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March 20, 2002
Prozac, Suicide and Dr. Healy
By Rick Giombetti
Dr. David
Healy of the Department of Psychological
Medicine at the University of Wales in the UK is hardly a household
name in the United States and that is a shame.
One of the world's leading research psychopharmacologists,
Healy's expert testimony in last year's Paxil civil trial was
one of the deciding factors in the plaintiff's jury victory in
that case. Wyoming resident Donald Schell, 60, killed his wife,
daughter and granddaughter and then himself with a gun in 1998
after only two days on Paxil. Schell's surviving family members
sued Paxil manufacturer UK-based Glaxo-Smith-Kline (GSK), the
world's largest pharmaceutical manufacturer, and won. The decisive
factor in the case was the company's own internal data demonstrating
that they knew Paxil could cause agitation and suicidal ideation
in research subjects. A month after the June verdict in the case,
GSK caved in to the British Medicines Control Agency's request
to put a suicide warning on Paxil.
The fact that a jury verdict in a civil
trial here in the United States has led to a suicide warning
being put on labels for a popular psychiatric drug in another
country has hardly been headline news. Two weeks after the verdict
in the Paxil trial, Houston area mother and convicted murderer
Andrea Yates drowned her five children while she was on not one,
but two antidepressant drugs with strong stimulant profiles.
What could have been an opportunity for the mass media to educate
the public about the dangers of antidepressant drugs, instead
has been a non-stop awareness campaign for the mental health
industry about the need for more psychiatric "treatment."
The real story that has been missed in the Yates case is the
fact that it is a story about psychiatric treatment failure.
Yates had been getting psychiatric drugs for her post partum
depression for years. She was on high doses of two antidepressants
drugs at the time she drowned her children but went ahead and
did what these drugs are supposed to prevent anyway.
Meanwhile, Dr. Healy Hasn't shied away
from linking Prozac, Paxil and the other SSRI's to suicide. He
figures at least 250,000 people have attempted suicide worldwide
because of Prozac alone and that at least 25,000 have succeeded.
He was offered a job at the University of Toronto affiliated
Center for Addiction and Mental Health (CAMH) in 2000. Healy
was making arrangements for moving his family to Toronto when
he gave a lecture at the CAMH on November 30, 2000 where he reiterated
his position on Prozac and suicide. He also made a lot of other
statements, backed up by statistical data, that are politically
unpopular with many of his psychiatric colleagues. Such as the
fact that psychiatrists have more patients in their care then
ever before. Healy was unceremoniously turned down for the CAMH
job. Speculation has it that Prozac manufacturer Indianapolis-base
Eli Lilly may have had a hand in Healy's firing. An international
controversy has ensued about Healy's case and the implications
it has for academic freedom in academic medicine. Healy filed
a multi-million dollar breach of contract lawsuit against the
CAMH and the University of Toronto on September 24 of last year.
A summary of the entire David Healy affair
can be read on the Internet at http://www.pharmapolitics.com.
I recently completed an e-mail interview
with Healy about Prozac and suicide, the CAMH lecture and many
other contemporary issues in psychiatry today. Below is the transcript.
--Rick Giombetti Seattle
RG: How do Prozac and
the other SSRI's (Selective Serotonin Reuptake Inhibitors) like
Paxil cause suicidal ideation ("We can make healthy volunteers
belligerent, fearful, suicidal and even pose a risk to others,"
you wrote in the June 2000 Primary Care Psychiatry. "People
don't care about the normal consequences as you might expect.
They're not bothered about contemplating something they would
usually be scared of)?
DH: There is a greater difference between
Prozac and other SSRI's on the one side and placebo on the other
side in the rate in which they cause agitation, than there is
between Prozac and the other SSRI's and placebo and the rate
at which they get people who are depressed better(i.e. the SSRI's
cause more agitation in testing subjects than sugar pills, but
they also tend to outperform sugar pills at getting depressed
people better). The fact that companies have chose to market
them as antidepressants rather than agents that cause agitation
is a business decision rather than a scientific matter. It is
certainly not one that was "ordained by God." You could
say that the fact that some people who are depressed get better
is a side effect.
These drugs are drugs that primarily
work on the serotonin system. There is no evidence for any abnormality
in the serotonin system in people who are depressed. There are
however variations in the serotonin system in people who are
depressed. There are however variations in the serotonin system
in all of us so that some of us will have quite different effects
from these drugs than others. It would have been a relatively
simple matter to do work on this 10 years ago to find out which
of us were more likely to have problems with the drug than which
of us were more likely to do well on them.
