13 ms·

The psychiatric drug crisis

156 points by npalli 13y ago

whalemaker 13y ago
Obscure psychiatric drugs are also ridiculously expensive sometimes. A friend of mine switched from a brand name anti-psychotic to a generic version. He went from paying over $1200 a month to $22 for 30 pills, for something as important as preventing his psychotic episodes.
- eksith 13y ago
  That's just obscene! All that markup over just the label. I understand that it takes R&D to develop new drugs, but the amount of profit sought by drug companies is stomach churning.
  - forrestthewoods 13y ago
    Obscene? What's the "correct" markup? I sell digital, single-player video games. My manufacturing cost is zero and markup is infinite.
    - msvan 13y ago
      Your marginal distribution cost is zero, but the manufacturing cost to design and develop the game is clearly not zero. The issue is that just because you can charge a lot doesn't mean you should. Although capitalism rarely works that way.
      - forrestthewoods 13y ago
        Perhaps a fair price point would be one that generates enough revenue to cover development costs and perhaps fund the next project as well? That sounds pretty reasonable.
      - quanticle 13y ago
        I think talking about capitalism, or rather, "free market", in the context of drug production is laughable. Free markets, as conventionally defined, have two characteristics: 1. Producers and consumers are both equally informed 2. There are so many producers and so many consumers that no single producer or no single consumer is able to appreciably change the market price Neither of those assumptions hold with the the drug market. Drug makers are massively more informed about the benefits and side effects of their drugs than I am. And there aren't that many drug manufacturers - and ongoing mergers keep shrinking the pool. In reality, the drug market is a barely regulated oligopoly, where a few large players manipulate the price signal to coordinate behavior so that they can move in relative unison to screw over the consumer. It's just like oil companies or airlines.
    - anigbrowl 13y ago
      The correct markup is cost + opportunity cost, known in economics as 'normal profits'. Your manufacturing cost is not zero at all. You have significant fixed costs; your marginal cost is zero, or so close to it as to be negligible. Your average fixed costs fall with each copy sold, but unless you consider your time and labor entirely worthless you have to sell quite a few copies before you break even. Also, since your game is a discretionary expense, there's no significant opportunity cost to the non-purchaser, whereas the opportunity cost to someone who eschews or can't afford to purchase medication might be the person's life.
  - jaredhansen 13y ago
    >amount of profit sought by drug companies is stomach churning What's the right amount of profit a company should seek? For reference, following are the latest reported profit margins of several companies: Eli Lilly: 20.34% AstraZeneca: 13.33% Novartis: 17.33% Apple: 19.53% Google: 18.11% Microsoft: 24.95% It's not at all clear to me that drug companies are somehow seeking more profits than other companies (or that they would generally be able to attain them in any case).
    - johnchristopher 13y ago
      > It's not at all clear to me that drug companies are somehow seeking more profits than other companies. Could it be high-level tax evasion ?
      - quanticle 13y ago
        If it is, then why isn't everyone doing it? Are you saying that somehow AstraZeneca has wizardly accountants that Apple does not?
    - HarryHirsch 13y ago
      It's the fact that pharmaceutical companies are involved in the sphere of public health that makes people uneasy about excessive profits, whatever "excessive" means. It's not only profits: lifestyle drugs, like statins and medication for ED are obviously a source of easy profit, meanwhile research into antibiotics is falling by the wayside. The fact that the existing antibiotics are becoming useless and there is nothing to replace them is going to be a disaster. There is this current discussion about vaccination skepticism (to use a polite word); one reason that parents omit to vaccinate their children is that no one living has experienced what a genuine measles or polio epidemic is like. The availability of antibacterials since the 1930s has been a similar miracle. You do not have to die of a severe infection, you can take medication against it. Unless there is investment in research, serious infectious diseases will be back.
      - ninguem2 13y ago
- kvb 13y ago
  Note that generics are not identical to branded drugs; I believe the FDA has a +/-20% bioavailability tolerance. For medications with broad dose-response curves (e.g. most painkillers, probably lots of other classes of drugs) this isn't a big deal, but for other medications it can be. As I understand it, psychiatric medications often have narrower dose-response curves (disclaimer - IANAD).
losethos 13y ago
Highs and lows balance. You must endure persecution to win blessings. Doctors are brute-nigger-retards. God says... recently encourage shoulders etext90 how sleeper aches roared adomed lover baffling expects 'may assented casts vagrant bulk employest no_more_tears Place prepared debtors uncorruptness indeed mastery dang_it mindful threatenest prose manifold shamefulness Israel findeth disagreements crown changeableness beloved dissolution eat hear givers proclaim I'm_bored cleansing restest enacted night withdrawing earnestness //www unlike Newsletters Angel talents commercial alleging lure finest Continency clearly supported preach ambition disgusted Men what_luck dollar wast enmity forwards lingering commencement persecuted heresy liked fishes struggles regardless asked unexplained god wedlock Jew teachers salt banished at deemed flame Balaneion enough combine instantly writing ----- I am at peace -- nothing and I mean nothing can prevent justice.
tokenadult 13y ago
"Gary Greenberg is a practicing psychotherapist" What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful?
- lutusp 13y ago
