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HS 228 – The Medicalization of Everyday Life with Dr. Allen Frances

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Dr Allen Francis joins Jason Hartman on today’s Holistic Survival Show to discuss the importance of changing diagnosis methods in the US and the drug usage trends resulting from this. As the situation currently standard, the number of people dependant on anti-depressants, anti-anxiety drugs and anti-psychotic drugs is truly staggering – a topic which Francis attempts to explain and understand.

 

Key Takeaways

02.20 – In America, the current statistics for the usage of anti-depressant or psychiatric medication are quite staggering.

04.20 – By advertising directly to consumers, drug companies are now making billions of dollars in unnecessary prescriptions.

08.10 – Ideally, the same disassociation will occur with drug companies as has occurred with big tobacco companies over the last 2 decades.

09.40 – A simple change of paying primary care doctors more and giving them more time with patients could transform medical standards in the US.

13.50 – A ‘let’s hope for the best’ mentality only serves to cause more problems.

15.45 – The debates on mass shootings and the motivation behind them always falls to more generalized gun crime, rather than on what drugs were being taken.

17.30 – Comparing the varying medical markets and systems of the US to other countries such as Egypt yields some unbelievable results.

19.30 – DSM-5 turns everyday issues into massive diagnosable health concerns.

21.25 – The guidelines mean that everyone who is a specialist sees their specialty in everybody.

 

 

Tweetables

How can we, as a society, support the careless prescription of fake and unnecessary medication? Tweet this!
The best anti-depressant in the world may be as simple as exercise. Tweet this!
Rather than correcting our current terrible situation, DSM-5 will only further open the floodgates. Tweet this!
The best thing for selling the pills is selling the ills! Tweet this!

 

 

Transcript

Introduction:

Welcome to the Holistic Survival Show with Jason Hartman. The economic storm brewing around the world is set to spill into all aspects of our lives. Are you prepared? Where are you going to turn for the critical life skills necessary to survive and prosper? The Holistic Survival Show is your family’s insurance for a better life. Jason will teach you to think independently, to understand threats and how to create the ultimate action plan. Sudden change or worst case scenario – you’ll be ready. Welcome to Holistic Survival; your key resource for protecting the people, places and profits you care about, in uncertain times. Ladies and gentlemen, your host: Jason Hartman.
Jason:
It’s my pleasure to welcome Dr Allen Frances to the show. He is Professor Emeritus and former Chair of Psychiatry at Duke University, former Chairman of the DSM-IV Task Force and author of Saving Normal: An Insider Revolts Against Out-of-Control Psychiatric Diagnosis DSM-5, Big Pharma and the Medicalization of Everyday Life. He’s been dubbed the most powerful psychiatrist in America during the 1990s and it’s a pleasure to have him on today. Allen, welcome, how are you?

Allen:
Well thank you, because I think it’s very important to get this message out and I think the only way society can change is people like you giving us an opportunity to discuss what I think is a real problem.

Jason:
This is a real problem and I’m so glad you came on the show to talk about it today. It seems like we’ve got a name for everything, and probably have those things don’t even need to be diagnosed with a name! Then, of course, when you give it a name, you can create a drug for it too, right?

Allen:
Well, it’s incredible. 25% of people in the United States would qualify for a mental disorder in any given year. 20%, so one in five, average Joes, which is almost one person per family is taking a psychiatric medication.

Jason:
Say that again, one in five people are taking a psychiatric medication?

Allen:
You got it.

Jason:
That is insane! 20% of the population is taking a psychiatric drug? Wow.

Allen:
Women over 40 – one quarter are taking anti-depressants.

Jason:
So 25% there, okay.

Allen:
In teenage boys, 20% are diagnosed with ADD and 10% are taking medication. I could go on and on with the numbers.

Jason:
One of my prior guests, Allen, said this all started in the ’70s when the drug companies were running out of customers for one reason or another and they had to just come up with a whole new category.

Allen:
The first burst of medicalization of everyday life came with valium and librium in the ’70s. The drug companies realized that this could be the motherload and that psychiatric problems could be their biggest revenue producer. It got much worse in the late ’90s; the drug companies did an amazing thing. They lobbied for and received the right to directly advertise to consumers. Only New Zealand, amongst other developing countries allowed this because it’s crazy. If you let the drug companies mislead consumers, they then go to the doctor’s office saying ‘I have this diagnosis, I need this medicine’, and if they do that, it increases the likelihood they’ll get the medicine by 20 times. So what’s happened is the drug companies have brainwashed the consumers, they’ve lavished untold attention on doctors, all with the message that mental disorders are easily diagnosed, often missed, always caused by a chemical imbalance and easily treatable with a pill. The result of this is amazing profits for these companies. Anti-psychotics a couple of years ago were taking $18 billion, anti-depressants were getting $11 billion. Stimulant drugs for ADHD were approaching $10 billion. Companies are doing great in psychiatry, but it’s not good for the people taking these unnecessary pills.