RG: You testified in
the Paxil trial in Wyoming on behalf of the plaintiffs. The plaintiff's
position in the case, vindicated by both the jury and judge in
the case, was that Paxil was the primarily responsible for Donald
Schell shooting his wife, daughter and granddaughter to death
before killing himself with a gun in 1998. Schell had been taking
the drug for two days. Based on the internal Glaxo-Smith-Kline(Paxil's
UK-based manufacturer and world's largest pharmaceutical company)
documentation you reviewed as an expert witness in that case,
what would you have to say about Paxil and suicide to an individual
contemplating a prescription for the drug?
DH: The evidence across the board from
all of the companies producing SSRI's is that their drugs can
make 1 in 20 of us agitated to the extent that we drop out of
trials. This agitation in some cases will include thoughts of
suicide, self-harm or strange out of character thoughts. The
agitation may even develop to psychotic proportions.
Part of the problem with SSRI's is the
they have been prescribed to many people by a doctor who may
not be aware of these side effects and may not have warned you
about the side effects. If you then develop problems on the drugs
you many not link the drug to the problem or you may feel now
that you have a very severe nervous problem that and your physician
is the only way out of the problem. A hostage dynamic can develop.
There is a particularly difficult scenario
where a patient is faced with a physician who tells them that
any increased nervousness they now have is not being cause by
their pills and that the answer to this is to continue with the
pills. In this case many people may not even let the physician
know how serious this increased nervousness is - as they feel
they are not being listened to. This situation can arise in part
because physicians are dependent on companies for information
about any problems that can be caused by the drugs are informed
that there is no problem of this kind that stem from the drugs,
that any problem of this kind stems from the illness. In such
circumstances where a physician is relying on what they have
been told by the company and not listening to their patient,
there is a real risk of things going badly wrong. Some people
will only escape disaster if they halt their pills.
RG: The story of Houston
area mother Andrea Yates drowning her five children has led to
quite a campaign of awareness about mental illness in the mass
during the past several months. First, it was post-partum depression
and now, with the recent revelation in the testimony in the Yates'
murder trial that she believes she is possessed by Satan, schizophrenia.
What hasn't happened with the Yates case has been an honest accounting
of what it really is about: Another case of psychiatric treatment
failure. Andrea Yates' post partum depression had been getting
treated with drugs for years and she was on two antidepressants
at the time she drowned her five children. I'm not asking for
much from the mass media on the reporting of this case. Just
the barest mention of two words with this case would be helpful:
Effexor and Remeron.
At the time of the drownings
Yates was on 450 mg/day of Effexor, or 75 mg above the maximum
recommended dosage, and 45 mg/day of Remeron, or the maximum
recommended dosage. Yates had been taken off 4 mg/day of the
tranquilizer Haldol two weeks before she drowned the children
and the Remeron was added to her prescription, which continued
to include the Effexor. Now there is a wealth of clinical date
out there about these two drugs but the media has to look at
it instead of helping the mental health industry promote mental
health awareness.
It turns out that a gem
of study titled "Mirtazapine(Remeron) Versus Venlafaxine
(Effexor) in Hospitalized Severely Depressed Patients With Melancholic
Features" was published in the August 2001 Journal of Clinical
Psychopharmacology. It's a gem with regard to the Yates case
not only because it compares two groups of patients put on the
same antidepressant drugs she was on at the time of the drownings,
but because it does not omit the fact that concomitant medications
were being administered to the patient/subjects(a rarity for
the published results of clinical studies, indeed).
Out of the group of 78
patient/subjects put on Remeron, 56 percent of them were administered
the benzodiazepine tranquiler Oxazepam to counter agitation and
35 percent were administered the hypnotic Zolpidem to counter
insomnia. Out of the 79 patient/subjects in the Effexor group,
49 percent were administered Oxazepam and 41 percent were administered
Zolpidem.
Here are the other vital
statistics provided by the article: 62.8 percent of the Remeron
group were female and 68.4 percent of the Effexor group were
female. The maximum dosing of the Remeron group ranged from 45-60
mg/day and 300-375 mg/day for the Effexor group. The study lasted
eight weeks and 23.1 percent of the Remeron group dropped out,
plus 35.4 percent of the Effexor group dropped out of the study.