  > What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful? The same question could be asked of any psychologist, psychotherapist or psychiatrist, regardless of their publication record. There are no objective, scientific, rigorous evaluation criteria anywhere in the field, which explain why the mental health field has the reputation it does. No one asked it of Diederik Stapel, and, in spite of his enviable publication record and fame, he turned out the be a total fraud: Link: http://news.sciencemag.org/people-events/2012/11/final-report-stapel-affair-points-bigger-problems-social-psychology http://news.sciencemag.org/people-events/2012/11/final-repor... Quote: " In their exhaustive final report about the fraud affair that rocked social psychology last year, three investigative panels today collectively find fault with the field itself. They paint an image of a "sloppy" research culture in which some scientists don't understand the essentials of statistics, journal-selected article reviewers encourage researchers to leave unwelcome data out of their papers, and even the most prestigious journals print results that are obviously too good to be true."
  - gohrt 13y ago
    That quote may have been in context of a psychiatry study, but applies equaly well to huge swathes of medical research.
    - lutusp 13y ago
      With one important difference -- when a medical procedure or substance is shown to be useless or dangerous, doctors stop using it or go to jail. By contrast, psychologists just carry on with business as usual -- for example, there are still therapists offering recovered memory therapy. If a medical drug were proven ineffective as anti-depression drugs have, doctors would have to stop prescribing it or be sued for malpractice. You can't sue psychologists for malpractice, because there's no such thing as good psychological practice for comparison. If psychologists were forced to adopt evidence-based practice, they would be subject to lawsuits for the first time, which is why they have resisted such proposals: Link: http://www.apa.org/monitor/feb05/pc.aspx http://www.apa.org/monitor/feb05/pc.aspx Quote: "Some APA members have asked me why I have chosen to sponsor an APA Presidential Initiative on Evidence-Based Practice (EBP) in Psychology, expressing fears that the results might be used against psychologists by managed-care companies and malpractice lawyers." The critics were right -- evidence-based practice would have been a disaster for psychology -- and the proposal (2005) was shouted down.
TheLegace 13y ago
My ADHD medication Strattera costs $170 a month and since the generic version only saves me $20 causes serious nausea and vomiting I don't have any choice. And its one of the only medications you can't develop a tolerance for. Luckily I'm Canadian, working part time at a Canadian university where health insurance covers the costs.
- aweisberg 13y ago
  For the last 18 years or so I have been taking some form of low cost Ritalin with a co-pay between 15-25 dollars. This ancient medication that is a generic costs 130 dollars a month and that is the negotiated rate! The money isn't going to research and it isn't going to manufacturing so where does it go?
  - rsl7 13y ago
    the cayman islands.
    - deleted 13y ago
      [deleted]
  - TheLegace 13y ago
    Ugh don't even get me started on Ritalin(although it was cheap for me). It caused such a huge depression that permanently changed who I was and still feels there's no going back to before I took it.
  - Daniel_Newby 13y ago
    You can get that ancient medication for a pittance, but it will be the immediate release form that has a harsh onset and a harsh withdrawal in 2 hours. You are paying for the formulation of the pills, which you evidently consider worth it.
  - driverdan 13y ago
    You're joking right? Drug companies are businesses just like any other. They try to maximize revenue just like everyone else.
dancric 13y ago
The book, "Anatomy of an Epidemic", provides a really comprehensive look at how we ended up in this situation. Some of the keys here: 1) A desire to bring a level of "science" to a part of our physiology we don't understand. The thinking here is that while we do not understand the etiology of depression, we can at minimum begin to use blunt tools to solve problems. The issue as anyone who has studied complex systems understands, is that the feedback loops are so dense, there is no method to understand what is happening. 2) Financialization of treatment – drugs make more money than therapy and other methods. Or to use an HN phrase, drugs are more easily scaled to the population than other methods. The incentives throughout the entire system push people this direction, regardless of the underlying research. 3) Treatment doesn't happen instantly in any case. The issue with much of the research today is that we take a very limited time window to evaluate the efficacy of different treatments. If, instead, we looked at treatment over the life course, the results are often radically different. This is where startups like Seven Cups of Tea will hopefully play the world. This mental health crisis offers a huge opportunity for disruption and creativity. As a quote in the Stanford alumni magazine said this month: "One hundred years from now, people will look back at the age of giving SSRIs and they will have a reputation that's akin to bloodletting."[1] [1] http://alumni.stanford.edu/get/page/magazine/article/?article_id=64350 http://alumni.stanford.edu/get/page/magazine/article/?articl...
- jonah 13y ago
  "...they will have a reputation that's akin to bloodletting" Here's to hoping so! And sooner than that.
- scythe 13y ago
  >A desire to bring a level of "science" to a part of our physiology we don't understand. Confer: http://thelastpsychiatrist.com/2006/11/massacre_of_the_unicorns.html http://thelastpsychiatrist.com/2006/11/massacre_of_the_unico... http://thelastpsychiatrist.com/2010/01/the_massacre_of_the_unicorns_i.html http://thelastpsychiatrist.com/2010/01/the_massacre_of_the_u...
FrankenPC 13y ago
Maybe humans are just...unhappy? By that I mean as a race, we are inherently unstable (see: entire human history) and for a long time we kept it together by forming very tight family and community bonds. We had central, realistic, and tangible goals. We had an invisible friend (religion). As science has systematically stripped all that away (for the better mind you...), nothing has filled those needs. We don't need more facebook and texting, we need human contact. HAHAHA! Just kidding! Did you see the latest iPhone! It's got moar processors!
- guard-of-terra 13y ago
  http://blog.wilshipley.com/2005/05/on-being-crazy.html http://blog.wilshipley.com/2005/05/on-being-crazy.html is a very insightful read on that subject, from a successful but unstable person. Is mankind only so smart because if we get any smarter, we cease to function correctly? Maybe it's just not evolutionarily advantageous to be smarter than we are; it makes us mopey, and we end up cutting our ears off when we're trying to woo girls, which rarely results in offspring.
