Übersetzung hat geschrieben:
Let them eat Prozac! ("Füttert sie mit Prozac")
Ein Interview mit David Healy
Die letzten fünfzehn Jahre sahen die großangelegte Rückkehr des Marketings neuer Psychopharmaka.
Die Behauptungen über die therapeutische Wirkung dieser Medikamente nehmen fast kein Ende, wobei die verbreitetsten unter ihnen, insbesondere Prozac, einen kultähnlichen Ruf, ähnlich dem des LSDs in früheren Zeiten, erreichen.
Eine finstere Seite lauert hiner den Multimilliarden-Anzeigenkampagnen und Sponsoringleistungen an Ärzte für die neueren Psychopharmaka.
Eine dunkle Seite, die unbequeme Tatsachen beinhaltet, die schon lange bekannt waren, wie beispielsweise der Umstand, daß Patienten, wenn sie neuere Psychopharmaka einnehmen, ein höheres Suizidrisiko haben, als wenn sie die Medikamente erst gar nicht eingenommen hätten.
Oder, daß Plazebos die gleiche oder eine bessere Wirkung hatten, als die neueren Antidepressiva in klinischen Untersuchungen.
David Healys neues Buch "Let them eat Prozac" versucht, diese und viele andere unangenehme Tatsachen über die Vermarktung der Wirkstoffklasse der Selektiven Serotonin Wiederaufnahmehemmer (SSRI)-Antidepressiva ins Licht der Öffentlichkeit zu rücken, namentlich Paxil, Prozac, Zoloft u.a
Gespeist aus seiner Karriere als ein Akademiker und praktischer Psychiater und als ein Gutachter in Prozessen gegen dir Pharmaindustrie, "Let them eat Prozac" zeichnet Healys Entwicklung von einem Berater der Pharmaindustrie zu einem unabhängigen Kritiker derselben, die ihren Höhepunkt in einem Rücktritt von einem Stellenangebot der Universität von Toronto und in der Folge einer Klage wegen Vertragsbruchs(?), nachdem er eine öffentlich Vorlesung gehalten hatte. (Anm. d. Übers.: Hier bin ich mir nicht sehr sicher, ob ich das richtig habe... ...es könnte auch "Klage auf Vetragserfüllung gemeint sein)
"Let Them Eat Prozac" ist für jeden von Interesse, der mehr über eine Geschichte erfahren will, von der die meisten Menschen in den Vereinigten Staaten und anderswo nichts ode nur wenig wissen.
Es sollte auch von besonderem Interesse für jeden sein, der vor hat, an der kommenden Anhörung vor der FDA zur Verschreibungspraxis neuer Antidepressiva an Kinder telizunehmen.
"Let Them Eat Prozac" ist im Moment nur über den kanadischen Verlag Lorimer erhältlich. Trotzdem kann es aus den USA bestellt werden.
(Was ich am Tag, bevor ich diesen Artikel schrieb, selbst getan habe...
[Bestellinfromationen gekürzt. Anm.d.Übers.])
Um das amerikanische Publikum vor der kommenden FDA-Anhörung über das Buch zu informieren, führte ich per E-Mail ein kurzes Interview mit dem Autor. --RG
Der Titel dieses Buches hat schnell meine Aufmerksamkeit erregt.
Ihre Karriere als Autor, die sich hauptsächlich der Geschichtsschreibung der Psychopharmakologie widmet, drehte sich um die Elfenbeintürme des Akademischen und von Fachleuten überprüfte akademische Veröffentlichungen. Der Titel ihres neuen Buchs ist geeignet, das Bild eines aufgebrachten Pöbels zu beschwören, der darüber, womit er von der Psychatrie und der Pharmazeutischen Industrie die letzten fünfzehn Jahre gefüttert wurde, verärgert ist.
Ein aufgebrachter Pöbel, der Rechenschaft für die Vermarktungsmethoden der neuen Generation von Psychopharmaka fordert, wie in der kommenden Anhörung zur Verschreibungspraxis von Antidepressiva für Kinder durch das FDA am 2. Februar.
