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What happens when drugs are found to be unsafe and ineffective? Not much.

by Ben Hansen, MindFreedom Michigan

You've heard the hype: New psychiatric drugs like Zyprexa and Risperdal, called atypical antipsychotics, are a vast improvement over old drugs like Haldol.

Whether or not the new drugs work any better, they make a lot of money for the drug companies. While a month's supply of an old drug like Haldol costs less than $30, a month's supply of Zyprexa can cost over $500.

To determine if these drugs are worth their outrageous price, the National Institute of Mental Health conducted one of the largest and longest independent studies ever, the Clinical Antipsychotic Trials of Intervention Effectiveness, or CATIE. Four years and $44 million later, the CATIE study, published in September 2005, reached a startling conclusion: the new drugs "have no substantial advantage" over the old ones.

Atypical antipsychotics, it turns out, are a massive rip-off. They're no better than old drugs which weren't very good to begin with.

Government programs like Medicaid pay for over 90 percent of all antipsychotic prescriptions. Across the nation, state budgets are being squeezed by Medicaid, and Medicaid is being squeezed by the high cost of prescription drugs. Atypical antipsychotics are among the most expensive.

Studies by Mark Duggan, a professor of economics at the University of Maryland, reveal these facts:

* Among the top 30 drugs by total U.S. revenue, Zyprexa has the highest price per prescription.

* Between 1996 and 2001, while Medicaid spending on prescription drugs doubled and spending on psychiatric drugs tripled, Medicaid spending on atypical antipsychotics jumped over 600 percent.

* Looking at the rate of hospitalization and side effects like movement disorders, diabetes, and weight gain, Duggan concluded that atypical antipsychotics "have not led to significant improvements in the health of schizophrenia patients... If anything, the results suggest that health outcomes decline following the shift to the new drugs." ("Does Medicaid Pay Too Much for Prescription Drugs? A Case Study of Atypical Anti-Psychotics," 2003.)

We're paying all this money for high-priced drugs, yet patients are getting sicker, not healthier. It's a scandal of monstrous proportions.

From the minute CATIE's results were announced, the pharmaceutical industry and front groups like the American Psychiatric Association (APA) and the National Alliance for the Mentally Ill (NAMI) have rushed to defend their favorite drugs: the most profitable ones.

APA's medical director, James Scully, said it would be a "dire mistake" to restrict doctors from prescribing certain drugs "based on cost." The APA apparently believes taxpayers should pay for any drug no matter how expensive and ineffective, so long as doctors follow APA guidelines approved by the drug companies.

NAMI responded to CATIE in predictable fashion, blaming the study's unexpected results on patients who participated in the study. Many patients dropped out or discontinued medication, NAMI said, because they suffer from a co-occurring disorder called anosognosia, or "lack of insight" into the need for treatment.

NAMI also complained that CATIE "only lasted for 18 months." Curiously, NAMI has never criticized drug company clinical trials lasting 12 weeks or less. Such trials provide the basis for claiming new drugs are safer and more effective than old ones.

Drug companies themselves have responded to CATIE, bending over backwards to find a silver lining inside a dark cloud. Pfizer boasted that its drug, Geodon, is less likely to cause weight gain than Zyprexa, not mentioning other side effects which caused 79 percent of those on Geodon to stop taking it.

Johnson & Johnson, maker of Risperdal, followed NAMI's lead and blamed the patients. "The CATIE study reinforces the overwhelming need for greater medication compliance," the company web site says. In 2003 Johnson & Johnson introduced the first atypical "long-acting injectable," which allows doctors to forcibly inject the drug whether patients want it or not. This guarantees "compliance."

Business goes on as usual, and CATIE appears to have changed nothing. Drugmakers and mental health professionals have a long history of ignoring the results of scientific studies they don't like.

In December 2000, the British Medical Journal published a systematic review of 52 randomized trials comparing atypical antipsychotics with older drugs, concluding there was "no clear evidence that atypical antipsychotics are more effective or better tolerated than conventional antipsychotics." The study was ignored.

In November 2003, the Journal of the American Medical Association published the results of a two-year randomized trial comparing patients on Zyprexa with patients on Haldol, concluding there were "no significant differences" between the two groups. Zyprexa had no advantage over Haldol in terms of compliance, symptoms, or overall quality of life. The study was ignored.

In October 2005, one month after CATIE was published, the Journal of the American Medical Association published a meta-analysis of 15 randomized trials of more than 5,000 elderly patients treated with atypical antipsychotics. Patients taking the drugs had a 54 percent increased chance of dying within 3 months, compared with patients taking placebo sugar pills. The study was ignored.

