Health Podcast Highlights

• Dr Martin Whitely’s professional journey [05:03-08:34]
• Influence of American medicine [08:42-10:36]
• DSM-V: The history of the manual [10:38-12:24]
• A History of ADHD [12:32-15:43]
• Adult ADHD [19:45-21:28]
• ADHD Medication [22:25-24:39]
• Professional reputation hinged on ADHD Industry [24:45-26:38]
• Marketing of pharmaceuticals [26:46-29:02]
• How the Science Industry is funded by medicine [29:04-30:12]
• Book: Overprescribing Madness and current state of play of depression and the use of antidepressants [30:55-36:12]
• Who are the health leaders responsible for the overprescription [38:56-43:07]
• Recommendations [45:42-47:40]
• Conclusion [51:29-57:55]

Dr Martin Whitely: Overprescribing Madness Introduction

Well, today we are going to explore mental health and it is, of course, huge and according to the statistics, a growing problem. And certainly, today’s pandemic, which we find ourselves in, is certainly not going to be helping. 

However, mental health has been an issue for many, many years. And so it’s interesting to get a perspective on this, to look at the evidence and see how effective certain treatments are or aren’t, rather than just to assume that because it has been promoted, because it has been prescribed, because it has been given to you, that it is effective.

My guest is Dr Martin Whitely. Martin is a mental health patients rights advocate, researcher, author, former economics teacher, and also former West Australian State politician. He was a member of the West Australian Parliament from 2001 to 2013 and is a prominent and influential critic of ADHD (Attention Deficit Hyperactivity Disorder) child prescribing. 

Now, he did his Ph.D. and was entitled Attention Deficit Hyperactivity Disorder Policy Practise and Regulatory Capture in Australia from 1992 to 2012. And in it, he investigates the relationship between Australian ADHD child prescribing rates, and regulatory capture of ADHD policy and practise. He’ll explain regulatory capture.

Martin’s research interests include pharmaceutical regulation, the effects of academic redshirting. That’s a term I hadn’t been familiar with but delayed school entry. Apparently, that’s redshirting. On a psychosocial and educational outcome, diagnostic Crippen overprescribing in mental health. 

Martin won the Curtin University 2017 Research and Engagement News Story Award for his research entitled: Influence of birth month of West Australian Children on the probability of being treated for ADHD. And he then went on to do it not just for West Australian children but looked at it globally, which we discuss in some detail. And I got to tell you, it’s an eye-opener.

Martin has a unique perspective on this very important issue. He was an economist. He was a teacher, a high school teacher. So he saw students firsthand. He was in politics. He’s a researcher. So this really is quite an insight. And he forensically dissects this in his 2021 book: Overprescribing Madness: What’s Driving Australia’s Mental Health? I hope you enjoy this conversation I had with Dr Martin Whitely

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge the traditional owners of the land on which I am recording this podcast, the Gadigal people of the Eora Nation, and pay my respects to their elders past, present, and emerging.

Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we are going to explore mental health and it is, of course, huge and according to the statistics, a growing problem. And certainly, today’s pandemic, which we find ourselves in, is certainly not going to be helping. 

However, mental health has been an issue for many, many years. And so it’s interesting to get a perspective on this, to look at the evidence and see how effective certain treatments are or aren’t, rather than just to assume that because it has been promoted, because it has been prescribed, because it has been given to you, that it is effective.

Dr Ron Ehrlich: [00:01:07] And I think this cuts to the very bigger issue about an issue which I have explored on my podcast and in my book and I’ve been interested in for many years. And that is the role of the chemical food and pharmaceutical industry in all levels of health care. 

And that means from regulatory bodies, government policy, universities, journals, right to the doctor’s surgery, right to the prescription pad, and right into your home potentially. So this is an important thing to become aware of. Often said it’s sometimes hard to tell the difference between evidence-based medicine and evidence-based marketing.

And, you know, when we are sold certain commodities, we don’t get confused as to whether one commodity is better than another. We kind of know we’re being marketed to. And so we kind of we make an emotional choice, if you like, based on how we feel about it, whether we can afford it, et cetera, et cetera. It’s when it comes to food and health, nutrition and health. 

What I think many people and many health practitioners, many, many well-meaning health practitioners don’t realise also and that is all too often we are being marketed to — it may be a public health story, but underlying it is often a commercial interest.

Dr Ron Ehrlich: [00:02:30] Well, my guest today explores that in some great detail in a recent book that he has written, which we’re going to touch on today. My guest is Dr Martin Whitely. Martin is a mental health patients rights advocate, researcher, author, former economics teacher, and also former West Australian State politician. He was a member of the West Australian Parliament from 2001 to 2013 and is a prominent and influential critic of ADHD (Attention Deficit Hyperactivity Disorder) child prescribing. 

Now, he did his Ph.D. and it was entitled Attention Deficit Hyperactivity Disorder Policy Practise and Regulatory Capture in Australia from 1992 to 2012. And in it, he investigates the relationship between Australian ADHD child prescribing rates, and regulatory capture of ADHD policy and practise. He’ll explain regulatory capture.