Wie kamen sie auf den Titel dieses Buchs?
Als ich eines Nachmittags mit einem Kollegen über den Entwurf des Buches sprach, ging mein damals vierzehnjähriger Sohn gerade durch das Zimmer und sagte "Du weißt, wie du es nennen solltest - füttert sie mit Prozac". Verlage und Herausgeber hassen den Titel gleichermaßen, aber sie konnten auch keinen besseren vorschlagen.
The publication of the book appears to be a quite Canadian event, but it clearly contains information that is of interest to anybody living in a society touched by the aggressive marketing of the newer antidepressant drugs. It appears the seminal event that led to the publication of this book was your firing from a professorship at the University of Toronto and the subsequent breech of contract lawsuit. What were the primary purposes for publishing this book and why did Lorimer become the publisher?
The book was essentially written before I got fired. So my firing was added onto rather than the center of or reason for the book.
I approached a number of university publishers who said it would be a better trade book and a number of trade publishers who said it would be a better university press book and they all said, "By the way, no one is interested in a book on the pharmaceutical industry."
The book ended up with Lorimer who publishes for the Canadian Association for University Teachers--so this is a CAUT book. Why? Well first of all it is a privilege to be linked to CAUT who did so much for me. But also I think the Canadians more than either the Americans, the British or other Europeans have got a grip on the corporatization of healthcare and especially the issue of how this impacts on academic freedom or the traditional role of the universities and if you want to make a difference on these issues this is the coalition to link in to it seems to me.
But the book is also now due out in Spring in the US from New York University Press who have done a great job on editing it into better shape and making it generally more user friendly.
One of the things to note is that the book comes with a website and the hope was to make the whole episode into a resource for social scientists, bioethicists and anyone interested in healthcare and corporate governance issues. To this end CAUT, who host the website healyprozac.com, are open to having other accounts of academic freedom cases posted on this site but also contrary views on how this data stacks up provided the view is not simply polemical. The site makes available a huge amount of material which does offer the opportunity for people to make up their own mind and any relevant material could be posted. The criterion for access is a posting that contains new material that can contribute to genuine debate in these areas.
The subject of ghost writing is dealt with in your book. This is a subject that has touched us in the Seattle area where I live, as Dr. David Dunner of the University of Washington admitted to the Guardian last year that he "ghost wrote" (i.e. he had nothing to do with an article he "authored") an article for the March 1995 issue of European Neuropsychopharmacology. From reading the descriptions of the publication process in the medical academic journals in the outline for the book on the Internet site, it sounds more like a public relations operation on behalf of pharmaceuticals and their products than a scientific undertaking. Is this a fair characterization of the current state of medical academic publishing?
Ghostwriting is at the heart of the process. I am due to lecture today (October 28) at Grand Rounds in the Neuropsychiatric Institute in UCLA. This will be webcast. At the heart of this talk will be just this issue with some of the examples outlined in the book.
Ghostwriting though is not the biggest problem. Often these writers (at the firms hired by pharmaceutical companies to write peer-reviewed articles for academic journals) will write better than most academics and they get results out quicker and will often be more honest. The key problem is lack of access to the data from these trials and against the background of this lack of data, the questions of ghostwriting, conflict of interest, and consultancies assume the importance they have. I think though journals who are worried about how to make sure authors are real authors are missing the key point. In the article you refer to the key point is not whether David Dunner was an author in the usual sense of the word but the fact that the data in that article are just plain wrong. They give the impression there is no difference between placebo suicidal act rates and Paxil suicidal act rates, when in fact the raw data shows a possible up to 8-fold higher rate of suicidal acts on Paxil.