Well, am I on to something
here? Is it unreasonable to suggest that Yates was suffering
from extreme agitation and/or insomnia, given that she was taking
high doses of both Effexor and Remeron, and that this might have
been a factor in her actions the day she drowned her children?
What do you know about Effexor and Remeron? (Effexor is known
as a "Serotonin and Norepinephrine Reuptake Inhibitor"
or "SNRI" and Remeron is known as a "Noradrenergic
and Specific Serotonergic Antidepressant," "NaSSA")
DH: The European tradition had been that
all antidepressants could cause a problem. This included the
tricyclic antidepressants which like Venlafaxine (Effexor) inhibited
both serotonin and norepinephrine reuptake. The clinical trials
of Mirtazapine (Remeron) submitted to the FDA that got it a license
contain an excess of suicides and suicide attempts in those trials
compared to placebo. I don't know the details for Venlafaxine
(Effexor).
Your point about it not being unreasonable
to suggest that Yates was suffering from extreme agitation and/or
insomnia on the combination of Effexor and Remeron is a reasonable
one.
(At this point Healy thanks me for the
reference to the study and asks me for the name of the first
study author in order to find out more details about it -RG)
RG: "No Such Thing
As An Antidepressant" is the title of one of the chapters
of Peter Breggin's book The
Antidepressant Factbook.
Breggin writes, "Is it possible that there is no such thing
as a genuine antidepressant? Before the scientific data had confirmed
my suspicions, I doubted that a drug could actually 'treat' depression.
After all, if depression is a product of our conflicts, stressful
life experiences, and stifled choices, a drug would have no direct
effect on treating it. Meanwhile, study after study has confirmed
that antidepressants typically perform only a little better than
sugar pills. In some studies, antidepressants actually turn out
to be less effective than the lowly sugar pill." Breggin
then goes on to cite the clinical data in a review of the performance
of seven antidepressants in 45 clinical trials. Is there such
a thing as an antidepressant drug and is controlled clinical
testing anyway for us to answer this question?
DH: The Breggin line that there is no
such thing as an antidepressant because depression arises from
conflicts and you couldn't expect a drug to treat that does not
follow a coherent medical logic. The problem with a wide variety
of nervous states we are faced with is that we don't know the
origins of these. To say that they arise from conflicts is too
simplistic.
But even if they did arise from conflicts
it is not clear that an entirely artificial solution that had
little to do with conflicts wouldn't be a way of treating the
problem. In many medical states from broken legs through to cardiac
problems the answer may be to insert something artificial like
a metal plate or a plastic valve in order to produce a new modus
vivendi(manner of living). The origins of these problems are
not a deficiency of metal in the leg or plastic in the heart
but the metal in one case and the plastic in another may provide
a workable solution. However, having said this antidepressants
are not a cure in the sense that they do not correct either the
biological abnormality that may be involved in depression or
event the biological predisposition to depression. Some antidepressants
are energy enhancing. Others like Zoloft, Prozac and Paxil are
more anxiolytic(anxiety relieving). This may or may not be helpful
thing to do in the case of someone who is depressed.
Controlled clinical testing doesn't answer
the question of whether there is such a thing as an antidepressant
or not. What trials do is to show whether a drug can do something
or not. Whether it is wise to then do that something or not is
an entirely separate question and it is probably the case that
many clinicians don't take the time to make a clear decision
as to the wisdom of using an antidepressant in the case of each
of the patients that they ultimately go on to prescribe for.
The overwhelming majority of who are prescribed antidepressants
are at little or no risk for suicide or other adverse outcomes
from their nervous state. Treatment runs the risk of stigmatizing
the person as well as giving them problems that they didn't have
to being with.
RG: I'm looking at a
copy of the August 2001 issue of Primary Psychiatry. Of course,
it's filled with psychiatric drug ads almost exclusively featuring
middle-aged and older female models. Most of the models are smiling
widely because of the happy pills they are on (Effexor, Risperdal,
Remeron, Celexa, Vivactil). The Zoloft add features a portrait
painting of a female face filled with anxiety and depression.