Atypical antipsychotics continue to be prescribed in growing numbers not only to patients diagnosed with schizophrenia, but also to nursing home residents, prison inmates, and even schoolchildren labeled with learning disorders.

Judging by third quarter 2005 profits, business is booming:

* Sales of Risperdal, Johnson & Johnson's biggest-selling drug, reached $916 million, up 23 percent.

* Seroquel, $706 million, up 32 percent.

* Abilify, $206 million, up 58 percent.

* Geodon, $148 million, up 18 percent.

* Zyprexa, $1.035 billion, up 1 percent.

Zyprexa's maker, Eli Lilly, said the company's diabetes drugs earned $653 million, up 13 percent. Among all drugs studied by CATIE, Zyprexa was most likely to cause weight gain and high blood sugar leading to diabetes.

Now that CATIE has been published in the New England Journal of Medicine, will our government take action to punish drugmakers and mental health professionals who deceived the public, harmed patients, and defrauded taxpayers? Don't bet on it.

Related Ragged Edge articles:

Buying Sickness, a review by Cal Montgomery

Ben Hansen is an anti-psychiatry activist who lives in Traverse City, Michigan.
His email address is heartofbear@hotmail.com


Ben, This is a very helpful balance that people need to be aware of as they consider how to respond to psychosis. Recent research also points out that we have lost touch with various psychotic conditions being treatable by therapy and culturally based approaches, something that hasn't been possible since just after I finished my training in 1970. I greatly appreciate your advocacy. John


Great article, More people need to be aware that the drug companies do not have out best interests in mind. They've got their claws deep into the pockets of many people.


Thank you for this very informative information. I will share this with my daughter who has a son that has psychiatric disabilities. It has been awful to see that he now has high blood pressure, high cholesterol and weight gain at the age of 11 years old. It is important to also note that social services and schools actually push and promote drugs for children.


Brenda Barnes

Once again it's profits before people. While mental illnesses do need to be treated, the treatment must not be worse than the disease itself. NAMI and APA should be ashamed of themselves for refuting the study. It's not only the costs, its the SEs.*
A 4 year study should be proof if it's valid.
How was the study performed? That may make a difference in it's accuracy.
SEs side effects.

There is a fantastic book about how the health care non-system hypes profits and drugs, damn the costs and regardless of any benefit over current treatments.

Hope Or Hype
Richard Deyo & Donald Patrick, MDs
1601 Broadway, New York NY 10019
0814408451 $24.95 1-800-250-5308

Why are Americans obsessed with medical miracles? In Hope Or Hype: The Obsession With Medical Advances And The High Cost Of False Promises, two doctors who are experts on ethical and policy issues in the medical world examine the false premises and promises the medical community makes to consumers, from pharmaceutical and equipment companies eager to promote new technologies and cures to physicians and hospitals too quick to prescribe costly medicines or surgeries. The hazards of such unnecessary treatments are provided within an overview of the drug and medical industries as a whole.

Thank You Ben. I look forward to seeing your comments on the Michigan Algorythm Project coming here soon.
Persons seeking to form an antipsychiatry group in Central Indiana U.S.A. may contact me through Ben.

Dear Ben,
This is a great article and should be circulated all over the world especially to "Parents Magazine", "New Mother" and all school systems. I hate psychiatry/pharmaceutical rackets and all the fraud involved with these criminals. After ten years of babble and repetitive garbage rehearsed to us I know this is just a form of Genocide and the damage that happens even after only a week can ruin the family, the human being drugged and all the quality of life for anyone involved.


Excellent article!

For those who'd like to now connect the dots between Big Pharma, their drugs, schools and our children, here's well-researched information about TeenScreen.

Hello Ben:
I just thought I'd let you know that I've created a companion blog to my first one and I've linked this article among several others. Much thanks for your investigative work.

Spiritual Emergency

Spiritual Recovery

I hope that the family whose child is on an atypical antipsychotic will get the child OFF as soon as possible. Perhaps the most heartbreaking thing to see is the spread of the lethal atypicals - first to people with mental illness, many of whom now have diabetes, some of whom are now dead - dying before the FDA got around to placing a warning on the label for diabetes, hyperglycemia, and death - then the elderly being given them off-label (gotta keep those people with dementia and Alzheimers drugged and quiet, until they die of heart attacks and strokes). And now, perhaps the most vulnerable population of all, or at least the only one left to push drugs on to, children. I got a letter from one mother who said her boys had been given over time about 12 different psychotropic medications and that they had MORE THAN DOUBLED their body weight on Zyprexa. The Pharma is a big selling machine and a death machine: Over 100,000 people die every year from pharmaceutical drugs.

I lost a member of my family and my life will never be the same. And I will never stop fighting back.

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