Who’s this Healy bloke then?  David Healy, author of Pharmageddon, is Professor of Psychiatry at the University of Bangor in Wales, who also runs the blog davidhealy.org and set up Rxisk.org – of which more later.  He’s a respected psychiatrist, psychopharmacologist, scientist, and author who was the first to draw attention to the links between popular antidepressants and suicide.

So it’s “a psychiatrist’s eye-opening view of medicine and the drug industry,” eh? Do we need another book-length list of professional grievances with the pharmaceutical industry?  I’d say that yes we do, especially if it brings to light new information that has yet to be revealed.  If you've read Deadly Medicines and Organised Crime by Dr Peter Götzsche and don’t want more of the same, the good news is that Pharmageddon takes an almost entirely different tack.  Rather than Götzsche’s prolonged and merciless anti-pharma broadside, Healy’s latest steps back and zooms out – first of all, to identify that mainstream medicine as a whole in the 21st century is “at death’s door”, and secondly to see what solutions there might be. 

Prof David Healy, author of Pharmageddon

More a plea for ‘physician, heal thyself’ then? You could say that. 

OK, start at the beginning.  Essentially, Healy’s thesis is that orthodox medicine as practised between the 1940s and the mid-1970s was something of a golden age.  New, exciting and, crucially, effective treatments were coming onstream for conditions that were previously untouchable – he’s very keen on penicillin, for obvious reasons, the antipsychotic (anti-schizophrenia) drug chlorpromazine and the amphetamines, for example.  Then bureaucracy got involved in the form of the US government: the 1962 update to the 1938 Food, Drugs and Cosmetics Act, inspired by the thalidomide tragedy, has become, according to Healy, a malevolent cloud oppressing all of medicine, worldwide – in spite of its good intentions and those of its proposer, Senator Estes Kefauver of Tennessee.  For example, older drugs have been progressively replaced with expensive, on-patent agents that are both less effective and more dangerous.

Interesting.  Why did Kefauver get involved in the first place?  He was concerned about cartel pricing among the drug giants of the time, along with false and misleading advertising and inadequate testing of new drugs.  The thalidomide tragedy ensured that Kefauver’s 1962 Bill became law as a matter of urgency, with five major consequences for pharma: drugs had to be tested on animals for toxicity pre-launch, control of advertising shifted to the Food and Drug Administration (FDA), prescription-only status was maintained for all new drugs, companies had to prove their products worked for a specified condition and they had to use controlled trials to demonstrate drug benefits – although companies maintained patent rights on products.  Intriguingly, Healy maintains that “one of his aides slipped these [controlled-trial requirements] into the 1962 act” without his knowledge, which raises interesting questions of motivations, foresight and consequences, whether deliberate or otherwise.

Perhaps I haven’t had enough caffeine yet today, but I can’t see a problem with any of this.  All I can say is, you need to read the book – you’ll find details of where to buy Pharmageddon at the end of this review.

That, sir, is a cop-out.  You want more?  OK.  These five points lead directly to the main aspects of Healy’s theory, well summarised near the end of the book on page 263: “When it comes to pharmaceuticals, because of prescription-only arrangements, the current operation of patent laws, the sequestration of trial data, the ease with which medical experts can be seduced by junk epidemiology, and the extent to which bad data has driven out good data, this is not a market that can respond to patient pressure.  It is a market where patient pressure is perverted by pharmaceutical marketing campaigns, where outcomes can get worse with no apparent consumer (medical) concern” – doctors are the consumers of drugs under prescription-only arrangements, not patients – “...a rigged market that operates in terms of five-year plans.  Indeed, it is a polity, rather than a market, that in its control of information is perhaps best described as totalitarian.”

He’s not sitting on the fence, is he?  No – Dr Healy is writing an impassioned cry for the reclamation of the profession he loves from the soulless forces of profit and standardisation: what he calls the “eclipse of care”.  He’s excellent on how controlled trials became the drug industry’s best marketing tool, and how an overwhelmingly ghostwritten medical literature is today based on shockingly incomplete data and uses the concept of statistical significance to ‘disappear’ adverse events – even deaths and suicides.

Unbelievable.  How does Dr Healy propose we row back from this crazy situation?  Again – you’ll have to read the book!  But one key idea is Rxisk.org, which allows patients to record adverse drug events in a formal manner, share the results with their doctor and, via a database, discover whether others have had the same or similar experiences.  The end result, in Dr Healy’s words, will be to “wrest control away from the “shadow government” that runs health care”.

And, of course, greater emphasis on prevention through diet and lifestyle, increased personal responsibility for our own health and a long-overdue focus on natural healthcare will also hit the ‘shadow government’ where it hurts.  Quite right! And no, you can’t have my job.

Details

Author: David Healy, MRC Psych

Title: Pharmageddon

Publisher: University of California Press, Berkeley and Los Angeles, USA

Date of publication: 2012 (hardback), 2013 (paperback)

ISBN: 978-0-520-27576-8

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