Category: pharmaceutical Industry

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Are Psychiatric “Medications”Essentially The Same As Recreational Drugs?

Welcome to From Insults to Respect. Today we shall look at a theory that is certain to fire up some mighty strong emotions.

Most advocates within the medical profession say their prescriptions for psychiatric drugs, which they refer to as “medications,” improve the health outcomes for their patients. There are some within the profession that fervently object to this claim and provide extensive research evidence for their position, but nevertheless are clearly a minority. Meanwhile, taking legal and illegal recreational drugs are mostly viewed as distinctly different not only by medical doctors, but a majority of those in the general population.

That said, I do think it is useful for us to look at the case that although there are some differences, essentially they are the same when it comes to opportunities to 1. assess side effects/toxicity as one makes decisions to partake, and 2. what keeps users to continue consuming them.

Assessing Side-Effects and Toxicity

The Food and Drug Administration provides readily available information on the internet, regarding the side effects and toxicity of these substances. Updated research on this information is regularly appearing in the press. For example, we have recently seen stories about how even one glass of an alcoholic beverage can have negative effects on some aspects of health outcomes.

Anyone who wants to delve into a more thorough assessment of health consequences of any of the legal and illegal recreational drugs and psychiatric drugs can do a literature search. I have found Google Scholar fairly easy to use for this purpose. It provides the abstract of the research for free. There is an occasional pay wall that can be modestly costly in order to read the entire paper, but anyone who wants to make a fully informed decision on the risk of partaking can obtain the available evidence at a reasonable cost. Many of the published evidence can be misleading particularly because most studies look at just short-term results, yet many folks take these drugs for much longer. But this is true for recreational and psychiatric drugs, so assessing safety is hardly perfect regardless of what drug is being considered.

The Physical and Psychological Reasons People Continue to Consume These Legal, Illegal, and Psychiatric Drugs Are Essentially the Same.

Let’s begin this theory by using nicotine as an example and by taking a close look at an impressive study in the scientific literature (see HERE).

smoking 5Our body, upon beginning the habit of consuming nicotine, at first fires its receptors more frequently than usual upon each exposure to this drug. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first start smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”

For smokers, we see evidence of tolerance in studies that indicate fewer responses than do non-smokers to the same amount of nicotine (Perkins et al. 2001b). More specifically, we see a reduction on measures of subjective stimulation that may be viewed as pleasurable, such as arousal, vigor, and a subjective experience often referred to as “head rush” or “buzz.”

Once the down regulation process is complete, you end up with enough receptors to function fairly well as long as you continue to consume using this drug. withdrawal 2However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not regularly consuming the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.

The relief that smokers feel each time they give themselves another dose of nicotine creates the powerful illusion that cigarettes help them to deal with stress. Thus, in a study published in the American Psychologist, researchers found the following:

smokingSmokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

drug withdrwal 1Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.

Another major part of the addiction process is that the addictive substance often is used as part of a ceremony creating a very pleasant experience. As an example of this, listen to the actor John Cusack explaining his smoking habit:

John Cusack

John Cusack

To me, cigars are a much better situation than cigarettes. Cigarettes are compulsive and cigars are kinda, languid, luminous conversation. Like you’re gonna sit for a couple of hours and talk to somebody. If you gotta smoke, I would say, at least have a long conversation with someone you like, rather than just compulsively sucking down a cigarette. That’s how I’m gonna lie to myself so I can keep smoking cigars.

Although the cigarette habit is not John’s cup of tea, many people have fond associations of sharing a cigarette with others, and drinkers have associations of some very good times hanging out with their buddies. Of course, others have very negative associations with an addictive substance.

Can it be that the same two mechanisms–reduced receptors and pleasant ceremony– that creates the illusion for nicotine users are similar for other drugs that are the other legal, illegal, and psychiatric drugs?
Clearly, regular users of alcohol go through a withdrawal reaction when they don’t get a drink around the time they usually imbibe. We get a delightful sense of this listening to Jimmy Buffet singing about it being five o’clock somewhere and his desire for the relief he needs by taking a swig of his favorite intoxicating drink.

How intense the need can become is powerfully brought home to us during Ray Milland’s Academy Award winning portrayal of Mr. Birnam, an alcoholic in the movie, “The Lost Weekend.”

Ray“Just give me a drink,” says Mr. Birnam with exquisite anguish.
The bartender, in a disbelieving voice: “Mr. Birnam, this is the morning!”
“That’s when you need it most, in the morning,” Mr. Birnam replies with disgust. “Haven’t you learned that yet! At night, it’s a drink, in the morning, it’s medicine!”

Like nicotine, regular consumers of alcohol get a pleasant relief from the sensation of drug withdrawal reactions, and it is often associated with particularly good times.

Often, it is a combination of these drugs that work together to create the illusion that they are a type of “medicine,” relieving stress and feeling an improved sense of being.