Dr Ron Ehrlich: [00:03:39] Martin’s research interests include pharmaceutical regulation, the effects of academic redshirting. That’s a term I hadn’t been familiar with but delayed school entry. Apparently, that’s redshirting. On a psychosocial and educational outcome, diagnostic Crippen overprescribing in mental health. 

Martin won the Curtin University 2017 Research and Engagement News Story Award for his research entitled: Influence of birth month of West Australian Children on the probability of being treated for ADHD. And he then went on to do it not just for West Australian children but looked at it globally, which we discuss in some detail. And I got to tell you, it’s an eye-opener.

Martin has a unique perspective on this very important issue. He was an economist. He was a teacher, a high school teacher. So he saw students firsthand. He was in politics. He’s a researcher. So this really is quite an insight. And he forensically dissects this in his 2021 book: Overprescribing Madness: What’s Driving Australia’s Mental Health? I hope you enjoy this conversation I had with Dr Martin Whitely. Welcome to the show, Martin.

Dr Martin Whitely: [00:05:01] Thank you, Ron. It’s a pleasure to be here. 

Dr Ron Ehrlich: [00:05:03] Martin, your book, Overprescribing Madness. Well, as I said to you when we met, when I emailed you and invited you, I wish it was a book I could say I enjoyed. But it is a very, very beautiful, well-written, incredibly resource. How did someone, tell us a bit about before we dive into it and the issues you raised in it? I wondered if you might share with us your own journey. What brought you to the point of writing such an important book? 

Dr Martin Whitely’s professional journey

Dr Martin Whitely: [00:05:32] I guess it all started when I was a teacher in Perth and in the late 1990s in Perth had the highest rates of ADHD prescribing in the country and they rival the rates in North America. And I just saw a number of boys in my classroom that were heavily medicated and I just thought, this isn’t right. And I just thought this distinctly uncomfortable about this. 

And from that, I left teaching and went into politics and decided to try to tackle overprescribing of ADHD medications as a primary focus of mine, and then came to realise that the patterns of diagnostic, you know, the ever-expanding boundaries of mental illness and the influence of the pharmaceutical industry sort of extended beyond ADHD and became concerned about the Australian response to the FDA warnings about suicidal ideation associated with antidepressants is when people under 25. So they were the two sorts of triggers. 

Dr Martin Whitely: [00:06:34] And I got interested because I was a teacher, I had the opportunity to have an impact because I was a politician. And then after leaving politics, I became a specialist in this area. 

And immediately after leaving politics, I was a mental health advocate where I sit with patients often during psychiatric interviews and got to see up close what was happening to a lot of these patients who were often very concerned about being heavily medicated and sometimes against their will. So that’s the short story that basically started off as a fairly narrow interest in ADHD overprescribing and sort of spiralled out from there.

Dr Ron Ehrlich: [00:07:14] Well, and I mean, to have the opportunity to see it at the coalface as a teacher is a really unique perspective. Were you teaching in high school? Were you in primary high school?

Dr Martin Whitely: [00:07:26] I was teaching at a very well resourced private boy’s school in Perth and in the western suburbs of Perth, which is the equivalent of the North Shore, if you like, in Sydney. And a really, really good school, really good kids, incredibly well resourced. But there was a lot of academic competition. And I saw this sort of pressure on the kids who weren’t achieving what mum and dad might be expecting that achievement.

Come year 11, I actually noticed this pattern of behaviour of these ADHD Connors writing scales would come across my desk as a teacher. With little Johnny’s year, 11 exam results came home and he was getting seasoned and that he was an engineer and mummy was a doctor. And I wasn’t happy about this. 

So I thought I felt distinctly uncomfortable about it. And not also, to be honest, I mean, I looked at the behavioural criteria for ADHD and I saw myself in all sorts of things. Being born in 1989 rather than on 1959, I would have been a prime candidate for a diagnosis. Well, I would be I mean, I’d still qualify for a diagnosis and just thought this is not right.

Dr Ron Ehrlich: [00:08:35] Yes. So much of that sounds so familiar to me too. I would have probably landed with a diagnosis like that too. But it’s interesting isn’t it, because we seem to follow America in so many things. I know it was instrumental in a lot of nutritional advice that came out in the 60s and 70s, eventually culminating in a food pyramid which led to its own problems. But we’ve also been greatly influenced by the American model, too, haven’t we? 

Influence of American medicine

Dr Martin Whitely: [00:09:07] Yeah, I wrote about this extensively in my book. In fact, it’s a little early to chat with, but it’s the greatest example of cultural capture. And I forget about the cat caller in McDonald’s. The American Psychiatric Association on Australia is enormous. We have outsourced the definitions of who’s mad and who’s signed to the Americans. 

And frankly, I don’t think they’re the role model for delivering sanity. And the American Psychiatric Association is a very haven within the organisation. It’s acknowledged that they have a very unhealthy close collaboration with the pharmaceutical industry.

Dr Martin Whitely: [00:09:46] And we’ve embraced the Diagnostic and Statistical Manual of Mental Disorders, DSM for short. And we’ve followed the diagnostic criteria in that document like it’s the Bible of psychiatry, which is often described as whilst there was a fairly rigorous debate about the new edition of DSM – DSM 5 – which came out in 2013, also was a fairly rigorous debate in the US. 

