The pharmaceutical industry and the fight against gun control

By Paul Woodward

The Washington Post reports: One year ago, 20 children and six staff members at Sandy Hook Elementary School in Newtown, Conn., were gunned down by Adam Lanza. In the aftermath, there was hope among gun-control advocates that the event would spark pro-control reform. They’ve set their eyes onon a few states, but over the past year, more of them have loosened gun restrictions than tightened them. While gun control may face an uphill battle, though, a related policy area has seen change in the wake of the tragedy.

“We think that Sandy Hook opened up the eyes of governors and state legislators and policymakers around the country that mental health has been cut enough,” Andrew Sperling, the director of legislative advocacy at the National Alliance on Mental Illness, told Post TV’s “In Play.”

Some 36 states increased their mental health-care budgets in 2013, according to NAMI. In Colorado, where James Holmes opened fire on a crowded movie theater a little over a year ago, the mental-health budget was increased by 13.5 percent.

State-level efforts have focused on five broad categories — the mental-health system, crisis and inpatient care, community mental health, criminal justice and mental health, and civil rights and stigma reduction — NAMI wrote in a fall report.

The Post fails to note that the innocuously named NAMI, receives most of its funding from the pharmaceutical industry.

It’s not that pharma has a natural alignment with the opponents of gun control, yet what the NRA and its supporters have succeeded in doing in the wake of Newtown is to shift the debate away from gun control onto mental health — a shift which clearly serves the interests of the drug industry.

27% of all mental health services in the United States come through Medicaid and Medicaid is a cash cow for the pharmaceutical industry.

In the 1980s and ’90s, the psychiatric system went through a major transformation as psychiatric medication replaced psychotherapy as the standard of care. This broadened the scope of psychiatry in two ways. With patient care being reduced to medication management, doctors could see more patients. And with a massive growth in the number of Americans receiving disability for mental illness, the market for psychiatric medication has been booming, thanks in part to Medicaid funding.

The pharmaceutical industry has only one interest: selling drugs. It can reasonably be described as the most successful form of organized crime in human history. When companies repeatedly pay billions of dollars in settlements, it is clear that they regard such settlements as simply a component in the operating costs.

That the drug manufacturers are really nothing more than sophisticated drug pushers can be illustrated in numerous ways — consider for instance the way in which attention deficit disorder has become such a profitable diagnosis.

After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic A.D.H.D., helping youngsters succeed in school and beyond.

But Dr. Conners did not feel triumphant this fall as he addressed a group of fellow A.D.H.D. specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

None of the above considerations should be taken to imply that mental health services are not indeed neglected in this country — simply that drugging and forced treatment are not the answer.

As for the issue of the epidemic of school shootings, ironically this has mostly served as a distraction from the much larger issue of gun violence.

Following the Gabrielle Giffords shooting in 2011, Emily Badger wrote:

Today, gun laws that target the mentally ill — alongside convicted felons — are founded on a series of assumptions: that people with mental illness are particularly dangerous, that legislation restricting their gun ownership will lead to decreased violence, and that this strategy will make a difference in the overall safety of society.

Such laws also assume that the background-check system is an effective means in the first place of keeping guns out of the hands of any type of dangerous person.

“In a society like ours where firearms are so prevalent — there are more handguns than there are people in the U.S. today — that seems like a highly dubious proposition,” [the director of the Division of Law, Ethics, and Psychiatry at Columbia University, Paul] Appelbaum said. “People who really want guns are arguably likely to be able to get them whether they are covered by this statute or not. It’s an empirical question as to whether this actually works in keeping guns out of anybody’s hands, or at least very many people’s hands.”

The best data Appelbaum has found, which dates to the late 1980s and early ’90s, also suggests that, at most, 3-5 percent of violent acts in the U.S. are attributable to serious mental illnesses as a risk factor — and most of those acts don’t involve guns. More recent studies in England and Sweden suggest that number for violent acts may be as low as 1-2 percent.

“To say that another way, if no one with a mental illness committed a violent act, we would still have 95-97 percent of the baseline level of violence,” Appelbaum said. “However you cut it, it looks as though we’re just talking about the tip of the iceberg in terms of problems of violence in our society, which raises the quite reasonable question as to why we’re so focused on the mentally ill?”

Not only is that focus a distraction, he adds, but it comes with the significant downside of further stigmatizing people with mental illness and confusing the public as to the notion that mental illness is a significant cause of violence in this country.