Sunday, 15 February 2015

'Prozac Nationalism' by Siobhan Tolland, May/June 2012, Scottish Left Review

This morning I was sent this piece by a colleague, from the Scottish Left Review, Issue 70, May/June 2012: 'Prozac Nationalism' by Siobhan Tolland, and thought it very pertinent for now:

"Prozac Nationalism,
Written by Siobhan Tolland 

 In 2010, the Scottish Government quietly abandoned its commitment to reduce antidepressant use within Scotland. The original commitment came amidst a wave of concern and worry that ten per cent of Scots were taking antidepressants, and the SNP promised to promote alternative treatments. Recommending this abandonment, the Scottish Governent Audit Committee suggested that the reduction commitment did not reflect the complexity of treatment options within Scotland. Importantly, it argued, recent research concluded most GPs were prescribing appropriately anyway. Thus concerns over the high use of antidepressants within Scotland were unfounded. 

At present the mental health strategy, Towards a Mentally Flourishing Scotland, is under review, but the abandonment of that commitment is a cause for concern. And abandoning it on the basis of the Aberdeen University research is extremely concerning for it accepts a very controversial view of mental illness that reduces complex emotions to a single biomedical cause. Depression, for instance, is caused by chemical or biological abnormalities of the brain, and should be treated accordingly. Accepting the study’s conclusion that GPs were prescribing appropriately then means they also accept Depression is biomedical in origin. As a consequence, it promotes antidepressant medication above, say, counselling, CBT or even exercise.

The biomedical view additionally prevents any social analysis of unhappiness or desperately low mood, and medicalises these problems. It ignores the correlation between poverty, inequality and poor mental health, for instance. Research suggests that poor mental health is caused by poverty, for instance, with Bristol University suggesting that as many as 50 per cent of people in poverty have signs of depression. Reverting to a biomedical discourse of poor mental health prevents these social and economic connections from being established, siting responsibility on the individual’s biology, and not society.  And thus any sense of collective social responsibility for our health and welfare is abandoned. We don’t need to change society to make it more mentally healthy, we just need doctors and scientists manipulate the brain.

The SNP’s change in strategy is important then because the biomedical discourse moves away from a social analysis of health. It is also often seen as a discourse  that is of considerable benefit to the pharmaceutical industry. There was a 234 per cent rise of antidepressants between 1992 and 2002, for instance, and this has steadily increased since then. The pharmaceutical industry’s profit has risen accordingly, outstripping most other industries in terms of median profit. The industry is staggeringly massive, the Guardian newspaper comparing their size to ‘behemoths’, ‘outweighing entire continents’. ‘Big Pharma’ (as they are often called) has promoted and pushed antidepressant medication continuously, facilitated by the biomedical discourse. That the Scottish Government accepts current antidepressant use as ‘appropriate’ then shows a strategy more in alignment with industry’s needs than those who need mental health support.

This alignment with industry is actually disturbing when we consider that the actual usefulness of antidepressant medication is under question. The Scotland Action on Mental Health (SAMH) study, for instance, stated that around 50 per cent of people found medication did not actually improve their mood, and that 60 per cent of people reported side effects from the most common antidepressant type (SSRIs), when taking it and when trying to withdraw. More generally, Joanna Moncreiff, Psychiatrist and critic of the ‘chemical cure’ states that the biomedical origin of depression is a myth and that the only reason medication works is because they put people in a chemically-induced altered state that suppresses or masks emotional problems. Antidepressant medication does not really solve the issues of Depression then. At best they mask people’s feelings through drugs.

Worse, the side effects reported by SAMH are severe, including anxiety, anger and even violence. Some critics even accuse this medication of being dangerous, and point to thousands of deaths caused by such drugs. A very public example of this was Glaxo Smith Kline which was accused of withholding important clinical trial information regarding the high likelihood of under-18s having suicidal thoughts when taking Seroxat. Some independent trials suggested the suicide risk was up to six times higher than normal. It was suspected that such information was withheld for nearly a decade.  One ex Pharmaceutical industry chemist suggests that we have a billion dollar industry making a lot of people sick and profiting from it. Antidepressant medication as ‘appropriate’ treatment is a statement that should be treated with extreme caution then. Something the Scottish Government clearly has not done.