Jason:
I agree with you and we’re going to dive in with that. First, Allen, just define the categories. When you talk about psychiatric drugs – certainly we’re all familiar with the SSRI category which would include Prozac, Lexapro, those types of things. You mentioned the old ones, if you will, the 1.0 version, which is valium and – what else did you mention? I can’t remember.

Allen:
Librium.

Jason:
Librium. How many categories of psychiatric drugs are there?

Allen:
Well, basically the benzodiazepines, the anti-anxiety drugs – the most commonly used one now is Xanax or Alprazolam. It’s almost always prescribed by primary care doctors and is almost never a good drug to be taking. It’s very addicting; if people are on it they should wonder why they’re on it but don’t try to get off it quickly because it has very severe withdrawal symptoms. That’s the problem with taking a lot of drugs that are unnecessary. They have a lot of withdrawal symptoms, so don’t stop just because you hear on this program that you may not need the medication. You may get worse if you stop. The anti-depressants you’re familiar with. The anti-psychotic drugs like Zyprexa, Risperdal, Abilify and Seroquel – these have become enormous profit centres for the drug companies. They’re often prescribed liberally where they don’t really belong, especially to kids and old people. They shorten the lives of old people in nursing homes, they often make kids get really fat and we already have an epidemic of childhood obesity – and with that comes diabetes and heart disease.

Jason:
And a whole host of new potential psychological issues, like self-esteem oriented problems, right?

Allen:
That’s it. I think the point here is when the medicine is needed. It is needed for maybe 5-10% of the population. It can be life-saving, it can be wonderful; I’m not against medicine. I am very much against a careless use of medicine for fake diagnoses that are made, often by primary care doctors. 80% of the psychiatric medicines given in America are prescribed by primary care doctors, and usually after 7 minute appointments and under heavy pressure from drug salespeople. They’re also under heavy pressure from patients who have watched the advertisements. A good diagnosis requires time and expertise. Very often, people come on the worst day of their life for the evaluation. If you just wait for a month, they’ll be better. But once they start the medicine, they attribute the gain to the medicine and will often stay on a course of something that’s harmful, not helpful for long periods of time.

Jason:
First of all, explain the dynamics. You mentioned at the beginning that the drug companies are lavishing attention on these doctors, and then you also mentioned that the doctors are under heavy pressure from the drug companies. How do they do this? I know it’s not legal, but I’m sure it goes on anyway, to actually pay the doctors to recommend the drugs. What can they do? I have doctor friends – they say that golf tournaments are sponsored, and with a lot of the fun activities that go on at conferences and so forth, the tab is picked up by these companies. What are the dynamics of that?

Allen:
Well it’s actually getting much better. This is partly because of congressional investigations of the outrageous bribing of doctors to do stuff, but yeah, there’s golf tournaments, vacations, great meals, paying doctors to give talks. For a while they controlled all of medical education – every speaker would be sponsored by the drug companies. They did pizza lunches for the residents so they’d get them at a young age and have pizza lunches every day. It’s a whole system of brainwashing and commercializing the medical profession. Fortunately, that’s getting better now. Associations that were largely financed by drug companies are pulling away and the journals are becoming more independent. They were also very dependent on drug company advertising. The drug companies have been so outrageous that there’s now a necessary kind of correction, and I think the best hope is that we will have the same situation with drug companies that we have with big tobacco companies. They seemed to rule the world 25 years ago, but they were wittled down to size. There was a David and Goliath battle but David was right and it made that situation right. I’m hoping that the same will be true of drug companies.

Jason:
I’m glad you made the distinction, by the way, that some of these do help people and are necessary, but the vast majority (probably 75% of the market) are not necessary. They’re massively over-prescribed. I’m a business person and one of the things that frustrates me constantly is the area of law in that lawyers are not required to specialize. I always compare it to medicine. Doctors are required to specialize – you’re either in family practice, or you’re an internist, or you’re a brain surgeon. If you specialize in psychiatry, that’s the thing. It seems like we should take away the rights of the General Practitioner to be prescribing these drugs. You should have to go to a psychiatrist, I think. Is that a good solution or not?