  - kirubakaran 13y ago
    Disproof : Richard Feynman
    - gohrt 13y ago
      How many offspring did Feynman have?
      - kirubakaran 13y ago
        "Feynman would marry twice more and have two children with his third wife." http://www-history.mcs.st-and.ac.uk/Biographies/Feynman.html http://www-history.mcs.st-and.ac.uk/Biographies/Feynman.html Anyway, my point is, being smarter is not an excuse for "cutting one's ears off when trying to woo girls" (re:my parent comment) or for otherwise being socially dysfunctional.
- 13y ago
paul9290 13y ago
I haven't read this entire article, but my experiences with a handful of anti-depressants is that they all are a placebo. Though not for profits. Sell people hope and promise of becoming "normal," and they buy it in the million. Again this is my own personal experience in taking various anti-depressants for a few years. Overall what helped me was talking to other people and realizing were all nuts (deal with same issues) and yet very normal. So if your dealing with depression and anxiety and are hiding it, from my experiences please do not. Please talk about it with as many people as possible; realize we are all the same and deal with the same similar issues!
- nwh 13y ago
  I'm sure your anecdotal experience with a handful of drugs is representative of everybody else's experience. (It's not)
kyro 13y ago
Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if they have a treatable illness. I would ask psychiatrists I trained with to explain why a drug worked or why a disease developed. They would do nothing more than give me the same surface-level information we all know: SSRIs block serotonin reuptake, leading to more serotonin in the synaptic cleft that would then cause increased stimulation, and voila, you're not depressed. This is information anyone can attain with a google search. The majority of their knowledge dealt with pharmacological dynamics. I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." It was evident that their treatment protocol was largely one of extremely unsupported trial-and-error based on very, very unique experiences, anecdotes, and preferences each psychiatrist had. Now, I don't want to discredit the entire field. I do know friends and family who have benefited from psychiatric medications, although that could entirely be due to placebo effect. What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. Mechanically so that we may develop effective meds, abstractly so that we may learn how to manipulate cognitive processes, like with what we see with CBT, which has worked wonders for many with depression -- no medication involved. tl;dr: Psychiatry is a very, very loose and abstract field. You can't run any diagnostic tests on patients. It's mostly a field of educated guessing and confirmation bias. We need better mechanical and abstract understanding of the mind before we douse it in chemicals.
- pyre 13y ago
  > although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lifetime to be used for other things. I'd almost say that the brain is sort of like an evolutionary algorithm. Given similar parameters, the results largely resemble each other, but alter things enough and the results can be way off.
md224 13y ago
Fun Fact: Selective Serotonin Reuptake Inhibitors, the class of drugs used to treat depression and anxiety disorders by increasing the availability of serotonin, have a mirror opposite: Tianeptine (http://en.wikipedia.org/wiki/Tianeptine http://en.wikipedia.org/wiki/Tianeptine), which acts as a Selective Serotonin Reuptake Enhancer. Incredibly, this drug has also been effective at treating depression. That's right: two classes of drugs with polar opposite first-order effects are used to treat the same disorder, and both of them apparently work.
- angersock 13y ago
  The molecule looks somewhat obscene.
  - jrockway 13y ago
    It might want to get that chlorine looked at.
- jes5199 13y ago
  I've been meditating on this fact for a while. (I take an SSRI, and I believe that it helps me, but I would love to know why.) I think one possible understanding of depression is that it is a feedback loop - it's a sort of standing wave or Nash equilibrium of patterns of thought causing patterns of behavior causing patterns of sensation causing patterns of emotion that cause patterns of thought, etc. And, perhaps, that just by changing any random variable(s) in that loop (mucking with reuptake, or cognitive behavioral therapy, or any of a whole bunch of other possible changes) has a probability of disrupting the equilibrium and suspending the depression. It's not clear to me how to test this hypothesis, though.
  - taway2012 13y ago
    Hmm, check out 'Autopilot' by Andrew Smart. It has some sections about equilibrium etc. And 'On Intelligence' by Jeff Hawkins (very under-rated book imho). Good luck!
    - 13y ago
unono 13y ago
Hackers can make huge money in psychology/psychiatry (both prescientific fields). Life logging and it's analysis - quantified self. Positive psychology would be the better angle to play it, unregulated, big money in the self-help culture. Mobile apps are the right medium for it. There was recent doc on it 'Monitor Me' by bbc horizon. edit: to replyers, it didn't want to post links for everything, so google 'monitor me bbc horizon youtube', 'quantified self', 'self help industry', 'positive psychology'
- sillysaurus2 13y ago
  I'm trying to understand what you're saying, but honestly I have no idea what you just said. Would you clarify your meaning? edit to reply to your edit: no, you'll have to do much better than that if you want to actually communicate with people and not be ignored or dismissed as crazy. Would you please spend at least 10 minutes typing an explanation of (a) what are you talking about, and (b) why is it valuable? Maybe I should point out that your edit seems to assume that most people understood part of your original comment. Actually, I think nobody understood any of it. So you'll have to rewrite what you originally said. (One strategy would be to make your comment longer and more thorough, and don't assume that anyone understands what you're saying unless you've explained it thoroughly, even if it seems obvious to you.)
  - unono 13y ago
