In Medicine, The Power of No vs Psychiatry’s Massive Over-treatment

Published with the permission of Vera Sharav of AHRP. She sends out an email with these informative articles on a regular basis.

I’m sorry about the strange formatting. Often have trouble when transfering from an email. And I did all sorts of stuff to try to get it straight too.

The article:

New York Times columnist, David Leonhardt, applauds the new Medicare policy inaugurating comparative risk/benefit analyses of medical treatments as a means of reducing healthcare costs–and also to reduce risks of serious side-effects from unnecessary treatments.

He notes the likely resistance by the public that has an ingrained instinct to “try-anything-and-everything,” without regard for the evidence showing that unnecessary treatments are accompanied by serious adverse effects–including treatment-produced deaths.

He notes that “unnecessary care causes a lot of pain and even death.”

The examples he cites as overused and medically unnecessary treatments: Unnecessary and overused CT scans which will result in an estimated 15,000 deaths from radiation; unnecessary caesarean births; unnecessary prostate cancer treatments which leave men incontinent and / or impotent; the popularity of cardiac stenting–despite lack of evidence that they actually reduce heart attacks.

However, missing from the discussion entirely, is the current aggressive move by the American Psychiatric Association to vastly INFLATE the patient roster by deeming that healthy people are in need of early intervention for presumed risk for illness. By adopting “Risk Syndrome” diagnoses, the APA provides a rationale–though an unsubstantiated rationale–for EXPANDING the use of expensive psychotropic drugs–and thereby INCREASING the cost for mental health care.

The APA has embarked on an aggressive course of adding diagnoses to its diagnostic / practice guide, the DSM-V, and lowering the threshold for existing diagnoses to include healthy people who do not meet current diagnostic criteria.

APA’s move occurs just as an avalanche of evidence has exposed psychiatry’s misdiagnosing practices and its failed pharmacological treatments–including the misdiagnosing of American children as “bipolar” for which they were prescribed antipsychotics, the most toxic drugs in pharmacopoeia, whose cost has depleted public healthcare budgets. Psychiatry is attempting to expand its reach by designating healthy people as being “AT RISK” for mental illness IN THE FUTURE–thereby providing a rationale for increased use of psychotropic drugs to the delight of its corporate retainers, the drug manufacturers.

As acknowledged by Dr. Allen Frances, Prof. Emeritus, former chairman of psychiatry, Duke University and the DSM-IV Task Force [1,2]: “Among the most problematic suggestions for DSM-V, the proposal for a “Psychosis Risk Syndrome” stands out as the most ill–conceived and potentially harmful.”

“The whole concept of early intervention rests on 3 fundamental pillars– being able to diagnose the right people and then providing them with a treatment that is effective and safe. “Psychosis Risk Syndrome” fails badly on all 3 counts: It would misidentify many teenagers who are not really at risk for psychosis. The treatment they would most often receive (atypical antipsychotic medication) has no proven efficacy, but It does have definite dangerous complications.

“It has been estimated that the false-positive rate would jump from about 70% in specialty clinics to about 90% in general practice. This means that as many as an astounding 9 in 10 individuals identified as “risk syndrome” would not really be at risk for developing psychosis.”

Unlike patients in other fields of medicine, those designated mentally ill–or even being declared “at risk” of mental illness lose their autonomy. Hundreds of thousands of teenagers and young adults (especially those on Medicaid) would be coerced into consuming atypical antipsychotic drugs–even as there is no proof that these expensive drugs prevent psychotic episodes, and despite abundant evidence that these drugs trigger life-long debilitating disease, such as, diabetes and cardio metabolic diseases [3] –and are associated with reduced life expectancy [4]―to say nothing about their high cost, other side effects, and stigma.

This APA’s effort to expand its reach by pathologizing those it deems “at risk” could, as Dr. Frances warns, “lead to a public health catastrophe and no field trial could possibly justify its inclusion as an official diagnosis. The attempt at early identification and treatment of at risk individuals is well meaning, but dangerously premature. We must wait until there is a specific diagnostic test and a safe treatment.”

It is clear that the beneficiaries of APA’s expansionist DSM-V revisions are those with vested financial stakes in maintaining high volume sales of clinically dubious, but highly profitable drugs.

References:
1. DSM5 and “Psychosis Risk Syndrome:” Not Ready For Prime Time By Allen
Frances, MD, Psychiatric Times, March 19, 2010
http://www.psychiatrictimes.com/display/article/10168/1541615

2. Opening Pandora’s Box: The 19 Worst Suggestions For DSM5 Commentary By
Allen Frances, MD, Psychiatric Times. COMMENTARY, February 11, 2010
http://www.psychiatrictimes.com/dsm/content/article/10168/1522341

3. Cardiometabolic Risk of Second-Generation Antipsychotic Medications
During First-Time Use in Children and Adolescents By Christoph U. Correll,
MD; Peter Manu, MD; Vladimir Olshanskiy, MD; Barbara Napolitano, MA; John M.
Kane, MD; Anil K. Malhotra, MD, JAMA. 2009;302(16):1765-1773

4. A Systematic Review of Mortality in Schizophrenia: Is the Differential
Mortality Gap Worsening Over Time? By Sukanta Saha, MSc, MCN; David Chant,
PhD; John McGrath, MD, PhD, FRANZCP, Arch Gen Psychiatry.
2007;64(10):1123-1131.

Contact: Vera Hassner Sharav
veracare@ahrp (dot) org

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