Consider Jerry Irby who tells us in his song, One Cup of Coffee and a Cigarette:

IrbyHotlineNow when I get up in the morning
And I’m feeling mighty low
There’s just one thing that will pep me up
And I want you all to know.
Well it happens every morning
No matter where I’m at
I just gotta have a cup of coffee
And a cigarette
Coffee, coffee,
And a Cigarette
Is a habit
That you can’t forget…
There is no doubt that each of the legal, illegal. and psychiatric drugs have powerful withdrawal actions that is relieved when one once again consumes them. The ceremony that medical doctors use to encourage their patients to use psychiatric drugs involves a highly respected professional describing a process in which people often report feeling better as a result of consuming their prescription.

With so called “antidepressants” the withdrawal reaction is referred to as “Antidepressant Discontinuation Syndrome.” It causes a variety of symptoms like nausea, insomnia, fatigue and achiness. Interestingly, prescribing doctors of these drugs, when the patient reports not being helped by the first prescribed drug, often will prescribe others, and even a cocktail of others until the patient reports improvement. During this time the patient might have improved without the drug but attribute feeling better to the drug.

Different people find some drugs pleasant when they first try them while others are not. I know someone, for example, who loves his cigarettes but doesn’t like how marijuana makes him feel. The process that doctors use when trying different prescriptions until one is found that the user happens to feel better on serves this illusion creating process perfectly.

Support for the theory I am putting forth comes from several studies.

People Who Get Over Depression Without “Antidepressants” Do Better Than Those Who Had Taken Them

A recent publication in the journal American Psychologist by Professor Steven Hollon neatly summarizes what I am referring to.

Depression is an inherently temporal phenomenon. Any given episode tends to remit spontaneously even in the absence of treatment but recurrence is common (at least among people seeking treatment). There is reason to believe that depression may be an evolved adaptation (like pain or anxiety) that increases reproductive fitness (the likelihood that one’s gene line will pass on). If so, then any treatment that facilitates the functions that depression evolved to serve is likely to be preferred to one that only anesthetizes the distress.  

After this opening statement, Prof. Hollon provides a more complete description of his theory:

Depression is an adaptation that evolved because it keeps organisms focused on (ruminating about) complex social issues until they can be resolved and that medications work not so much by addressing a nonexistent deficit in neurotransmitters in the synapse as by perturbing underlying regulatory mechanisms to the point that they reassert homeostatic control over those systems. If the latter is true then medications may work to suppress symptoms in a manner that leaves the underlying episode unaddressed and patients at elevated risk of relapse whenever they are taken away. 

So, I hope you will consider this theory of the illusion regarding how helpful these drugs are and please feel free to express your reactions in the comment section below.

My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
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The Disrespectable Pharmaceutical Industry

In recent years, we have been hearing about several unsettling stories involving the pharmaceutical industry, one involving suicide under pressure. Another, about the exorbitant cost of life saving EpiPens. And another, about the deadly selling of addictive pain killers.

Suicide Under Pressure

On August 11, 2016, the New York Times carried a story titled “Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell.” Here we learn about a 27-year-old salesman for Abbott Laboratories who rode his motorcycle to a remote railroad track and jumped in front of a train.

Friends of Mr. Awasthi visiting the spot where he committed suicide. Atul Loke for The New York Times 
He left a note that said, “I’m going to commit suicide because I can’t meet my company’s sales targets and my company is pressuring me.” More than 250 fellow Abbott drug sales personnel walked off the job for a day, protesting what some called the company’s overly aggressive sales policies that compromised patient health.

drugs 4A six-month investigation by The New York Times found that in the push to win customers, some Abbott managers instructed employees to pursue sales at virtually any cost. Among the ploys used to sell drugs, Abbott managers told sales staff to hold what the company called health camps, where representatives would perform tests on patients for various ailments in an effort to drum up business for doctors, who would then prescribe Abbott drugs.

The article goes on to tell us:

Rajeev Khanna, who managed six sales representatives for neurology medicines in northern India, said he was fired after complaining to Abbott’s office of ethics and compliance that his team was submitting fake invoices to increase sales.

The Life Saving EpiPens

Immediately on the heels of the suicide story, I began to hear the media uproar over the marketing strategy by the company that manufactures EpiPens.

Between 1 and 2 percent of people who have particularly strong allergic reactions can go into a state known as anaphylaxis, when their airways swell and close. Fortunately, there’s a simple treatment for such reactions–Epinephrine. Epinephrine is very, very cheap. It costs less than a dollar per milliliter, and there’s less than a third of that in an EpiPen.

But to save a life, Epinephrine must be delivered quickly and in the proper amounts. People suffering severe allergic reactions often can’t do it themselves. Drawing the drug into a syringe and then administering it to someone else requires training and precision that most people lack. The EpiPen was created so that pretty much anyone can deliver the proper dose with no special training. Pull off the safety cap, put the tip against the thigh, and push. Boom. Epinephrine delivered.

According to the New York Times,

The EpiPen isn’t new; it has been in use since 1977. Research and development costs were recouped long ago. Nine years ago, it was bought by the pharmaceutical company Mylan, which then began to sell the device. When Mylan bought it, EpiPens cost about $57 each.

Unfortunately, research shows that Epinephrine degrades pretty quickly over time, and therefore it is recommended that EpiPens be replaced every year. People who have serious allergic reactions need to store EpiPens in several easy to reach places, so they often need to buy several.

drus 9Mylan has a veritable run of the market. It therefore, in a few short years, raised the price of EpiPens again and again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.