The Paxil ad features a model whose face is filled with anxiety
and worry, obviously because she hasn't had a prescription filled
for her happy pill yet(Of course, there is no suicide warning
anywhere to be found in the ad, which I assume is now required
by law in the UK). There is one ad featuring a male model for
the narcolepsy drug Provigil. In one frame the professional looking
male model with thick glasses is overcome with fatigue. In the
next frame he is as happy as can be with a wide smile across
his face.
Has the aggressive marketing
of psychiatric drugs as happy pills(to the general public as
well as doctor's in professional journals) over the past decade
and-a-half turned MD's into Dr. Feelgoods?
DH: I spend a good deal of time cutting
out adverts for psychotropic drugs to use to illustrate my talks.
The marketing of psychiatric drugs and the change of climate
that this marketing brings about has turned what used to be physicians
into what lawyers now refer to as pharmacologists. It has become
standard practice in the US for you to get your drugs from a
pharmacologist and to get therapy from a psychologist or counselor
paid at a lower rate. This split is, I would have thought, disastrous.
It means that the people who monitor the impact of therapy on
you are not trained at all to know about the hazards of that
therapy.
RG: Out of curiosity,
I wonder if you have any analysis and/or opinion about Loren
Mosher's Soteria experiment (This was an experiment in drug-free
psychiatric treatment conducted under the auspices of the National
Institute of Mental Health during the '70s. The experiment went
well by all accounts. It's just that not only was Soteria drug-free,
but Mosher staffed the experiment with non-professional counselors.
Soteria was quickly defunded and forgotten by the late '70s).
I bring this up because I don't recall it being mentioned in
The
Anti-depressant Era
and it is a case often brought up by critics of the politicization
of clinical testing in psychiatry (The most recent example being
Robert Whitaker's book
Mad In America).
DH: Unfortunately, although I have recently
met Loren Mosher, I haven't analyzed or come up with a view on
the Soteria experiment. This is an omission, particularly in
the light of the fact that I have a new book out from Harvard
University Press this month on the antipsychotics called The
Creation of Psychopharmacology. It picks up many of the issues
touched on in a variety of your questions but unfortunately not
Mosher's Soteria Experiment.
It sounds like Whittaker's book Mad in
America is one that I need to get.
RG: At the press conference
announcing your lawsuit against the University of Toronto and
the CAMH, you said that any punative damages you might win in
your suit would be put into an academic trust fund. The reaction
to the events of September 11 has lead to new threats to academic
freedom. For example, a Palestinian professor was recently fired
from his tenured position at the University of South Florida
and calls for the firing of University of Texas journalism professor
Robert Jensen soley for his anti-war beliefs have been made (here
in Seattle by right-wing talk radio host Michael Medved). How
would such an academic freedom trust fund be made available to
professors who believe their academic freedom has been violated?
DH: I have no idea how academics suffering
from violations of academic freedom post-September the 11th would
be able to access an Academic Freedom Trust Fund into which I've
made contributions. I have no idea for the simple reason that
if there is money that results from the lawsuit I will be handing
it over to others to manage and would not wish to have any say
on how it should be accessed or who should be able to access
it. My plans would be to walk away from the management of any
such funds so that no one could argue that I was using it to
further my own ends.
The CAMH Lecture
RG: In The Antidepressant
Era you took exception to Breggin's argument in Toxic
Psychiatry
that pharmaceutical companies exercise undue influence over research
and the medical literature that gets published. Has your treatment
by the CAMH changed your position on the influence of the pharmaceutical
industry over research and academic freedom in publication?
DH: The Antidepressant Era is all about
the extraordinary influence that pharmaceutical companies can
have over research and the medical literature. The difference
between the position I take in this book and Peter Breggin's
argument is that I believe that psychotropic drugs can be helpful
where he seems to think that physical treatments generally are
both unhelpful and ethically dubious. My treatment by the CAMH
hasn't altered my perceptions on this issue.
RG: At the beginning
of the CAMH lecture you mentioned a couple of the crucial laws
passed during the 20th century that were landmarks in the "War
On Drugs" here in the United States (The 1914 Harrison Narcotics
Act, which made the opiates and cocaine available by prescription
only and the 1951 Humphrey-Durham Amendment to the 1938 Food,
Drugs and Cosmetics Act, which made the new antibiotics, anihypertensives,
antipsychotics, antidepressants, anxiolytics and other drugs,
available by prescription only).