Allen:
Probably not. Here’s the problem. We have far too few primary care doctors. We’re over-specialized in America and it’s not just a problem with psychiatry. It’s a problem across all specialties. We need to have more primary care doctors, but they need to have more time with these patients and more training. They’re noble. By and large, it’s not that they’re bad people. They want to do a good job; the problem is that they only get 7 minutes per patient. They work like dogs, they’re underpaid and that’s why we have so few of them. I think we could improve medical care in this country immeasurably if we paid primary care doctors better and we gave them the time to deal with patients. They don’t get to know their patients because they don’t have time.

Jason:
You know that trend is going the opposite way with nationalized healthcare. They’re probably going to be spending less time and knowing their patients even less – that’s a subject that I don’t really want to dive into but you can comment on it if you like.

Allen:
A different time.

Jason:
Fair enough, we’ll leave that one on the shelf. So there are too few primary care doctors, that’s what you said? You didn’t say there were too few psychiatrists.

Allen:
No, I think that the issue is that there will never be enough psychiatrists to deal with every human problem. We’re going to be depending on primary care doctors, and I’m not against that. I am against their receiving so little training and I’m terribly against their being lobbied by drugs companies the way they are. I’m sympathetic to the fact that very often, the patients are forcing their hand and they have no choice, and I mostly want them to have more time and fewer patients. If the primary care doctors know their patients and have time to speak to them rather than just prescribe a pill and give them a free sample, I think we’d have better care in this country. Certainly, we have to re-educate the public. Parents need to protect their kids from being over-medicated and not think that every time they give their kid some medicine it’s going to improve school performance. People need to realize that these medicines have harms as well as benefits and unless you have a severe problem, you’re better off not being on them.

Jason:
Right, I couldn’t agree with you more. A lot of it has to do with just diet and exercise and good old basic stuff that’ll just make you feel better.

Allen: 
Exercise is one of the best anti-depressants and anti-anxiety solutions I’ve ever known. If we can just get people to start and to stick to it, it has amazing benefits. That’s actually been demonstrated and has been proven true in my personal experience with patients. The hard part is getting people started. If people want a good anti-depressant and their problem isn’t severe depression, the best anti-depressant in the world may be exercise.

Jason:
Yeah, take a jog around the block and get those endorphins going.

Allen:
Whatever it is for you, do it every single day. The main point is that people don’t do it. Each person has to find his particular thing that he’ll do, and whatever it is, he has to do it every single day.

Jason:
Give us an example with maybe one of these drugs – feel free to pick one. What goes on when someone takes one of these drugs? I know that the SSRI drugs and that whole category has been linked to suicide and maybe to these mass shootings, although that seems pretty suppressed in the media. I’ve talked about that in the past with other guests. What happens to people when they take these things? What does it do to them?

Allen:
It varies with the drug, the dose, the person and the circumstance. If someone has a psychotic illness and they don’t take an anti-psychotic, they’re likely to stay very sick. The brain learns to have hallucinations and delusions and rather than getting better they get worse. For people with psychotic illnesses, anti-psychotics are wonderful, but they’re being given out promiscuously, often for fake bipolar disorder, for conduct problems in kids and in situations where they’re not clearly indicated, they can cause the person to get sleepy. It also causes them to gain weight and the biggest problem with the current drugs is that the weight gain can be enormous. It can be 10% of your body weight in just 12 weeks. So it’s not just that you’ll feel different, it’s also the long-term risk that maybe you’ll get diabetes or heart disease. We have less receptive measures for risks and harms than for benefits. All of the risk-benefit analyses that are done in deciding when a treatment is indicated tends to be skewed towards a ‘let’s hope for the best’ option, without really taking into account that often you have the unintended consequences of the worst.

Jason:
What about the mass shooting and the link to these drugs?

Allen:
I have strong feelings about this. We will never, ever be able to predict who the mass shooter is. We can pick out a group of people who are high-risk, but we’ll never be able to say which guy and when he will do it. When we look for explanations, we’ll always try to find an easy answer and my personal feeling is that the best we can do it provide easy access to treatment for people with psychiatric problems. That’s the best prevention. It’s not going to catch everyone, but it will catch some. Many people won’t go for treatment, many people may not be helped by it, but it’s the best we can do. My feeling – and I’m not sure if you share this – is that easy availability to guns turns what might be a small murder situation into a mass murder situation. If we can’t predict the mass murderer, the best we could do is try to make sure that people who have a history of mental illness or a proclivity to domestic violence or substance abusive have a much tougher time getting their hands on guns.

