ANOTHER VIDEO FROM DR. LIEBERMAN
On October 28, Jeffrey Lieberman, MD, President of the APA, made another video. This one is titled An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs, and was made for Medscape. You can see the transcript at the same site. Medscape is a web resource for medical practitioners.
The video is Dr. Lieberman’s commentary on an article that appeared in JAMA Psychiatry online on August 28: Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials, by Arif Khan, MD, et al.
Dr. Lieberman tells us that:
“The bottom line from this very good and important study, which was carried out with a large amount of data obtained from the administrative database of the FDA, is that psychotropic drugs are in the aggregate very beneficial — not just in suppressing patients’ symptoms, but in extending their overall survival and reducing mortality. In the ongoing debate in the literature as well as in the media about whether psychotropic drugs are overprescribed or are potentially detrimental to health, as physicians we must always be aware that medications should be used only when indicated and very judiciously in all people, particularly in children and the elderly — but we should never withhold them when they are needed, because they are very beneficial in terms of therapeutic effects. They should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans.”
“They found, as has been previously reported many times, that individuals who have psychiatric disorders, and particularly schizophrenia, bipolar disorder, and depression, have lower overall survival (increased mortality). Of interest, being on a psychotropic medication (antipsychotic, mood stabilizer, bipolar medication or a combination of drugs) was associated with increased survival and lower mortality in patients with schizophrenia or bipolar disorder.”
WHAT THE ARTICLE ACTUALLY SAYS
The JAMA Psychiatry article by Arif Khan et al searched the FDA data bases for Summary Basis of Approval (SBA) reports of new and supplemental drug applications for 28 drugs approved between 1990 and 2011.
The researchers extracted mortality and drug exposure information from these SBA reports and collated the results. The combined analysis included data on 92,542 clients.
The authors drew the following conclusions.
“These data suggest that increased mortality rates reported in population studies are detectable among adult patients with psychiatric illnesses participating in psychopharmacological trials. Furthermore, 3- to 4-month exposure to modern psychotropic agents, such as atypical antipsychotic agents, selective serotonin reuptake inhibitors, and selective serotonin-norepinephrine reuptake inhibitors does not worsen this risk. Given the inherent limitations of the FDA SBA reports, further research is needed to support firm conclusions.”
So as you can see, there’s a huge discrepancy between the conclusions drawn by the authors and the “conclusions” promoted by Dr. Lieberman on his Medscape video. Dr. Lieberman stated that:
“…psychotropic drugs are in the aggregate very beneficial — not just in suppressing patients’ symptoms, but in extending their overall survival and reducing mortality.” [Emphasis added]
The researchers point out that these studies entailed only 3-4 month exposure to the drugs – clearly not enough time to make any kind of definitive statement about reductions in mortality rates. This is especially true in that psychiatrists routinely tell their clients that they need to take the drugs for extended periods – sometimes for life.
The researchers also point out that the FDA’s SBA reports have some “inherent limitations” with regards to the present study. They discuss some of these limitations:
“Because of the abbreviated and variable form of FDA SBA reports, we could not assess premorbid history, age and sex of the clinical participant, family history, course of illness, or details of any autopsy reports. Furthermore, deaths occurring among clinical trial participants exposed to placebo or active comparators were infrequent and difficult to interpret.”
“In addition, we could not fully evaluate all the clinical trial data for a variety of reasons. First, the data included in the FDA SBA reports in general consist of data from the registration or “pivotal” trials. These are only a fraction of studies conducted, and unfortunately data from the others cannot be accessed via the FOIA as interpreted by the FDA.” [Emphasis added]
And again, they stress the need for caution in interpreting their findings:
“Our results suggest that further detailed analysis of the clinical trial data by the FDA or the pharmaceutical companies is required before any firm conclusions can be drawn.
Furthermore, it is desirable to acquire much longer-term data, such as a decade in duration, regarding potential mortality risk when exposed to psychotropic agents based on the findings from the population studies. To obtain definitive results, prospectively designed studies are required.” [Emphases added]
It is clear that Dr. Lieberman has significantly misrepresented the results of the Khan et al study. So there are two possibilities: either he was genuinely confused, or he is consciously attempting to deceive medical practitioners who rely on Medscape.