I argue I should have
the right to go across the street to the coffee shop I frequent
and have my afternoon cup of coffee spiked with 5 mg of Ritalin
or 5 mg of Prozac or 5 mg of Remeron or 5 mg of Cocaine or whatever
I want. It's laws like the one mentioned above that stand in
the way of me being able to do this. Furthermore, my government
shouldn't be granting exclusive patents over drugs I paid to
develop. Public Citizen has pointed out that the majority of
the costs of brining a prescription drug to the market is put
up by tax payers and our reward for this is to have to pay the
the extortionately high prices for drugs made possible by exclusive
patents. In a decriminalized free market, I don't have to pay
the Mob's high drug prices or have the blessing of a doctor to
take a drug. I can report any adverse event I might experience
to a doctor without fear of legal sanction against me. If the
FDA made adverse event reporting mandatory for doctors and adverse
event forms widely available to the public for the purpose of
voluntary reporting, then researchers could probably get more
good data on drugs than they currently do from the clinical testing
controlled by the pharmaceutical industry.
What is your opinion
of a free market for drugs (I ask because you mentioned in The
Antidepressant Era the fact that you could prescribe anything
you want for yourself while your patients don't have this privelege)?
DH: My use of the idea of making all
these drugs available over the counter was as a thought experiment
to try and bring home to people how much prescription only status
channels us down a disease model. This shows up clearly in the
difference between the marketing of St John's Wort and the marketing
of Prozac. You can get St John's Wort to treat yourself for stress
and burnout, to get Prozac you have to be made depressed. There
are implications for this.
There are a whole lot of other ways to
solve many of the problems we have however. One would be to insist
that pharmaceutical companies have to make their data and not
just their trials publicly available. It would be a simple matter
to say that the data is inherently unscientific while it remains
proprietary. There is no other branch of science in which the
raw data remains inaccessible to investigators generally and
indeed essentially to the public.
The whole area of how to handle drug
misuse etc. is a complex and fraught one. I see my role in the
debate as trying to bring certain angles of the problem to light,
angles that are not ordinarily commented on. I don't presume
to know the answers.
RG (The following are
two question for Healy that are answered below) "Coming
from my perspective the antipsychiatry arguments that madness
does not really exist are simply wrong." All right, then
define what a mental disorder is. Your colleagues at the American
Psychiatric Association haven't helped with this issue with each
new edition of their burgeoning Diagnostic and Statistical Manual
of Mental Disorders. Having read about a third of the DSM-IV-TR
so far, it's easy to see the politics and difficult to see the
science driving the most popular diagnoses such as AD/HD for
unruly school boys, Delusional Disorder of both the Grandiose
and Persecutory Type for the homeless or JFK assassination conspiracy
buffs, Generalized Anxiety Disorder for middle and upper income
women, etc., etc.,.
"In the same way
fear of God was once seen as a good thing that held social order
in place. The fear then became anxiety and anxiety disorders
- something to treat. What this shows is that there are forces
at play, that can change not only the kinds of drugs we give,
not only the conditions we think we are treating, but our very
selves who are doing the giving. Forces that can change us more
profoundly than we can be changed by a handful of LSD containing
dust," you said near the end of the CAMH lecture. You are
sounding a lot like Thomas Szasz here(author of the "Myth
of Mental Illness") yet you don't see eye to eye with him
on the existence of madness. I mean something like the above
quote suggests that mental disorder has been invented to replace
the Church in managing social order, i.e. Szasz's "Therapeutic
State." Elaborate further on what mean by the above quote
because something like it could confuse people about your position
on these issues.
DH: In the case of Thomas Szasz he was
arguing that it was unreasonable to say that psychoneuroses were
diseases. I agree with him. However I have not been a psychotherapist
earning my living out of treating minor mental disorders. I'm
at the coalface in a District General Hospital setting managing
psychoses. Many of these patients can end up in states of rigid
immobility that we know can last for months or years if left
untreated. Others are consumed by nihilistic delusions of various
sorts. Yet others have thought disorder of a kind that most clinical
observers looking at it have said indicates frontal lobe dysfunction.
It is these states that I am happy to say look like real diseases.
Saying that these look like real diseases
does not mean that they have to be treated with physical means.
I am happy to respect a person or their families wish to leave
the state untreated. I also believe that when we finally understand
the biological underpinnings of things this will put us in a
better position to know how to handle many of these states by
non-physical means. Genetic testing for disorders like phenylketonuria
makes it possible to avoid the damage that this illness causes
by simply managing your diet properly.