Jason:
Sure, that carries a whole other debate that we don’t have time for, but the thing I wanted to point out, and of course you know this, obviously, is that the drug companies are huge advertisers on all sorts of different media – whether it be radio, television, magazines, print media. They’re just everywhere. They’re all over the web and these ads follow you around the web. It’s mind boggling how they’re just everywhere. I’ve just got to think that these media companies are afraid to say anything bad. They’ve seen people and writings about how that’s the thing that all these shooters have in common: they’re all taking these drugs. It’s a chicken and egg argument, for sure, but I just wonder about the cover-up. You talked before about the doctors being pressured, the doctors being lobbied and sponsored, and this is another way that I think the truth of what might be an issue – I’m not saying it is and maybe nobody knows. It’s just not out there. You don’t hear about it in the mainstream media. The debate always falls to gun control, but it never goes to what pills is the guy taking. It seems like we’d want to know that.

Allen:
I would be focusing on both because I think it often is a chicken and an egg situation, and often there are some hints because of a violent problem in the first place. I think the larger issue is that they spend $60-$70 billion a year on marketing and lobbying for their drugs. They spend very little on real research. Most of the research is done just to try and get a longer patent and to make the drug really expensive. An amazing new phenomenon was with the Hepatitis C drug that went out at one thousand bucks a pill. 84 pills are needed, which is $84,000 to treat someone. In Egypt, they negotiated a price of $900 for the 84 treatments. $84,000 here, $900 in Egypt, and in Egypt they’re making money. It’s not a free market so they have a monopoly over pricing that they’ve gained because of their control of the politicians. We really need to break their monopoly over pricing to make everything more transparent. This is a situation where we need regulation because without regulation, it’s your money and your life.

Jason:
The problem with regulation is you make the government bigger and then there’s more chance for corruption. I just can’t believe that. In Egypt is it really the same drug?

Allen:
Exactly the same drug. Overall, we pay at least twice as much for every drug than the rest of the world. That’s because in other countries, people who are buying the drug have the right to negotiate. Here, the drug companies talk the politicians into not giving the buyers the right to negotiate. It’s a one-way market, and when health is concerned, it’s like they have a gun to your head.

Jason:
Yeah, unbelievable. The same is true with Wall Street. I like to say that Wall Street just owns the government, and that’s the way they commit all their crimes, and even if they’re legalized crimes they get the regulations they want passed. Keep in mind that those regulations help keep established players and keep their semi-monopolies. New people can’t enter the market and can’t afford the compliance.

Allen:
I think the one thing that worked with tobacco was public outrage that finally overwhelmed the big bucks. When we took away the companies’ right to advertise outrageously and misleadingly and we had a cancer education campaign about the dangers of smoking, it worked. We used to have 60-70% of our people smoking; now it’s fewer than 20%.

Jason:
It’s awesome. I know, it’s great. It seems like a lot more people are still smoking in Europe and in other countries, which is awful. Philip Morris went overseas and the crack-down happened here. Tell us about DSM-5. Does that pose a risk to children? First of all, tell people what DSM-5 is.

Allen:
It’s a diagnostic system which determines who’s healthy and who’s sick, who gets treatment and what kind of treatment. It also decides whether it’s paid for by insurance or not. It’s very powerful in the courts and in custody battles. It determines who gets disability and school services. It’s become way too powerful in the world and the problem with DSM-5 (the latest version) is that it takes a situation where we have diagnostic inflation and a chance to make diagnostic hyper-inflation. It turns normal grief into major depressive disorder; it turns my forgetting of old age into minor neurocognitive disorder; it turns my overeating into binge eating disorder; it turns my grandchildren’s temper tantrums into mood disregulation disorder. It makes it even easier to get Attention Deficit Disorder for kids, and especially for adults. My concern is that we have a terrible situation now and DSM will be opening the floodgates, rather than trying to correct the problem.

Jason:
How new is DSM-5? The fifth version of it.

Allen:
One year.

Jason:
It’s a year old, so we’ve had 5 of them. When did DSM start? Was it in the ’70s?

Allen:
DSM-1 and -2, no-one cared about. DSM-3 was a big change. It introduced criteria for each diagnosis, and this means that people can agree on the diagnosis if they use the criteria. More importantly, it became a bestseller. DSM sells several hundred thousand copies every year – much more than they’re commissioned. It changed the public discourse. People became interested in diagnosing themselves, in diagnosing their lives, diagnosing their bosses. It influenced how doctors practiced and recently it’s been very misused by the drug companies because they’ve learned that to sell the pills, the best thing they can do it sell the ill. Selling a psychiatric diagnosis is the most effective way of pushing the pills.

Jason:
Who creates the DSM? A committee, I suppose, right?

