psychiatrists and general practitioners often give people rather arbitrary diagnoses and forget to give them a tapering plan when they write a prescription.

Therefore, according to Peter Gøtzsche, 98 per cent of the consumption of drugs should be removed.

The focus should not be on diagnosis, medical treatment, chemical substances and their effect on the brain, but on people who have a mental hardship and their stories.

With the book, he wants to ‘poke a hole in psychiatry’s official balloon so big that it stays on the ground.’

‘Biological psychiatry is based on a series of misunderstandings and myths, which do not hold water on closer scrutiny. One of the great myths, which more than half the patients have been told, is that they suffer from a chemical imbalance in the brain. The drug will then correct the imbalance, and often they are also told that the drug is like insulin to a patient with diabetes, i.e. you give your body something it is lacking. But it is a very harmful myth,’ says Peter Gøtzsche.

Peter Gøtzsche is a specialist in internal medicine and professor of Clinical Research Design and Analysis at the University of Copenhagen. He teaches how scientific research should be carried out properly, and he is one of the leaders in the field worldwide.

In 1993 he co-founded The Cochrane Collaboration and established the Nordic Cochrane Centre, which is situated at Rigshospitalet (Copenhagen University Hospital). The Cochrane Collaboration is a network of 34,000 medical researchers in more than 100 countries whose main task it is to assess the scientific research critically.

He has published more than 70 scientific articles in the five major medical journals and has been cited more than 15,000 times by other researchers.

He has, time and again, through his scientific analyses, stepped forward and given his honest opinion – and time and again he has been exposed to verbal beatings, but he also has been instrumental in obtaining changes in the healthcare system.

When women today, in Denmark and in a large number of other countries, are informed much more clearly about several negative effects of screening for breast cancer, mammography screening, it is solely due to Peter Gøtzsche’s scientific work. Several countries, e.g. the United Kingdom, have reconsidered their screening program as a result of his research. And he believes that mammography screening will be phased out in his lifetime, globally.

He has documented that systematic health checks do not save lives. He has documented how neither chemicals nor mattress covers help allergy sufferers against dust mites, which manufacturers and doctors treating people for allergy did not like. Through political contacts and years of persistent work, he has achieved to make the European Parliament arm wrestle with the pharmaceutical industry and won.

Now, the industry has to publish all research data, even if the conclusion is negative for the company. Previously, this data was hidden by the pharmaceutical industry deep in a drawer.

In 2013 he went ‘all in’ and wrote that the pharmaceutical industry makes use of mafia-like methods, in the controversial book “Deadly medicines and organised crime – How big pharma has corrupted healthcare.”

It cemented his sainthood in those parts of the medical profession that are critical towards the large drug consumption, in patients’ associations and among people with strong anti-pharma attitudes.

In 2014, the psychiatrists in Denmark dropped their prescription pen when the Danish newspaper Politiken published the feature article “Psychiatry gone astray” by Peter Gøtzsche, in which he strongly criticised doctors’ use of psychotropic drugs. The new book is Gøtzsche’s scientifically documented answers to the massive debate – both domestically and globally – that his points led to.

The psychiatrists in Denmark and their scientific association remonstrated with the professor over this and Gøtzsche calls the first few months of 2014 ‘a pure witch hunt after my person.’

According to Peter Gøtzsche, his critics tried to have him removed. How could anyone protect a man who meant something as controversial as ‘our citizens would be much better off, if we removed all psychotropic drugs from the market because doctors are unable to handle them?’

The row ended on the table of the then Minister of Health, Astrid Krag (Socialist People’s Party). She said that his point of view ‘will contribute to trivialisation and a reduction to a state of stupidity.’ She said publicly that Peter Gøtzsche and the Nordic Cochrane Centre – which is financed by the government, and which he had spent his life building up – were not identical. A point of view the severely criticised professor considered a threat of firing.

The media hurricane has not caused Peter Gøtzsche to change a comma in his views on and criticism of psychiatry and the doctors’ widespread use of psychotropic drugs.

‘Why should I? What I wrote at the time was true. I am not the only one with this point of view. Many sensible psychiatrists, doctors and other skilled scientists say the same. But we are up against the established system. I recognise that,’ says Peter Gøtzsche and continues:

‘In the book I now substantiate in great detail that if doctors do not improve in the way they handle psychoactive drugs, and prescribe them much less, and at the same time have a tapering plan prepared, many patients will be on drugs for the rest of their lives because they have been told that they have a chemical imbalance in the brain or will be brain damaged if they do not take the drugs. That is why I keep going,’ he says and refers to the 378 pages and hundreds of references to scientific studies and other literature described in the book.

Peter Gøtzsche is well aware of the fact that the artillery will once again be directed against him.

‘My wife and I have talked about it but we have agreed that it is the right thing to do. And why on earth should I not be allowed straight talk? This is the conclusion I have reached after scrutinising the science. There is a lot of evidence that shows that in particular leading American psychiatrists are corrupt to a substantial extent. They allow the pharmaceutical industry to manipulate with the clinical trials so that they come to wrong conclusions,’ he says.