I believe the real concern the antipsychiatrists
had was not so much whether mental illness was real or not, but
rather a concern at the extension of the psychiatric reach out
into the community that took place in the 1960s. Who were these
guys who were telling us how to live our lives - what training
do they have in how to live life.
If you read The
Creation of Psychopharmacology you realize that the origins
of operational criteria as found in DSMIII and IV etc etc are
not because the people who came up with the idea of operational
criteria knew what these diseases really were. Operational criteria
are a confession of ignorance. They do not legitimate the existence
of any of the disease entities that people are particularly keen
about nowadays.
RG: One of the more controversial aspects
of the CAMH lecture was your assertion that psychiatric patients
in Britain are being detained at 3 times the rate today than
they were 50 years ago. What prompted me to contact you was a
report about suicide in the UK I read at Organon's <PsychiatryMatters.md>
website back in January(Organon is the manufacturer of Remeron).
The report stated that the number of patients being admitted
to John Radcliffe Hospital in Oxfordshire for self inflicted
harm had increased from 1,000 per year in 1990 to 1,600 per year
by the end of the decade. The annual suicide rate for men aged
15-24 in the UK increased from 10 deaths per 1,000 in 1983 to
15 deaths per 1,000 in 1992. Today the suicide rate for young
men in the UK is double what it was in 1968. Do these kinds of
statistics buttress your argument that psychiatrists now have
more patients in their care than ever before? Could one argue
that this is an example of treatment failure on the part of psychiatry(The
60 percent increase in suicide admissions at one hospital in
the UK during the '90s, a decade when medical science had purportedly
made on revolutionary pharmacological break through after another
in the treatment of depression, hardly comes across as something
for psychiatry and the pharmaceutical industry to write home
about, much less to use as the basis for bankrolling awareness
campaigns about the need for people to seek "treatment"
for depression)?
(Healy provided me with the text of a
lecture he gave at the University of Toronto a year ago. This
lecture went over the statistical data underlying Healy's claim
that psychiatrists are treating more patients than ever before.
It compares admission statistics at North Wales Hospital in 1896
to 1996. The implications from the data are clear enough. Patients
in 1996 were being discharged from the hospital with prescriptions
for neuroleptic and antidepressant drugs that can cause agitation
and suicidal ideation. This may be the reason why the 1996 patients
have much higher suicide rates than the 1896 patients. The most
embarrassing implication of all for modern psychiatry is that
psychiatric patients of 1896 may very well have had better outcomes
in the area of death rates than patients of 1996 when the lack
of antibiotics in 1896 are taken into account. One conclusion
to draw from this data is clear: psychiatric patients at North
Wales Hospital in 1896 were dying primarily from physical causes
while a century later they were dying far more often from self
inflicted harm. A major indictment of the claim that the past
half-century has been a golden age in the treatment of psychiatric
illness. I would recommend everybody interested in this subject
e-mail Healy for a word copy of this interesting lecture at:
Healy_Hergest@compuserve.com.
RG: You noted the unceremonious
retirement of Thorazine's co-discoverer Jean Delay. His office
was ransacked during the May 1968 strikes and protests in Paris
and that at the time "he has no sympathy for the new world,
in which students can expect to address the professors in informal
terms." You go on to argue that "Both psychiatry and
antipsychiatry were swept away by a new corporate psychiatry.
Galbraith argues that we no longer have free markets; corporations
work out what they have to sell and then prepare the market so
that we will want those products. It works for cars, oil, and
everything else, why would it not work for psychiatry? Prescription
only status makes the psychiatric market easier than almost any
other market - only a comparatively few hearts and minds need
to be won."
Do you think your firing
by the CAMH and your suspicions that Eli Lilly had a hand in
it vindicates your argument about the take over of the profession
by what you call corporate psychiatry?
DH: I have never voiced suspicions that
Eli Lilly had a hand in my firing from CAMH. Lots of other people
have voiced those suspicions. Yet others again have made strong
cases for the possibilities that Pfizer or SmithKline may have
brought influence to bear on this issue.
It's a bit too early to judge whether
my firing by CAMH gives a good indication of where the profession
of psychiatry generally is at. Leaving my case aside however
I think the takeover by corporate psychiatry is fairly complete
at this point in time.
Rick Giambetti
lives in Seattle. He can be reached at: rickjgio@speakeasy.org
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