Behind the Aberdeen University study then lie a lot of question marks over their assumed truths of antidepressant medication. As a result the Scottish Government’s acceptance should be seriously questioned. The fact that the side effects of these drugs are so common and sometimes so terrible seemed to have no impact on the study’s conclusion or the Scottish Government in accepting it. It seems that antidepressant medication does not actually support or help people with poor mental health, but merely serves to put people into a drug-induced state. This ultimately functions as a form of social control because it prevents any serious questioning of the system that causes such poor mental health in the first place.

Given the controversy over antidepressants then, it seems strange that the Scottish Government saw no relevance in the fact that two authors of the Aberdeen University study were on the payroll of various drugs companies as speakers or consultants. Objectivity in such research is often questioned because of the considerable influence the industry exerts over it. In such medical research one-third of writers have substantial financial interest in their published work, through sponsorships consultancies and general payments by the industry. Indeed, a lot of the time the industry doesn’t need to offer financial incentives because they ghost-write over half of all publications about medication. Financial interest and profit skews a lot of medical research and there is often not even a pretence of objectivity.  It is this influence that the Scottish Government is rigorously trying to encourage, as it entices Big Pharma into Scotland and open NHS research up to that influence.

Since the opening of the Scottish Parliament, the lobbying organisation of the pharmaceutical industry (the ABPI) set up camp in Scotland and has continuously lobbied the government. ‘Big Pharma’ has the biggest political lobbying budget in Washington and spends more on marketing and advertising than they do on research and development. The ABPI is open about creating ‘foot soldiers’ within important areas such as support groups and sympathetic health professionals to weaken the political and ideological defences. And their presence in Scotland has initiated a political and cultural change that transforms science and health care to meet the needs of the industry. SNP’s change in policy regarding antidepressant medication highlights this influence.

SNP’s policy change reflects a wider financial strategy to bring more of the industry in to Scotland. In 2007, the Government announced a 55-acre Bio-quarter project beside the Edinburgh Royal Infirmary, as site of excellence in Life Sciences research. Attracting investment was one of the key objectives and the pharmaceutical industry now sits in the grounds of the hospital and research facilities. The next year, the Scottish Life Sciences Advisory Board (SLCAB ) was set up. This was a joint government, academic and industry initiative to develop innovation and growth within the life sciences (of which the drug industry makes up seventy per cent). This has led to government initiatives, grants and a close working relationship between the health minister and the ABPI, determining policy and future initiatives according to the needs of Big Pharma.

More worrying, by 2011 the SNP was openly promising to open NHS Research Scotland up to the pharmaceutical industry. This involved a mission to double the economic contribution of life sciences and accelerate growth with an emphasis on business and institutional collaboration. Promoting health seems pretty absent against this language of business interest. One example of such a promise was a joint partnership with companies carrying out clinical trials which involved streamlining the ‘regulatory approval processes’, meeting the open demands of the ABPI. Since Psychiatry and Neuroscience are proposed areas for NHS Research/industry development, the biomedical influence of mental health and illness seems pretty inevitable. Certainly the interests of industry will be higher up the agenda than ever before, as health becomes business and profit.

As the SNP prepares for the vote on independence then, it has been busily trying to develop the economic and financial future of Scotland. Life Sciences is one area where the SNP has seen an opportunity to develop wealth, making Scotland a viable independent economy. And it seems to be working. Scotland is bucking the European trend by attracting more drug industry investment in clinical trials, for instance. There is a real worry, however, that in the mission for independence, we have become lured by the promise of wealth and the might of Big Pharma.

The consequences of allowing the drugs industry this level of control over our mental health is terrifying, as SNP’s promotion of alternative treatment becomes less compatible with Big Pharma’s interests. Donald Trump’s permission to have a practically free reign over parts of northern Scotland has been met with incredulity and even horror. Allowing Big Pharma control within our health sector, however, has been met with very little opposition or even analysis within Scotland. The ABPI makes it clear: treating poor health is irrelevant if it cannot meet the needs of shareholders. And we are allowing this industry control over our mental health.

Dr Siobhan Tolland researches the politics of health in contemporary Scotland."

Link to Scottish Left Review, Issue 70, May/June 2012

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