In the book, Peter Gøtzsche scrutinises the treatment of the major psychiatric disease areas after having studied the scientific literature – as well as the non-published data, which the pharmaceutical industry has discarded over the years because the drugs did not show the desired effect.

‘This is data, which the psychiatrists rarely examine closely,’ he says.

‘Imagine if you tested healthy people for cancer with a test that gave a quarter of them an erroneous diagnosis, which led to treatment with chemotherapy for a cancer that wasn’t there. We wouldn’t allow such a poor test to be used in any other area of healthcare except psychiatry.’ From the book “Deadly psychiatry and organised denial”

Throughout the interview, Peter Gøtzsche uses the medical terms antipsychotics and antidepressants, although it is one of his important points in the book that exactly this use of medical terms is due to the pharmaceutical marketing, which the doctors have accepted.

‘Words like antipsychotics suggest of course that these drugs have a specific effect on psychosis, just as antibiotics actually have a specific effect on bacteria. Therefore, words like antipsychotics are totally misleading. The drugs do not have any specific effect on psychosis. The medicine affects the brain and calms the patients down. Not only their psychotic thoughts, all thoughts. Therefore, people medicated with antipsychotics still have their wild thoughts, but to a lesser extent. And for this reason, former patients also describe their condition as if they have been turned into zombies. The medicine is not good in itself. And doctors cannot handle it,’ he says.

For more than half a century, psychiatry has tried to find biological explanations for the mental sufferings people have endured at all times. With no luck, he says. Several hypotheses, for example that depression should be caused by a lack of serotonin, have been shot down.

Currently, no mental disorders can be detected, confirmed or excluded through blood samples, X-rays or other tests.

All psychiatric diagnoses are based on the patients’ symptom clusters. Therefore, a doctor or psychiatrist may diagnose a patient with a mental illness when a number of criteria are met. Criteria may change over time, producing diagnostic uncertainty, according to Peter Gøtzsche.

Until a few decades ago, homosexuality was listed as a mental illness but then it was agreed that it was a natural part of human nature. Today, the diagnosis has been removed from the diagnostic manual of mental disorders.

‘I criticise indeed the current psychiatric diagnostic practice, which is completely out of control. It takes so little to be diagnosed with a mental disorder according to the checklists used by psychiatrists and general practitioners that many of us could get one or more psychiatric diagnoses,’ says Peter Gøtzsche.

He refers to an American study claiming that 10 per cent of American adults are suffering from a depression at any given time.

‘No-one really believes this, do they? And it isn’t true either, as it hardly requires anything to be diagnosed with depression. If you in 8 days out of 14 have little pleasure in doing things you usually do, and have an additional symptom such as decreased appetite or sleeping problems, you suffer from a depression. But a young man whose girlfriend has left him will through all 14 days have less pleasure in doing the usual things and will have loss of appetite and poor sleep. He is feeling miserable and can be diagnosed with depression. It doesn’t make sense.’

Still, Peter Gøtzsche says, he has approached ‘the issue with an open mind.’ ‘I would become very happy if it turned out that a specific biochemical brain defect caused a mental disorder, and that we would then actually be able to cure the patients with drugs that correct the brain defect. I have nothing against drugs that works well. But psychiatry isn’t there yet.’

‘Psychiatry’s almost manic obsession with ineffective, addictive drugs has led to a disaster in public health so big that nothing I have seen in other areas of medicine comes close.’ From the book “Deadly psychiatry and organised denial”

‘Psychotropic drugs are not particularly specific and they cause huge problems for patients in the long term, because patients become addicted and have difficulty stopping. And some are not able to stop because they experience rather pronounced abstinence symptoms, although they are tapering slowly,’ says Peter Gøtzsche.

According to Gøtzsche’s interpretation of several studies, the drugs make matters worse. If the widespread use of psychotropic drugs had the same effect as insulin for diabetes, fewer people would need early disability pensions when they were in medical treatment, based on the thesis that psychiatric drugs cure people.

‘But no, the exact opposite has happened. In all countries where this has been studied, the number of persons who are outside the labour force because of mental disorders has exploded. And it goes hand in hand with the consumption of psychotropic drugs that has skyrocketed over the past 30-40 years,’ he says.

Hundreds of thousands of Danes take psychotropic drugs with pleasure. They believe that they have a positive effect of their medical treatment, which you want to reduce. How can you know better than them?

‘It is the spontaneous course of the disease that they confuse with an effect of the drug. You are sad, see the doctor, are diagnosed with a depression, and are prescribed an antidepressant. And then you feel better within a few weeks. It is therefore understandable that doctors and patients interpret improvements as a positive response to the antidepressant. Everyone seems to forget that if the doctor hadn’t done anything, but just said that it would become better within a few weeks, most of the patients would have felt better without treatment, avoiding the mistake of believing that it was a positive effect of the drug.’

It could also be the positive effect of the drug?

‘Large randomised trials including more than 100,000 patients, where one group received an antidepressant and the other group a placebo, show that it is doubtful whether antidepressants have any real effect. I document this in my book.‘

Why would psychiatrists want to treat patients with drugs if they have no effect at all?

