By Paul Woodward
Richard A. Friedman writes: Last year, more active-duty soldiers committed suicide than died in battle. This fact has been reported so often that it has almost lost its jolting force. Almost.
Worse, according to data not reported on until now, the military evidently responded to stress that afflicts soldiers in Iraq and Afghanistan primarily by drugging soldiers on the front lines. Data that I have obtained directly from Tricare Management Activity, the division of the Department of Defense that manages health care services for the military, shows that there has been a giant, 682 percent increase in the number of psychoactive drugs — antipsychotics, sedatives, stimulants and mood stabilizers — prescribed to our troops between 2005 and 2011. That’s right. A nearly 700 percent increase — despite a steady reduction in combat troop levels since 2008.
The prescribing trends suggest that the military often uses medications in ways that are not approved by the Food and Drug Administration and do not comport with the usual psychiatric standards of practice.
The military tests prospective enlistees with an eye toward screening out those with serious psychiatric disorders. So you would expect that the use of these drugs in the military would be minimal — and certainly less than in the civilian population. But the opposite is true: prescriptions written for antipsychotic drugs for active-duty troops increased 1,083 percent from 2005 to 2011; the number of antipsychotic drug prescriptions in the civilian population increased just 22 percent from 2005 to 2011, according to IMS Health, an independent medical data company.
The data suggest that military doctors may prescribe psychoactive drugs for off-label use as sedatives, possibly so as to enable soldiers to function better in stressful combat situations. Capt. Michael Colston, a psychiatrist and program director for mental health policy in the Department of Defense, confirmed this possibility. In an e-mail to me, Dr. Colston acknowledged that antipsychotic drugs have been used to treat insomnia, anxiety and aggressive behavior.
Yes, the medicating of combat troops has been done in such a way that it constitutes a form of drug abuse. A year ago the Army Surgeon General warned that medications being widely used to treat PTSD risk making the condition worse. And the dramatic rise in suicides has been widely linked to the effects of suicide-triggering medications.
But there is a gaping whole in Friedman’s commentary: no recognition that the misprescribing of psychiatric drugs by military doctors does not so much contrast with the practice of civilian doctors — it is merely an amplification of already excessive use in the wider population.
Look at the numbers that the author cites. A 1,083 percent increase in prescriptions for antipsychotic drugs for troops is contrasted with a 22 percent increase among civilians during the same period, 2005 to 2011. Yes, that’s a massive difference, but consider the 22 percent increase on its own.
This has nothing to do with a rise in the incidence of mental illness during this period. What it reflects is the massively effective marketing operations of the pharmaceutical manufacturers, incollusion with doctors who either get bribed or brainwashed, as they push off-label prescribing of these powerful and dangerous drugs.
At the same time there has been a relentless drive to expand the boundaries of diagnosis so that problems previously not regarded as illnesses — such as grief — can be medicated, or so that diagnoses previously reserved for adults are broadened to include teenagers and now even young children. Moreover, this class of drugs has been prescribed with increasing frequency to seniors even when this is known to increase the risk of mortality.
There is a reason that psychiatry is arguably the most corrupt branch of medicine and the most natural partner for the pharmaceutical industry. No other doctors have the opportunity to offer treatments based purely on subjective opinion.
Marcia Angell, former Editor in Chief of The New England Journal of Medicine writes:
As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession. Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly. They showered gifts and free samples on practicing psychiatrists, hired them as consultants and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials. When Minnesota and Vermont implemented “sunshine laws” that require drug companies to report all payments to doctors, psychiatrists were found to receive more money than physicians in any other specialty. The pharmaceutical industry also subsidizes meetings of the APA and other psychiatric conferences. About a fifth of APA funding now comes from drug companies.
Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.
The drug industry, of course, supports other specialists and professional societies, too, but [Daniel] Carlat [author of Unhinged: The Trouble with Psychiatry — A Doctor’s Revelations About a Profession in Crisis] asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness — no lab data or MRI findings — and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that.
Since the misfortune of Americans at large continues to provide such a lucrative market for those who trade in the myth that sorrow can be washed away with pills, then to the corporate drug cartels the misery of war must look like nothing less than El Dorado.
First posted at War in Context