    OK. I try to see articles and find a positive spin where I can say "hackers could ...". To some people it would be obvious, but to young or non-tech people it might not be, so it could be helpful to them. As other commenters have said, psychiatry/psychology is an ineffective field and also expensive. The self-help industry is kind of related to psychology/psyciatry, is unregulated, and a $11 billion a year field. I gave a mention of a documentary that came out recently about people building apps in this category of self help/health/life monitoring kind of stuff. Some terms to google to find out more are what I typed in the OC.
    - totierne 13y ago
      I would pay folding money for this software+usage data - and I am just an affected individual (bipolar for 20 years). I went through a phase of asking for survey information (after they had published their paper article etc.)- no one would give it up.
bdclimber14 13y ago
I think it's relevant to point out the potent anti-depressant effects many people experience with natural supplements such as sam-e and 5htp. It's unfortunate that these drugs are rarely prescribed (in the U.S.). Few clinical studies have been done on these and there is little economic motivation for drug companies since these are un-patentable substances.
dhubris 13y ago
Medication is only one tool, and often needs to be used in combination with other tools, but people are always looking for the quick fix. Dealing with some of this shit can take hard work over time. Here is a small look at my experiences dealing with depression, PTSD and medication: http://dhubris.livejournal.com/14447.html http://dhubris.livejournal.com/14447.html As I said, it works for me, but may not work for you. The study of the brain and how it works physically, electrically, chemically, consciously and emotionally, and all the complex interactions within that is in its infancy in a lot of ways. So yes, if you think there is a lot of stumbling around trying to figure out what works and what doesn't, you're right. Isn't that how most science starts?
brownbat 13y ago
Eh, maybe understanding of the brain is ripe for some kind of "scientific revolution." If so, I really hope Ed Boyden and the Synthetic Neurobiology Group are a part of it: http://www.ted.com/talks/ed_boyden.html http://www.ted.com/talks/ed_boyden.html The video is a little more optimistic, maybe even risks TED-utopianism... but it still has some really cool ideas, and shows that we have at least figured out a couple of things about brains.
danmaz74 13y ago
This article has its own very naive bias: Thinking that every phenomenon must have a "root cause" - ie, a simple cause-effect explanation - and that if you don't find the root cause, you can't control the phenomenon. Take for example serotonin reuptake inhibitors. It's not important to know if a deficiency in serotonin is the "cause" of depression. All we need to know is if increasing the levels of serotonin correlates with an improvement of the condition of the patient better than placebo.
- tsotha 13y ago
  From a drug designer's perspective, though, this is a problem. If you don't know why the current drugs work you're going to have a lot of trouble improving them.
  - danmaz74 13y ago
    Yes, but to know "why" (I'd much rather say "how") current drugs work you don't need to know "why" people get certain illnesses - that's my issue with the article. Their logic is: low serotonin levels aren't the cause of depression - so raising serotonin levels will not eliminate the cause of depression - so doing that isn't useful. That's a naive (and wrong) logic. Your heart going into fibrillation is not the cause of your heart problems, but treating the fibrillation can save your life - whatever the "cause" of that fibrillation.
    - tsotha 13y ago
      >Yes, but to know "why" (I'd much rather say "how") current drugs work you don't need to know "why" people get certain illnesses - that's my issue with the article. Well, that's true. But I think he makes a reasonably compelling argument that we don't in fact know why the current generation of drugs works.
jorleif 13y ago
The article has an interesting argument structure. First it undermines the science behind psychiatric drugs by referring to their discovery as serendipitous. Then it proceeds to point out that there is no good theoretical understanding for how the drugs work, even if there is understanding in what neurotransmitter levels are effective. Then the author proceeds to drop the "not better than placebo" results. Without knowing any psychiatric science, this narrative nevertheless seems suspicious. First of all, it is entirely irrelevant whether a discovery was made serendipitously or as a result of incremental science, as long as the effect is clear enough to be repeatedly found. This is not true in well understood fields, such as physics, where the theories are mostly not changed every now and then, but in complex fields, such as medicine and social sciences, the fact that something matches pre-existing theory is no evidence per se. The problem is "bumpy" enough that any theory is likely to flatten every bump that is not directly observed, even if that bump would be very useful in practice. This leads to most discoveries of any value being serendipitous. It also leads to incremental research failing to advance rapidly most of the time. So the lack of theory and serendipitous discovery are not problems in themselves. The finding that psychiatric drugs would not be better than placebos is indeed a problem. It does raise the question, of how the serendipitous discovery was ever made. Did it arise out of spurious correlations, so that when the drug was first discovered there happened to be a big incidental recovery in most treated patients? Then in later retrials people managed to trigger a sufficient placebo effect to get the whole thing going. It does seem a little unlikely, but one would have to examine how the first trials were performed.
jotm 13y ago
The discoveries of antidepressants and anxiolytics weren't accidental: testing something and seeing what it does, then finding a purpose for it is not accidental, it's basic science. It's how most chemicals were discovered. And there's no doubt these medications work in a lot of people (but not all), even though we don't understand how they actually work. Our ancestors did not know what fire was or how it worked, but they did use it because it was useful, the same applies here. Further development is going to be difficult without a good understanding of how the brain works, though - pharma companies need to focus on finding better ways to probe deeper and more accurately into the brain (and create good simulators for that later on) before developing new drugs.
dbuder 13y ago
The field of trying to cure the condition commonly known as being human.