‘Among other things because people do not know about the unpublished research. I have looked more deeply than just into the published research. I had access to a number of unpublished data that I describe in my book and which shows, for example, that antidepressants cause far more suicides than psychiatrists realise. The second reason is that drug marketing is very, very effective. It has convinced doctors to believe, for example, that antidepressants are effective drugs. They aren’t. Not at all.’

Peter Gøtzsche doesn’t deny that psychiatric drugs could be useful for a few patients, although the average effect, according to the professor, is close to being non-existent.

‘When the average effect of a treatment is close to zero, there might be some who benefit. But on the other hand this would mean that others will experience harmful effects, otherwise the average effect could not be close to zero. And the negative impact is experienced by those who feel trapped under a cheese-disk cover, have difficulty feeling pleasure, have sexual problems and other things that affect the quality of life. And if the drug has a real effect on a few patients, then the psychiatrists are not able to identify the relevant patients from their doubtful diagnostic questionnaires.’

When will psychiatric medication make sense?

‘In acute situations, where the patients are tormented and up in gear and cannot sleep, e.g. because of an acute psychosis. They should not be forced into treatment. If you take it easy and try to establish a relationship with the patient that builds on trust, the majority of these severely disturbed patients will ask for a sedative. Then we could give them the old sedatives, benzodiazepines, but only for a very short period. Studies have shown that benzodiazepines are more effective to calm down patients than antipsychotics, which are quite dangerous drugs, but for some reason psychiatrists choose to prescribe these drugs instead. I don’t understand why.’

Peter Gøtzsche’s criticism is addressing both the drugs themselves and the doctors handling the medication.

‘The worst thing is – and this often happens – that when a patient deteriorates on one antipsychotic, the psychiatrist increases the dose of the drug instead of tapering it, or uses two, three or even four other antipsychotics on top of the first one, which is contrary to the Board of Health’s recommendations. So they make matters worse. And they run a risk of killing the patients with the drugs.’

‘I am used to being called provocative or controversial, which I take to mean that I am telling the truth.’ From the book “Deadly psychiatry and organised denial”

Why do you put all psychiatrists in the same boat when you talk about ‘organised denial’ with ‘loose diagnoses and a loose hand on the prescription pad’?

‘I cannot write in every sentence that it does not apply to all psychiatrists. There are also excellent psychiatrists who do the right things. But remember that those who steer psychiatry from the top support the mythology they have helped create. And when very reliable research comes forward that says the opposite, they refer to unreliable research supporting their mythology. Instead of changing direction and say “sorry, we were wrong.” It doesn’t happen.’

You never see a professor of diabetes give statements about allergies, or a professor of schizophrenia comment on depression. How come you have strong opinions on a wide number of issues where you are not a specialist?

‘Please note that my views build on my studies of other people’s research. It doesn’t come out of thin air. In my entire life, my expertise has been to evaluate research articles critically. I am Professor of Clinical Research Design and Analysis. Therefore, I don’t speak about issues I know nothing about but about issues I have studied. And you don’t need to be a psychiatrist to assess the psychiatric pseudoscience.’

Now that you speak so directly, you run a risk that patients on their own or after pressure from relatives stop treatment.

‘It is very, very important that no-one stops psychiatric drugs abruptly. There must be a slow tapering guided by a professional and with support from family and friends. It is very important that no-one stops cold turkey. It can be life-threatening.’

‘When we respect the patients and treat them as reasonable beings, they will respect themselves, which is the first impor­tant step towards healing.’ From the book “Deadly psychiatry and organised denial”

According to Peter Gøtzsche, the problem with drugs when patients seek a doctor for their mental challenges is that drugs lock the patient into precisely the role of a patient.

Patients change their behaviour and no longer see themselves as the key to the solution of their negative, troubled and tormented mind.

‘They hear that they have a chemical imbalance in the brain and they therefore wait for the drugs to cure the defect, like insulin helps for diabetes.’

Peter Gøtzsche therefore believes that citizens above all should try to avoid that doctors put a psychiatric diagnostic label on their backs, as it virtually always means psychiatric drugs – along the way frequently more than one kind of medication simultaneously.

Instead, doctors should try to understand their patients and here psychotherapy is an effective solution, he says repeatedly.

In a Feature in Politiken, the country’s psychiatric professors wrote that ‘in recent years, psychotherapeutic methods have become more effective. And there are many indications that we will see further achievements.’ Psychiatry embraces psychotherapeutic methods. Don’t you hold a prejudiced opinion that the psychiatrists only prescribe drugs?

‘No, certainly not. The empirical studies I have reviewed show that it is very difficult to visit a psychiatrist without getting a prescription for a psychiatric drug. There are really many psychiatrists that do not learn psychotherapy. This they did 40 years ago, but then came an increased focus on biological psychiatry, which described chemical imbalances and a quick fix with a drug. Since around 1980, it has gone astray, which is also reflected in the consumption of psychotropic drugs that constantly rises, also because the industry constantly invents new psychiatric diagnoses so that they can sell more drugs. It is not psychotherapeutic methods that characterise psychiatry. But I’m glad that leading Danish psychiatrists have written positively about psychotherapy, as this is the way to go.’

lars.i.rasmussen@pol.dk