Allen:
Right, and I chaired the one for DSM-4. It’s sponsored by a professional organisation – the American Psychiatric Association – and it is a problem for all of medicine, not just for psychiatry. Most guidelines for diagnosing treatment are done by professional associations. They have an inherent conflict of interests. Sometimes financial, always influential. The specialists in any one area are not to be trusted in defining disorders in that area without external governance because they’ll always expand them. If you’re a rheumatologist, you see rheumatological symptoms everywhere. The diabetes people have made it much easier to get diabetes; the hypertension people have made it easier to get hypertension. If you believe in osteoporosis, everyone has osteoporosis – the woman who’s 50 should have the same bone density as a woman who’s 24. We have this tremendous expansion in diseases all across medicine, and that means treatment. The drug companies and device makers, and the people in the medical industrial complexes just jump on every suggestion that there are several million more people who have this problem and makes their share rich. A lot of the people who get the diagnosis wind up being more harmed than helped. The best example is prostate cancer. It used to be that a guy like me should be getting prostate tests every year. Now the recommendation is just the opposite. Unless you’re at risk, don’t do it. Even though lots of people die with prostate cancer, maybe 75% of men, in most instances it’s not what kills them. What may make their lives miserable is the treatment for a prostate cancer that wouldn’t have caused them much trouble. Overall, in America, we over-diagnose and over-treat, but psychiatry is a special case of that. I’m hopeful that we get wise to this, not just in psychiatry but in all aspects.

Jason:
Yeah, definitely. Very good point; it’s really interesting to understand this. The last parting thought I’d like you to address is it seems like a lot of the help are outraged. As the famous deep-throat from the watergate conspiracy said: ‘Follow the money’. It seems like the insurance companies would be bugged about this, right? They don’t want to spend a lot of money on paying for these drugs that are unnecessary, right? Why aren’t they outraged?

Allen:
No, they actually are part of the problem in two ways. Insurance companies are pastors. They don’t really care how much they spend because they’re a product in the denominator. One of the ways they cause problems is they require a diagnosis to pay the doc on the first visit. It’s a doctor’s diagnosis that often would be unnecessary if, as in the rest of the world, they had five or six visits to evaluate the patient before making the diagnosis. Many people who now have a diagnosis wouldn’t have one if the doc was able to observe them for a month – the problems would go away on their own. Once you give a diagnosis and give a pill, the pill will be the thing that’s carried forward when often in situations it’s not needed. The insurance companies are very short-term in their thinking. They don’t take a life-time course into their consideration; they’re thinking about the next quarter. Pills are cheaper in the short-run. Psychotherapy is more expensive in the short run but is a lot cheaper in the long run because people don’t have to stay on the pills. They should be financing pills and forcing diagnoses a lot less and in the long-run that would be cost-effective. They don’t care that much about cost-effective because in the long-run, they get their profit off the top.

Jason: 
Wow, it’s just amazing. This is just an unholy alliance in every direction. We’ve got iron triangles all over the place.

Allen:
We have among the worst healthcare in the world and we’re spending a fortune on it.

Jason:
It’s unbelievable. The Pharma companies have hijacked the government just like Wall Street has. It’s the same story. Alright, Allen Francis, thank you so much for joining us today. Give out your Twitter, or whatever you want to give out – any resources.

Allen:
I guess the best thing for people interested in these questions would be @AllenFrancesMD on Twitter.

Jason:
And Dr Allen Francis, thanks for joining us.

Allen:
Thank you and thanks for spreading the word.

Outro: 
What’s great about the shows you’ll find on www.jasonhartman.com is that if you want to learn how to finance your next real estate deal, there’s a show for that. If you want to learn more about food storage and the best way to keep those onions from smelling up everything else, there’s a show for that. If you honestly want to know more about business ethics, there’s a show for that. And if you just want to get away from it all and need to know something about world travel, there’s even a show for that. Yup, there’s a show for just about anything. Only from www.jasonhartman.com, or type in ‘Jason Hartman’ in the iTunes store.

 

Thank you for joining us today for the Holistic Survival Show, protecting the people, places and profits you care about in uncertain times. Be sure to listen to our Creating Wealth Show, which focuses on exploiting the financial and wealth creation opportunities in today’s economy. Learn more at www.jasonhartman.com or search ‘Jason Hartman’ on iTunes. This show was produced by the Hartman Media Company, offering very general guidelines and information. Opinions of guests are their own, and none of the content should be considered individual advice. If you require personalised advice, please consult an appropriate professional. Information deemed reliable but not guaranteed.

Episode: 228

Guest: Dr. Allen Francis

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