Toward making sense of the structural constraints of health & illness in the neoliberal variation of advanced (or late-) capitalist society …

“Because of diagnostic inflation, an excessive portion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds. We are becoming a society of pill poppers. [….] Loose diagnosis is causing a national drug overdose of medication. Six percent of [us] are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs. [….] Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops. An incredible 110,000 soldiers are now taking at least one psychotropic drug, many are on more than one, and hundreds die every year from accidental overdoses. 

Psychiatric meds are now the star revenue producers for the drug companies—in 2011, over $18 billion for antipsychotics (an amazing 6 percent of all drug sales); $11 billion for ADHD drugs. Expenditure on antipsychotics has tripled, and antidepressant use nearly quadrupled from 1988 to 2008. And the wrong doctors are giving out the pills. Eighty percent of prescriptions are written by primary-care physicians with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven-minute appointments, with no systemic auditing. 

There is also a topsy-turvy misallocation of resources: way too much treatment is given to the normal ‘worried well’ who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don’t get treated it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall. ‘Normal’ badly needs saving; sick people desperately require treatment. But DSM-5 seemed to be moving in just the wrong direction, adding new diagnoses that would turn everyday anxiety, eccentricity, forgetting, and bad eating habits into mental disorders. Meanwhile the truly ill would be even more ignored as psychiatry expanded its boundaries to include many who are better considered normal.” — Allen Frances, M.D. in the Preface to his book, Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (William Morrow, 2013).

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“We like to imagine that medicine is based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature, when in reality much of it is hidden from them by drug companies. We like to imagine that doctors are well-educated when in reality much of the education is funded by industry. We like to imagine that regulators let only effective drugs onto to the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients. [….] 

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of the government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies—often undisclosed—and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.” — Ben Goldacre, from the Introduction to his book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (Faber and Faber, 2013)

I have two bibliographies with titles germane to this post: Biological Psychiatry, Sullied Psychology, and Pharmaceutical Reason: A Basic Bibliography, and Sullied (Natural & Social) Sciences: A Basic Bibliography (this latter compilation includes works outside the scope of this post).