The notion that he is genuinely confused is hard to sustain because in the first half of his video, he makes it clear that he is aware of the debate concerning the mortality-drugs link. He says:
“This is important, because it has previously been suggested (and this fact has been used by critics of psychotropic medications) that psychotropic drugs, particularly the second-generation antipsychotic medications or mood-stabilizing drugs, contribute to side effects and medical comorbid conditions that shorten survival and increase mortality. These findings suggest that the opposite is true. Being on the medication in no way increased mortality; in fact, it actually reduced mortality, despite the fact that the studies that were obtained and analyzed were largely acute treatment studies of short duration, not the long duration that patients take these medications.”
Dr. Lieberman is obviously aware of the widely-expressed concerns that neuroleptics and SSRI’s are contributing to the increased mortality of people who take these drugs. He is also aware that the toxic effects of these products are cumulative, and that most of the mortality effects become apparent in the long-term, rather than in the first 3-4 months.
He should also be aware of the following studies:
Bralet M C, et al, Cause of mortality in schizophrenic patients: prospective study of years of a cohort of 150 chronic schizophrenic patients, Encephale. 2000 Nov-Dec;26(6): 32-41. [original article in French].
“Concerning the comparisons between the deceased subjects and the survivors, there were five significant differences: gender, age, duration of the illness, neuroleptic dosage, negative symptoms (BPRS negative subscale). The deceased subjects were older, there was more men, the duration of the illness and the neuroleptic dosage were higher and the BPRS negative subscale was lower. These five variables were introduced in the discriminant analysis to explore notably their respecting weight. The corresponding power of the five variables were in decreasing order: neuroleptic dosage, negative symptoms, age, gender, duration of the illness.” [Emphasis added]
Honkola J, et al, Psychotropic medications and the risk of sudden cardiac death during an acute coronary event, Eur Heart J. 2012 Mar: 33(6): 745-751.
“The use of psychotropic drugs, especially combined use of antipsychotic and antidepressant drugs, is strongly associated with an increased risk of SCD [sudden cardiac death] at the time of an acute coronary event.”
Osborn DP, et al, Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice eRsearch Database, Arch Gen Psychiatry. 2007 Feb; 64(2): 242-9.
“…a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD [coronary heart disease] and stroke.”
Berg K, et al, Pre-Admission Use Of Selective Serotonin Reuptake Inhibitors Is Associated With ICU Mortality, presentation American Thoracic Society 2012 International Conference, San Francisco.
“After adjusting for age, gender, ICD-9 diagnosis, disease severity and co-morbidities, the researchers found that patients on SSRI/SNRI’s prior to admission to the ICU were 73 percent more likely to die in the hospital (p<0.001), and that the increase in risk persisted at one year.”
Newcomer JW, Antipsychotic medications: metabolic and cardiovascular risk, J Clin Psychiatry. 2007; 68 Suppl 4:8-13.
“…psychotropic agents, including some antipsychotic medications, are associated with substantial weight gain, as well as with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease.”
Sernyak MJ et al, Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia, Am J Psychiatry. 2002 Apr; 159(4):561-6.
“In this large group of patients with schizophrenia, receipt of a prescription for atypical neuroleptics was significantly associated with diabetes mellitus.”
American Diabetes Association Professional Tool #1: Screening and Monitoring in a High-Risk Population: Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease
“A 2004 American Diabetes Association (ADA) Consensus Development Conference concluded that certain SGAs [second generation antipsychotics] are associated with the potential for rapid weight gain, deterioration in lipoprotein profile and increased risk of type 2 diabetes. Although the mechanisms underlying these effects remain incompletely understood, these potential side effects are of significant concern because of the association between these adverse cardiometabolic events and risk for diabetes and premature cardiovascular mortality.”