156 points by npalli 13y ago

Obscure psychiatric drugs are also ridiculously expensive sometimes. A friend of mine switched from a brand name anti-psychotic to a generic version. He went from paying over $1200 a month to $22 for 30 pills, for something as important as preventing his psychotic episodes.

eksith 13y ago
That's just obscene! All that markup over just the label. I understand that it takes R&D to develop new drugs, but the amount of profit sought by drug companies is stomach churning.
- forrestthewoods 13y ago
  Obscene? What's the "correct" markup? I sell digital, single-player video games. My manufacturing cost is zero and markup is infinite.
  - msvan 13y ago
    Your marginal distribution cost is zero, but the manufacturing cost to design and develop the game is clearly not zero. The issue is that just because you can charge a lot doesn't mean you should. Although capitalism rarely works that way.
    - forrestthewoods 13y ago
      Perhaps a fair price point would be one that generates enough revenue to cover development costs and perhaps fund the next project as well? That sounds pretty reasonable.
    - quanticle 13y ago
      I think talking about capitalism, or rather, "free market", in the context of drug production is laughable. Free markets, as conventionally defined, have two characteristics: 1. Producers and consumers are both equally informed 2. There are so many producers and so many consumers that no single producer or no single consumer is able to appreciably change the market price Neither of those assumptions hold with the the drug market. Drug makers are massively more informed about the benefits and side effects of their drugs than I am. And there aren't that many drug manufacturers - and ongoing mergers keep shrinking the pool. In reality, the drug market is a barely regulated oligopoly, where a few large players manipulate the price signal to coordinate behavior so that they can move in relative unison to screw over the consumer. It's just like oil companies or airlines.
  - anigbrowl 13y ago
    The correct markup is cost + opportunity cost, known in economics as 'normal profits'. Your manufacturing cost is not zero at all. You have significant fixed costs; your marginal cost is zero, or so close to it as to be negligible. Your average fixed costs fall with each copy sold, but unless you consider your time and labor entirely worthless you have to sell quite a few copies before you break even. Also, since your game is a discretionary expense, there's no significant opportunity cost to the non-purchaser, whereas the opportunity cost to someone who eschews or can't afford to purchase medication might be the person's life.
- jaredhansen 13y ago
  >amount of profit sought by drug companies is stomach churning What's the right amount of profit a company should seek? For reference, following are the latest reported profit margins of several companies: Eli Lilly: 20.34% AstraZeneca: 13.33% Novartis: 17.33% Apple: 19.53% Google: 18.11% Microsoft: 24.95% It's not at all clear to me that drug companies are somehow seeking more profits than other companies (or that they would generally be able to attain them in any case).
  - johnchristopher 13y ago
    > It's not at all clear to me that drug companies are somehow seeking more profits than other companies. Could it be high-level tax evasion ?
    - quanticle 13y ago
      If it is, then why isn't everyone doing it? Are you saying that somehow AstraZeneca has wizardly accountants that Apple does not?
  - HarryHirsch 13y ago
    It's the fact that pharmaceutical companies are involved in the sphere of public health that makes people uneasy about excessive profits, whatever "excessive" means. It's not only profits: lifestyle drugs, like statins and medication for ED are obviously a source of easy profit, meanwhile research into antibiotics is falling by the wayside. The fact that the existing antibiotics are becoming useless and there is nothing to replace them is going to be a disaster. There is this current discussion about vaccination skepticism (to use a polite word); one reason that parents omit to vaccinate their children is that no one living has experienced what a genuine measles or polio epidemic is like. The availability of antibacterials since the 1930s has been a similar miracle. You do not have to die of a severe infection, you can take medication against it. Unless there is investment in research, serious infectious diseases will be back.
    - ninguem2 13y ago
kvb 13y ago
Note that generics are not identical to branded drugs; I believe the FDA has a +/-20% bioavailability tolerance. For medications with broad dose-response curves (e.g. most painkillers, probably lots of other classes of drugs) this isn't a big deal, but for other medications it can be. As I understand it, psychiatric medications often have narrower dose-response curves (disclaimer - IANAD).

losethos 13y ago

Highs and lows balance. You must endure persecution to win blessings. Doctors are brute-nigger-retards. God says... recently encourage shoulders etext90 how sleeper aches roared adomed lover baffling expects 'may assented casts vagrant bulk employest no_more_tears Place prepared debtors uncorruptness indeed mastery dang_it mindful threatenest prose manifold shamefulness Israel findeth disagreements crown changeableness beloved dissolution eat hear givers proclaim I'm_bored cleansing restest enacted night withdrawing earnestness //www unlike Newsletters Angel talents commercial alleging lure finest Continency clearly supported preach ambition disgusted Men what_luck dollar wast enmity forwards lingering commencement persecuted heresy liked fishes struggles regardless asked unexplained god wedlock Jew teachers salt banished at deemed flame Balaneion enough combine instantly writing ----- I am at peace -- nothing and I mean nothing can prevent justice.

tokenadult 13y ago

"Gary Greenberg is a practicing psychotherapist" What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful?

