The Evening News and the Behavioral Blues: Comments on Joseph Wyatt and Donna Midkiff's Biological Psychiatry: A Practice in Search of a Science, and Stephen Wong's Behavior Analysis of Psychotic Disorders-Scientific Dead End or Casualty of the Mental Health Political Economy?

Article excerpt

THE EVENING NEWS: WYATT AND MIDRIFF'S BIOLOGICAL PSYCHIATRY

Today's network evening news programs, ABC, CBS, NBC, present thirty minute parades of drug commercials interrupted by segments of news. The floats in the parade, each a commercial that promotes a drug treating such conditions as sleep difficulties, sexual dysfunction, anxiety, and depression, 30-second dramas of positive life changes brought about by drugs. Then, like unreadable banners with small print flying behind each float, come rapidly spoken disclaimers about each drug's limits and side effects. Listen carefully. The rapidly disclaimer tag lines reference many of the problems addressed in Wyatt and Midkiff s article. Caveat emptor.

Thirty years ago psychiatry faced sharp declines in the number of medical school graduates and the intrusion of psychologists and social workers into therapeutic practice. Finding evidence to support medical foundations of psychological difficulties became a priority among psychiatric researchers, the authors report. When drug companies who shared an interest, including a large economic interest, in securing a biological-medical foundation for problems in living, joined the fray, the battle turned. Biological causation, drug companies asserted in media, office visits and advertising, warranted biological treatment. From 1985 to 1994 prescriptions of stimulants tripled and prescriptions of mood elevators doubled. The pharmaceutical industry initiated and continued intensive marketing of psychopharmaceutical products. As recently as 2001, the authors note, the industry spent $19 billion on marketing and $200 million on lobbying and campaign contributions. By 2003, the drug industry underwrote 70% of all clinical drug trials in the USA. And "off-label" drug prescriptions, prescriptions of medications not yet approved by the FDA, have soared.

Where's the evidence? Wyatt and Midkiff review oft-cited identical twin studies, a bedrock method in research on the relative importance of genetics and biological causation due to the appearance of psychiatric disorders in twins reared apart. They point to false assumptions and methodological problems that significantly weaken biological causation conclusions based on these studies. Similarly, the authors identify statistical flaws in autopsy-based evidence as well as problems in the logic of causality in brainimaging research. Wyatt and Midkiff also point to methodological issues in the culling of patients from placebo-receiving groups in controlled studies, even though these methods receive FDA review and approval, a problem that warrants further attention by both the authors and the FDA. Moreover, these are not problems with single studies. Rather, Wyatt and Midkiff present a strong case that they represent patterns of research practices that have been only partially examined, too often unchallenged, and then lost in the flood of dollars poured into drug marketing.

In a culture deluged with fast-food and instant electronic communication, the success of drug-based quick-fixes for anxiety and problem behaviors should not surprise us. But the real surprise, as Wyatt and Midkiff point out, is the failure of the scientific community to take a hard look at the economic interests that bend scientific findings for private gain.

THE BEHAVIORAL BLUES: WONG'S BEHAVIOR ANALYSIS AT A DEAD END OR A CASUALTY OF THE MENTAL HEALTH POLITICAL ECONOMY?

In 2003 the sales of only a single antipsychotic drug, Zyprexa, totaled $4.28 billion, Wong reports. Further, he adds, for two decades manufacturers of drugs have had had the highest profits of any American industry.

Fifty years ago state hospital administrators and medical staff faced overcrowded conditions. In 1954, armed with inconclusive and relatively small-sample research on the effectiveness and value of Thorazine, Smith Kline & French sent fifty representatives into the field to work with legislatures to develop drug budgets for state hospitals. …