Last year another Seattle area researcher Dr. Arif Kahn of the Northwest Center for Clinical Research colated the clinical trail data in the public domain for all the psychiatric drugs approved by the FDA for marketing from 1985--2000. Kahn found disturbingly high suicide rates among the 71,604 subjects who took the drugs in the clinical trials. Among the aggressively marketed newer antidepressants and neuroleptics the suicide rates almost matched the overall annual U.S. death rate. Dr. Kahn appears to be doing something you've been doing for years as an expert witness in lawsuits against pharmaceutical companies for the marketing of their newer antidepressants. How was this important, and apparently difficult to find, clinical trial data unearthed by way of discovery in court?
What Dr Khan and I have been doing is quite different. He accesses FDA reviews and not the raw data. He does not appear to have seen the raw data lying behind the tables prepared by the companies for the FDA. Had he had access to the raw data the figures he presented would have been far more alarming.
I noticed at the Internet site for the book that not even British government officials can observe the clinical trial data pharmaceutical companies used to make scientific claims about their aggressively marketed psychiatric drugs. Here in the U.S. we have a Freedom Of Information Act and discovery in lawsuits, but these instruments are too little too late for the people who have taken the newer antidepressants since they've been introduced to the market. It seems like the more clinical trial data pertaining to the newer psychiatric drugs gets put into the public domain, the worse the pharmaceutical companies and their drugs look. Do the events of the recent past with the newer generation of antidepressant drugs demand democratic transparency in the regulatory approval process for new drugs? By democratic transparency I mean putting all the clinical trial data into the public domain for comment before a drug can be approved for marketing.
FOIA will only get you FDA reviews in the main. From this you can get the names of individual trial protocols and you might be able to get summaries of these but you can't get the raw data. In Britain we have even less access, and any developments there have been in the UK are down to the efforts of the media and two women in particularly, Shelley Jofre and Boseley, who while looking at the scientific publications have said "wait a minute, this doesn't add up".
In the absence of access to data generated by people like the readers of this website taking risks with their lives and health with new drugs, only to have the companies bury the inconvenient findings, there is one other way forward. Groups like the American Psychiatric Association or the Royal College of Psychiatrists, who increasingly feature presentations of "data" from these trials at their annual meetings, could make it clear that they do not regard selected datasets without rights of access to the entire set as scientific data. I think there has been a shameful professional failing here.
Are there any antidepressants you are currently not prescribing? If there are any you are no longer prescribing could you explain why?
I have never prescribed venlafaxine (a.k.a Effexor). The data always smelt fishy to me and the marketing of this drug was even less satisfactory than that of the others--this is not to say there aren't some perfectly decent people in Wyeth, our local representative is one of the most decent we have.
The emergence of data in recent years especially on dependence and withdrawal from Paxil has meant that I no longer use this, where once I used it or recommended it a lot. I have many people who are suffering very severely with this withdrawal syndrome, which in some cases looks like it will mean that people cannot ever stop treatment. I do not want the SSRIs removed from the market, I have only ever wanted them to come with appropriate warnings, but if you had to make an exception to that it might be Paxil on the basis that we have 5 other SSRIs to choose from, losing one would not be a disaster.
I think its worth adding here that I can't see how anyone can prescribe Zyprexa. The basis for doing so on an informed basis just isn't there, given that Zyprexa manufacturer Eli Lilly refuses to put into the public domain the data on suicidal acts in their clinical trials and it seems that neither the FDA nor Arif Khan have access to this. Against a background of what seems to be the highest suicide rate in psychotropic clinical trial history, the fact that this drug had gone on to become the best-selling psychotropic agent at the moment I think stands as a good symbol of all the problems in the field.
David Healy is Reader in Psychological Medicine at the University of Wales College of Medicine and Visiting Professor of Medicine at the University of Toronto. He received his medical degree from University College Dublin and was a Clinical Research Associate at the University of Cambridge. Former Secretary of the British Association for Psychopharmacology, Healy is author of more than 120 peer reviewed articles and more than a dozen books, including The Antidepressant Era (Harvard) and The Creation of Psychopharmacology (Harvard).
Rick Giombetti lives in Seattle. This interview was originally published on his blog site.