lutusp 13y ago
> What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful? The same question could be asked of any psychologist, psychotherapist or psychiatrist, regardless of their publication record. There are no objective, scientific, rigorous evaluation criteria anywhere in the field, which explain why the mental health field has the reputation it does. No one asked it of Diederik Stapel, and, in spite of his enviable publication record and fame, he turned out the be a total fraud: Link: http://news.sciencemag.org/people-events/2012/11/final-report-stapel-affair-points-bigger-problems-social-psychology http://news.sciencemag.org/people-events/2012/11/final-repor... Quote: " In their exhaustive final report about the fraud affair that rocked social psychology last year, three investigative panels today collectively find fault with the field itself. They paint an image of a "sloppy" research culture in which some scientists don't understand the essentials of statistics, journal-selected article reviewers encourage researchers to leave unwelcome data out of their papers, and even the most prestigious journals print results that are obviously too good to be true."
- gohrt 13y ago
  That quote may have been in context of a psychiatry study, but applies equaly well to huge swathes of medical research.
  - lutusp 13y ago
    With one important difference -- when a medical procedure or substance is shown to be useless or dangerous, doctors stop using it or go to jail. By contrast, psychologists just carry on with business as usual -- for example, there are still therapists offering recovered memory therapy. If a medical drug were proven ineffective as anti-depression drugs have, doctors would have to stop prescribing it or be sued for malpractice. You can't sue psychologists for malpractice, because there's no such thing as good psychological practice for comparison. If psychologists were forced to adopt evidence-based practice, they would be subject to lawsuits for the first time, which is why they have resisted such proposals: Link: http://www.apa.org/monitor/feb05/pc.aspx http://www.apa.org/monitor/feb05/pc.aspx Quote: "Some APA members have asked me why I have chosen to sponsor an APA Presidential Initiative on Evidence-Based Practice (EBP) in Psychology, expressing fears that the results might be used against psychologists by managed-care companies and malpractice lawyers." The critics were right -- evidence-based practice would have been a disaster for psychology -- and the proposal (2005) was shouted down.

TheLegace 13y ago

My ADHD medication Strattera costs $170 a month and since the generic version only saves me $20 causes serious nausea and vomiting I don't have any choice. And its one of the only medications you can't develop a tolerance for. Luckily I'm Canadian, working part time at a Canadian university where health insurance covers the costs.

aweisberg 13y ago
For the last 18 years or so I have been taking some form of low cost Ritalin with a co-pay between 15-25 dollars. This ancient medication that is a generic costs 130 dollars a month and that is the negotiated rate! The money isn't going to research and it isn't going to manufacturing so where does it go?
- rsl7 13y ago
  the cayman islands.
  - deleted 13y ago
    [deleted]
- TheLegace 13y ago
  Ugh don't even get me started on Ritalin(although it was cheap for me). It caused such a huge depression that permanently changed who I was and still feels there's no going back to before I took it.
- Daniel_Newby 13y ago
  You can get that ancient medication for a pittance, but it will be the immediate release form that has a harsh onset and a harsh withdrawal in 2 hours. You are paying for the formulation of the pills, which you evidently consider worth it.
- driverdan 13y ago
  You're joking right? Drug companies are businesses just like any other. They try to maximize revenue just like everyone else.

dancric 13y ago

The book, "Anatomy of an Epidemic", provides a really comprehensive look at how we ended up in this situation. Some of the keys here: 1) A desire to bring a level of "science" to a part of our physiology we don't understand. The thinking here is that while we do not understand the etiology of depression, we can at minimum begin to use blunt tools to solve problems. The issue as anyone who has studied complex systems understands, is that the feedback loops are so dense, there is no method to understand what is happening. 2) Financialization of treatment – drugs make more money than therapy and other methods. Or to use an HN phrase, drugs are more easily scaled to the population than other methods. The incentives throughout the entire system push people this direction, regardless of the underlying research. 3) Treatment doesn't happen instantly in any case. The issue with much of the research today is that we take a very limited time window to evaluate the efficacy of different treatments. If, instead, we looked at treatment over the life course, the results are often radically different. This is where startups like Seven Cups of Tea will hopefully play the world. This mental health crisis offers a huge opportunity for disruption and creativity. As a quote in the Stanford alumni magazine said this month: "One hundred years from now, people will look back at the age of giving SSRIs and they will have a reputation that's akin to bloodletting."[1] [1] http://alumni.stanford.edu/get/page/magazine/article/?article_id=64350 http://alumni.stanford.edu/get/page/magazine/article/?articl...

jonah 13y ago
"...they will have a reputation that's akin to bloodletting" Here's to hoping so! And sooner than that.
scythe 13y ago
>A desire to bring a level of "science" to a part of our physiology we don't understand. Confer: http://thelastpsychiatrist.com/2006/11/massacre_of_the_unicorns.html http://thelastpsychiatrist.com/2006/11/massacre_of_the_unico... http://thelastpsychiatrist.com/2010/01/the_massacre_of_the_unicorns_i.html http://thelastpsychiatrist.com/2010/01/the_massacre_of_the_u...

FrankenPC 13y ago

Maybe humans are just...unhappy? By that I mean as a race, we are inherently unstable (see: entire human history) and for a long time we kept it together by forming very tight family and community bonds. We had central, realistic, and tangible goals. We had an invisible friend (religion). As science has systematically stripped all that away (for the better mind you...), nothing has filled those needs. We don't need more facebook and texting, we need human contact. HAHAHA! Just kidding! Did you see the latest iPhone! It's got moar processors!