Weinmann S et al, Influence of antipsychotics on mortality in schizophrenia: Systematic review, Schizophr Res. 2009 Aug; 113(1):1-11
“There is some evidence that long-term exposure to antipsychotics increases mortality in schizophrenia. More rigorously designed, prospective studies are urgently needed.” [Emphasis added]
On the basis of all this, it is difficult to avoid the conclusion that Dr. Lieberman made and published this video with the express purpose of deceiving medical practitioners who rely on Medscape for up-to-date information. He never once drew attention to the authors’ own cautionary statements. Even his presentation’s title (as shown on the transcript) is misleading: An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs. Combining the words “mortality” and “decade” in a title gives the impression that mortality figures were tracked for a ten-year period. This was emphatically not the case. What was analyzed was a decade’s worth of data, all of which involved a 3-4 month follow-up period.
His statement towards the end of the video is unambiguous:
“They [psychotropic drugs] should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans.”
When we remember the truly horrendous adverse effects of neuroleptics, SSRI’s, and benzodiazepines, it is an extraordinarily sweeping – even reckless – statement.
By way of contrast with Dr. Lieberman’s sweeping statement, here’s what Michael Birnbaum, MD, a psychiatrist at Zucker Hillside Hospital in New York said when asked by Medpage for a comment:
“The majority of the studies included in this paper were of 3 to 4 months’ duration, and so what we really need to do now is appreciate the long-term effects of these medications on the brain and the body…Our psychiatric patients are often on these medications for months if not years, so it would be important for us to recognize the potential impact of these medications on mortality long term.”
Of course Dr. Birnbaum is not an eminent thought leader like Dr. Lieberman.
Psychiatry is under attack on a wide range of fronts. The attacks are founded, and psychiatry has no rational, coherent response. All they can do is repeat their spurious mantra that all significant problems of thinking, feeling, and/or behaving are brain illnesses that need to be treated with drugs. They are blind and indifferent to the damage and disempowerment that they leave in their wake, and they grasp at any straw to support and promote their position. They appear to be incapable of critical self-appraisal.
Dr. Khan, psychiatrist, the principal author of the JAMA study, received $1,518,215 from pharmaceutical companies in the period 2010-2012 [Dollars for Docs]. At the present time he serves as Medical Director for two pharmaceutical companies: Columbia Northwest Pharmaceuticals LLC, and Rhine Pharmaceuticals LLC, of Bellevue, Washington (from his curriculum vitae).
Dr. Khan owns and operates Northwest Clinical Research Center in Bellevue, Washington. NWCRC is a prolific producer of psychiatric research. They publish papers in journals, and on posters which are displayed at various medical association conferences. I looked at two of their articles published in 2011: Weisler RH, Khan A, et al, and Khan A, Cutler AJ, et al. Both of these studies found favorable results for their sponsors’ products (Bristol-Myers Squibb and Forest Labs respectively).
MORTALITY AND PSYCHIATRIC “DIAGNOSES”
It is indeed the case that people who are assigned psychiatric “diagnoses” have generally higher mortality rates than the general population. This fact is frequently presented as proof that the conditions in question are real illnesses.
The logic, however, is fallacious. Mountain-climbers have higher than average mortality, but nobody would suggest that mountain climbing is an illness. The same could be said of people who routinely ride bicycles in heavy traffic, engage in unprotected sex, work in dangerous occupations, etc…
The excess mortality associated with psychiatric “diagnoses” derives from two main sources:
Firstly, the DSM criteria that define these so-called illnesses contain many items that are, I suggest, intrinsically linked to higher mortality. These include: disorganized behavior; poor nutrition; lack of goal-directed activity; risk-taking; distractibility; disrupted sleep pattern; agitation; attempted suicides; feelings of guilt; social isolation; animosity towards others; outbursts of anger; neglect of health; etc… Psychiatry uses items like these to define “mental illnesses,” and then “discovers” that the people with these “illnesses” have a high mortality rate. In fact, the high mortality rate is built into their very definitions of these conditions.
Secondly, the drugs that psychiatry uses to “treat mental illnesses” all have toxic effects, which over time create medical problems and lower life expectancy.
So, instead of helping these individuals overcome these problems and lead fruitful and longer lives, psychiatry drugs them, often involuntarily, and thereby shortens their lives even further.
Psychiatry is not something good that needs some minor corrections. It is something flawed and rotten that needs to be criticized, exposed, and ostracized.