Pharmageddon. David Healy

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      Pharmageddon

      David Healy

      UNIVERSITY OF CALIFORNIA PRESS Berkeley • Los Angeles

      University of California Press, one of the most

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      University of California Press

      Berkeley and Los Angeles, California

      © 2012 by David Healy

      Library of Congress Cataloging-in-Publication Data

      Healy, David, MRC Psych.

      Pharmageddon / David Healy.

       p. cm.

      Includes bibliographical references and index.

      ISBN 978–0-520–27098–5 (cloth : alk. paper)

      [DNLM: 1. Drug Industry. 2. Drug Utilization. QV 736]. I. Title.

      LC-classification not assigned

      338.4'76153—dc23

      2011026063

      Manufactured in the United States of America

      20 19 18 17 16 15 14 13 12

      10 9 8 7 6 5 4 3 2 1

      In keeping with a commitment to support

      environmentally responsible and sustainable printing

      practices, UC Press has printed this book on Rolland

      Enviro100, a 100% post-consumer fiber paper that

      is FSC certified, deinked, processed chlorine-free,

      and manufactured with renewable biogas energy.

      It is acid-free and EcoLogo certified.

       For over fifteen years I have been involved incases linked to injuries on drug treatment. Thisbook is for those who have survived to passtheir stories on, for the families who have beenleft behind, and especially for those who havestruggled to put things right.

      When she was a child I read Exodus

      To my daughter ‘The children of Israel…’

      Pillar of fire

      Pillar of cloud

      We stared at the end

      Into each other's eyes Where

      She said hushed

      Were the adults

      —George Oppen, “Exodus”

      The new wood as old as carpentry

      Rounding the far buoy, wild

      Steel fighting in the sea, carpenter,

      Carpenter

      Carpenter and other things, the monstrous welded seams

      Plunge and drip in the seas, carpenter,

      Carpenter, how wild the planet is.

      —George Oppen, “Carpenter's Boat”

       Contents

       Acknowledgments

       Introduction

       1. They Used to Call It Medicine

       2. Medicine and the Marketers

       3. Follow the Evidence

       4. Doctoring the Data

       5. Trussed in Guidelines

       6. The Mismeasurement of Medicine

       7. The Eclipse of Care

       8. Pharmageddon

       Notes

       Index

       Acknowledgments

      I have accumulated so many debts it would take an ocean-going liner to accommodate everyone who should be acknowledged. Some of those to whom I am most indebted have been critics, a number of whom over the last decade have held open a forum for debate in which I’ve been able to test and discard ideas. Ocean-going liners have luxuries like showers and bidets. Over the past year I’ve given lectures on the subject matter of this book in several North American settings under the informal title of “The Shower and Bidet Approach to Medical Care,” as well as in Oslo, Uppsala, Bruxelles, Gent, and Milan, and I have Andy Scull, Joel Braslow, Ned Shorter, Cindy Hall, David Antonuccio, Masumi Minaguchi, Tom Ban, and others to thank for this, and much else. Joanna Le Noury, Margaret Harris, Stef Linden, Tony Roberts, and other colleagues in North Wales have helped supply the data for many of these talks.

      It takes a lot to divert an ocean-going liner off course. Not so for a carpenter’s boat like George Oppen’s, where staying within the harbor walls seems advisable. There is a much smaller number of people to whom I owe particular debts who might fit on such a boat. These include Charles Medawar, Andrew Herxheimer, Vera Sharav, Annemarie Mol, Steve Lanes, Kal Applbaum, and Dee Mangin, who will see the beams they have contributed here but may feel they have been monstrously welded to the wrong seams, in which case they more than anyone are likely to turn green at the gills once the boat ventures out beyond the harbor mouth.

      Far from getting outside the harbor, at one point it looked like the boat would never float, but Jonathan Cobb came to the rescue through wonderful editing. Rather magically he showed me how to write the book I thought I’d written. Bev Slopen, my agent, and Hannah Love, my editor, have also had to keep faith through some tricky moments. And finally Sarah, Helen, and Justin have had to put up with a lot, including “sibling” rivalry.

       Introduction

      My father smoked all his adult life. He had a number of physical disorders, including ulcerative colitis, ironically one of the few conditions for which smoking is beneficial. In 1974, when he was in hospital for colitis, a routine chest X-ray revealed a shadow on his lung. Dr. Neligan, the surgeon called in, advised my mother on the importance of an operation.

      Our general practitioner at the time was Dr. Lapin, whom I remembered from childhood as being tall, silver-haired, and distinguished, often wearing a bow tie. He had spent time, I was told, as a doctor in the British army, a very unusual occurrence then in Ireland. To a child, Dr. Lapin