guard-of-terra 13y ago
http://blog.wilshipley.com/2005/05/on-being-crazy.html http://blog.wilshipley.com/2005/05/on-being-crazy.html is a very insightful read on that subject, from a successful but unstable person. Is mankind only so smart because if we get any smarter, we cease to function correctly? Maybe it's just not evolutionarily advantageous to be smarter than we are; it makes us mopey, and we end up cutting our ears off when we're trying to woo girls, which rarely results in offspring.
- kirubakaran 13y ago
  Disproof : Richard Feynman
  - gohrt 13y ago
    How many offspring did Feynman have?
    - kirubakaran 13y ago
      "Feynman would marry twice more and have two children with his third wife." http://www-history.mcs.st-and.ac.uk/Biographies/Feynman.html http://www-history.mcs.st-and.ac.uk/Biographies/Feynman.html Anyway, my point is, being smarter is not an excuse for "cutting one's ears off when trying to woo girls" (re:my parent comment) or for otherwise being socially dysfunctional.
13y ago

paul9290 13y ago

I haven't read this entire article, but my experiences with a handful of anti-depressants is that they all are a placebo. Though not for profits. Sell people hope and promise of becoming "normal," and they buy it in the million. Again this is my own personal experience in taking various anti-depressants for a few years. Overall what helped me was talking to other people and realizing were all nuts (deal with same issues) and yet very normal. So if your dealing with depression and anxiety and are hiding it, from my experiences please do not. Please talk about it with as many people as possible; realize we are all the same and deal with the same similar issues!

nwh 13y ago
I'm sure your anecdotal experience with a handful of drugs is representative of everybody else's experience. (It's not)

kyro 13y ago

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if they have a treatable illness. I would ask psychiatrists I trained with to explain why a drug worked or why a disease developed. They would do nothing more than give me the same surface-level information we all know: SSRIs block serotonin reuptake, leading to more serotonin in the synaptic cleft that would then cause increased stimulation, and voila, you're not depressed. This is information anyone can attain with a google search. The majority of their knowledge dealt with pharmacological dynamics. I sat in on a psychiatry conference one afternoon where the docs discussed the treatment of several patients. Never was a scientific article or concept uttered. It was all "well, let's try him on seroquel and olanzapine, let's also throw Paxil in there." It was evident that their treatment protocol was largely one of extremely unsupported trial-and-error based on very, very unique experiences, anecdotes, and preferences each psychiatrist had. Now, I don't want to discredit the entire field. I do know friends and family who have benefited from psychiatric medications, although that could entirely be due to placebo effect. What needs to happen first is that we need to attain a much deeper understanding of how the brain works on the low and high levels, mechanically and abstractly. Mechanically so that we may develop effective meds, abstractly so that we may learn how to manipulate cognitive processes, like with what we see with CBT, which has worked wonders for many with depression -- no medication involved. tl;dr: Psychiatry is a very, very loose and abstract field. You can't run any diagnostic tests on patients. It's mostly a field of educated guessing and confirmation bias. We need better mechanical and abstract understanding of the mind before we douse it in chemicals.

pyre 13y ago
> although that could entirely be due to placebo effect If the drugs had no effect, then why are people (ab)using drugs like Adderall to improve cognition, etc? A big problem with trying to make a science out of the brain, is that it can be very unique to the person. For example, in people that are blind since birth, the pathways in the brain that are normally used for visual processing can get re-purposed over a lifetime to be used for other things. I'd almost say that the brain is sort of like an evolutionary algorithm. Given similar parameters, the results largely resemble each other, but alter things enough and the results can be way off.

md224 13y ago

Fun Fact: Selective Serotonin Reuptake Inhibitors, the class of drugs used to treat depression and anxiety disorders by increasing the availability of serotonin, have a mirror opposite: Tianeptine (http://en.wikipedia.org/wiki/Tianeptine http://en.wikipedia.org/wiki/Tianeptine), which acts as a Selective Serotonin Reuptake Enhancer. Incredibly, this drug has also been effective at treating depression. That's right: two classes of drugs with polar opposite first-order effects are used to treat the same disorder, and both of them apparently work.

angersock 13y ago
The molecule looks somewhat obscene.
- jrockway 13y ago
  It might want to get that chlorine looked at.
jes5199 13y ago
I've been meditating on this fact for a while. (I take an SSRI, and I believe that it helps me, but I would love to know why.) I think one possible understanding of depression is that it is a feedback loop - it's a sort of standing wave or Nash equilibrium of patterns of thought causing patterns of behavior causing patterns of sensation causing patterns of emotion that cause patterns of thought, etc. And, perhaps, that just by changing any random variable(s) in that loop (mucking with reuptake, or cognitive behavioral therapy, or any of a whole bunch of other possible changes) has a probability of disrupting the equilibrium and suspending the depression. It's not clear to me how to test this hypothesis, though.
- taway2012 13y ago
  Hmm, check out 'Autopilot' by Andrew Smart. It has some sections about equilibrium etc. And 'On Intelligence' by Jeff Hawkins (very under-rated book imho). Good luck!
  - 13y ago

unono 13y ago

Hackers can make huge money in psychology/psychiatry (both prescientific fields). Life logging and it's analysis - quantified self. Positive psychology would be the better angle to play it, unregulated, big money in the self-help culture. Mobile apps are the right medium for it. There was recent doc on it 'Monitor Me' by bbc horizon. edit: to replyers, it didn't want to post links for everything, so google 'monitor me bbc horizon youtube', 'quantified self', 'self help industry', 'positive psychology'

sillysaurus2 13y ago
I'm trying to understand what you're saying, but honestly I have no idea what you just said. Would you clarify your meaning? edit to reply to your edit: no, you'll have to do much better than that if you want to actually communicate with people and not be ignored or dismissed as crazy. Would you please spend at least 10 minutes typing an explanation of (a) what are you talking about, and (b) why is it valuable? Maybe I should point out that your edit seems to assume that most people understood part of your original comment. Actually, I think nobody understood any of it. So you'll have to rewrite what you originally said. (One strategy would be to make your comment longer and more thorough, and don't assume that anyone understands what you're saying unless you've explained it thoroughly, even if it seems obvious to you.)
- unono 13y ago
  OK. I try to see articles and find a positive spin where I can say "hackers could ...". To some people it would be obvious, but to young or non-tech people it might not be, so it could be helpful to them. As other commenters have said, psychiatry/psychology is an ineffective field and also expensive. The self-help industry is kind of related to psychology/psyciatry, is unregulated, and a $11 billion a year field. I gave a mention of a documentary that came out recently about people building apps in this category of self help/health/life monitoring kind of stuff. Some terms to google to find out more are what I typed in the OC.
  - totierne 13y ago
    I would pay folding money for this software+usage data - and I am just an affected individual (bipolar for 20 years). I went through a phase of asking for survey information (after they had published their paper article etc.)- no one would give it up.