The government encourages the product’s use, but makes no effort to control its cost. As the New York Times article concludes:

EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.

Responding to the national outrage over high prices, Mylan announced plans to launch the generic version in “several weeks” at a cost of $300 per two-pack carton, compared with $608 for the branded EpiPen. But this lower price is still more than four times the cost just a few years ago.

drugs 10These latest two media stories are just a tip of the iceberg when it comes to how the pharmaceutical industry is treating its customers disrespectfully. Anyone who really wants to know the full story would do well to read Dr. Marcia Angell’s superb book, The Truth About the Drug Companies: How They Deceive Us and What To Do About It. The author has an M.D. degree, and for two decades was editor in chief of the prestigious New England Journal of Medicine. There she had a front row seat on the growing power and corruption of the industry.

What Dr. Angell Reveals

The most startling fact about 2002 is that the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion) . . . When I say this is a profitable industry, I mean really profitable. It is difficult to conceive of how awash in money Big Pharma is. (Marcia Angell)

drugs 1As Dr. Angell powerfully demonstrates, claims that high prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into marketing of their products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.

One of the most harmful practice occurring today is the pharmaceutical industry’s practice of creating “me-too” drugs. Instead of using their vast resources creating new drugs to improve treatment or tackle diseases that have no current effective treatments available, the industry typically places most of their research efforts to create a drug that does the same thing as an older drug that is about to lose its 20 year patent rights. Since, upon losing a patent right, a company realizes that other companies can begin to sell the drug at a reduced, more competitive rate, a company will change one molecule of the old drug, or make some other slight change, and then quickly look to see if the change does not lead to any loss of treatment effectiveness. If it proves to be just as effective, as it often is, the company will then seek a fresh new patent for what it claims is a brand new drug. Once a new patent is obtained, the company then begins to market the “new” drug on TV and in magazines, claiming it is the latest advance in the treatment of the particular disease, and the actors in the ads claim that they were hoping to get relief for years but only now, since the “new” drug became available, they finally feel well. Patients begin to demand that their doctor prescribe the new drug, which is far more expensive than the old drug that had been available for years but is no longer under patent protection.

drugs 11How do the drug companies get away with this, since a patent is only supposed to be issued when the new drug is useful, novel, and non-obvious. The drug companies have the largest army of lobbyists in Washington, D.C. If you think the gun lobby has an unfair hold on politicians, it is small potatoes when it comes to the pharmaceutical industry.

Some from the drug companies argue that they are only doing what the free market allows. But that is far from the truth. Through its lobbying efforts, drug companies have become utterly dependent on government-granted monopolies in the form of patents and FDA approved exclusive marketing rights.

drugs 5How do drug companies justify all of their me-too drugs? They claim that it is good to have more than one drug to treat a condition, because if the first one doesn’t work, the second might. Here’s Dr Angell’s reply:

[T]here is little evidence to support the notion that if a particular drug doesn’t work for a patient, a virtually identical one will. Or if one drug causes side effects, another one won’t. The companies could easily test this proposition. They could test their me-too drugs in patients who have not done well on the first one. But they don’t do that, probably because they don’t want to know the results–if Prilosec doesn’t work, Nexium probably won’t, either. They simply compare their me-too drug with placebos.

The above critique of the drug industry is really just a little taste of what is wrong. Other quick examples are, drug companies often rig clinical trials to make their products look far better than they are, and they use their legion of lawyers to stretch out for years government-granted privileges that run completely against the interests of the vast majority of its citizens.

What Can Be Done? 

drugs 6The solution to getting the drug companies to start treating us respectfully would be fairly easy if only Congress could fire up the will to stop listening to the industry’s lobbyists. Laws could simply be enacted that would replace the 20 year patents on new drugs with laws that would provide a patent that lasts only until the company recoups its investment in creating the drug. When the patent runs out, they could still continue to sell the drug without the patent. After all, companies that sell off-patent generic drugs do make profits, but just not as outrageous profits that allow the industry to employ more lobbyists on Capital Hill than there are congressmen.

Furthermore, laws can be easily enacted that would stop giving patents to companies when they create me-too drugs. If a drug company really believes creating me-too drugs are beneficial for their customers, they could still create and sell them at a modest profit.

There are several other laws that also would have to be passed to put a stop to all of the disrespectful actions, most of them neatly laid out in Dr. Angell’s book. None are difficult to achieve if Congress wanted to act.

drugs 7Unfortunately, the influence of the lobbyists have been way too great for the lawmakers to resist going along with the drug companies. So, as is often the case, it is up to those of us who are being treated disrespectfully to stand up and powerfully advocate that we begin to be treated respectfully. drugs 8This would entail making it known that we voters will only support candidates who are running for office who refuse to take money from the pharmaceutical industry. If there are no such politicians running in the district we live in, we must identify someone who is willing to run on this issue, and then we must work to get that person elected. Without such action, we folks will have to accept that being treated disrespectfully by the drug companies is just a sad part of life.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.