bdclimber14 13y ago

I think it's relevant to point out the potent anti-depressant effects many people experience with natural supplements such as sam-e and 5htp. It's unfortunate that these drugs are rarely prescribed (in the U.S.). Few clinical studies have been done on these and there is little economic motivation for drug companies since these are un-patentable substances.

dhubris 13y ago

Medication is only one tool, and often needs to be used in combination with other tools, but people are always looking for the quick fix. Dealing with some of this shit can take hard work over time. Here is a small look at my experiences dealing with depression, PTSD and medication: http://dhubris.livejournal.com/14447.html http://dhubris.livejournal.com/14447.html As I said, it works for me, but may not work for you. The study of the brain and how it works physically, electrically, chemically, consciously and emotionally, and all the complex interactions within that is in its infancy in a lot of ways. So yes, if you think there is a lot of stumbling around trying to figure out what works and what doesn't, you're right. Isn't that how most science starts?

brownbat 13y ago

Eh, maybe understanding of the brain is ripe for some kind of "scientific revolution." If so, I really hope Ed Boyden and the Synthetic Neurobiology Group are a part of it: http://www.ted.com/talks/ed_boyden.html http://www.ted.com/talks/ed_boyden.html The video is a little more optimistic, maybe even risks TED-utopianism... but it still has some really cool ideas, and shows that we have at least figured out a couple of things about brains.

danmaz74 13y ago

This article has its own very naive bias: Thinking that every phenomenon must have a "root cause" - ie, a simple cause-effect explanation - and that if you don't find the root cause, you can't control the phenomenon. Take for example serotonin reuptake inhibitors. It's not important to know if a deficiency in serotonin is the "cause" of depression. All we need to know is if increasing the levels of serotonin correlates with an improvement of the condition of the patient better than placebo.

tsotha 13y ago
From a drug designer's perspective, though, this is a problem. If you don't know why the current drugs work you're going to have a lot of trouble improving them.
- danmaz74 13y ago
  Yes, but to know "why" (I'd much rather say "how") current drugs work you don't need to know "why" people get certain illnesses - that's my issue with the article. Their logic is: low serotonin levels aren't the cause of depression - so raising serotonin levels will not eliminate the cause of depression - so doing that isn't useful. That's a naive (and wrong) logic. Your heart going into fibrillation is not the cause of your heart problems, but treating the fibrillation can save your life - whatever the "cause" of that fibrillation.
  - tsotha 13y ago
    >Yes, but to know "why" (I'd much rather say "how") current drugs work you don't need to know "why" people get certain illnesses - that's my issue with the article. Well, that's true. But I think he makes a reasonably compelling argument that we don't in fact know why the current generation of drugs works.

jorleif 13y ago

The article has an interesting argument structure. First it undermines the science behind psychiatric drugs by referring to their discovery as serendipitous. Then it proceeds to point out that there is no good theoretical understanding for how the drugs work, even if there is understanding in what neurotransmitter levels are effective. Then the author proceeds to drop the "not better than placebo" results. Without knowing any psychiatric science, this narrative nevertheless seems suspicious. First of all, it is entirely irrelevant whether a discovery was made serendipitously or as a result of incremental science, as long as the effect is clear enough to be repeatedly found. This is not true in well understood fields, such as physics, where the theories are mostly not changed every now and then, but in complex fields, such as medicine and social sciences, the fact that something matches pre-existing theory is no evidence per se. The problem is "bumpy" enough that any theory is likely to flatten every bump that is not directly observed, even if that bump would be very useful in practice. This leads to most discoveries of any value being serendipitous. It also leads to incremental research failing to advance rapidly most of the time. So the lack of theory and serendipitous discovery are not problems in themselves. The finding that psychiatric drugs would not be better than placebos is indeed a problem. It does raise the question, of how the serendipitous discovery was ever made. Did it arise out of spurious correlations, so that when the drug was first discovered there happened to be a big incidental recovery in most treated patients? Then in later retrials people managed to trigger a sufficient placebo effect to get the whole thing going. It does seem a little unlikely, but one would have to examine how the first trials were performed.

jotm 13y ago

The discoveries of antidepressants and anxiolytics weren't accidental: testing something and seeing what it does, then finding a purpose for it is not accidental, it's basic science. It's how most chemicals were discovered. And there's no doubt these medications work in a lot of people (but not all), even though we don't understand how they actually work. Our ancestors did not know what fire was or how it worked, but they did use it because it was useful, the same applies here. Further development is going to be difficult without a good understanding of how the brain works, though - pharma companies need to focus on finding better ways to probe deeper and more accurately into the brain (and create good simulators for that later on) before developing new drugs.

dbuder 13y ago

The field of trying to cure the condition commonly known as being human.