There was very little debate about it in Australia, and we just simply adopted this new version of the American Psychiatric Associations Diagnostic Manual without any thought for the impact would have on Australians. And not surprisingly, since DSM five has come out, we’re seeing an acceleration in the growth of mental health diagnosis and the use of psychotropic drugs. 

Dr Ron Ehrlich: [00:10:37] I mean, the DSM, well, five implies, and obviously there’s been a one, two, three, and four. And I wondered if you might give us a little bit of an idea of how the manual has grown over the years and with it, diagnoses.

DSM-V: The history of the manual

Dr Martin Whitely: [00:10:54] I think I’m doing this from memory. I think the first DSM came out about 1962, something like that. The light that was the DSM and the DSM 5 replaced DSM 4. DSM 4 came out in 1994 and DSM 5 came out in 2013 and with every new edition, there had been new psychiatric disorders added. 

In fact, it’s just grown from about 119, the original version, to well over 300 now. But not only have they invented new diagnoses, but they’ve also actually expanded the boundaries of existing diagnoses. So for instance, the definition of ADHD got progressively broader over that time.

Dr Martin Whitely: [00:11:38] And so you’ve got this diagnostic crape happening in two ways, whereby you’ve got more psychiatric disorders being recognised and the boundaries for them have got broader and broader and broader and broader. And that’s happened for conditions that I don’t think a valid like ADHD, but also things like autism. There’s been a massive expansion in the numbers of people that qualify for being on the autistic spectrum. 

Now, I’m not suggesting for one moment autism isn’t a real and valid diagnosis in some cases, but nonetheless, that same process of expansion and loosening of the boundaries as a kid, whether their pay for a condition that I think is an invalid diagnosis like ADHD, but also for other conditions.

Dr Ron Ehrlich: [00:12:25] Now, I know that I have always felt much better in the summer than I did in the winter. And I was kind of disturbed to find that that was actually now a condition referred to as seasonal affective disorder. And I think there is medication for them and it’s not Vitamin D. You’ve mentioned ADHD briefly. 

Now, I wondered if we might dive into that a little bit and just give some historical perspective, because like you and I think we may not be too dissimilar in our birthdays. You know what? There was just nobody in my class. 

I mean, there were some kids that were a little disruptive, of course, and one would have said, well, as real boys being boys or whatever. But now I think the statistic is that if I’m connected with the Mind Foundation in Sydney, and I think that one of the statistics was one in 10 kids are now being diagnosed with it. Is that what is what you’re seeing — 

A History of ADHD

Dr Martin Whitely: [00:13:22] In the US, that would be about right in approximate numbers. That would be about right diagnosed one in 10. And it varies from state to state. Depends where you live as it does in Australia. In Australia, it’s probably about at any given time, there’s probably about 1 1/2 to 2% of Australian children on ADHD medications. 

So it’s much lower in Australia, but it’s still growing exponentially. It’d be about one hundred and thirty — the latest statistics indicate it’s about 130 000 Australian children. That’s between the ages of zero and 17, they’re on ADHD medications. 

And typically boys around the globe.. Boys are about three times as likely as girls to be medicated. Medical use, the word medicated is becoming a more accurate description is drugged and the drugs are basically most commonly used.

Dr Martin Whitely: [00:14:15] Drugs are amphetamines like dexamphetamine, and even methamphetamine is used in the US for children as young as six, a brain or near amphetamines like Ritalin. There is a range of other non-stimulant drugs, but they’re the most commonly used drugs to treat it. The ADHD industry and is a massive industry globally. This year worldwide sales of ADHD drugs will be valued at over 25 billion dollars in the US.

Dr Ron Ehrlich: [00:14:45] Wow. In a year? [00:14:45][0.5]

Dr Martin Whitely: [00:14:46] A year. And that’s anticipated to double by 2030. So we’ve seen exponential growth with that. That is anticipated to increase and you’ve got to go back to understand. So you’ve got to go back to the diagnostic criteria, there’s no blood test, there are no brain scans, there’s no objective physical evidence. 

It’s simply based on parent and teacher reporting of children’s behaviours and the behaviours of things like fidgeting, losing things, you know, losing your toys and pencils, being distracted by extraneous stimuli, interrupting, playing too loudly, climbing excessively. My favourite one of all is avoiding or disliking homework.

Well, there are 18 different diagnostic criteria and children only have to display a minimum of six of these to be diagnosed. And how often do they need to display it? Well, the definition is they need to display them often. So what that means is —

Dr Ron Ehrlich: [00:15:49] So we have no blood tests. There’s no chemical imbalance which is going on, which objectively can determine a diagnosis. So it’s not like the cholesterol’s gone through the roof and they’ve got a calcium CT score of 400 or 500 and none of that. 

Dr Martin Whitely: [00:16:06] No, no. There’s no objective scientific test, no blood tests, brain scans. It says this in the DSM five, but nonetheless, it’s marketed as a neurodevelopmental disorder, which implies that it’s to do with brain function. So without a complete absence of any objective evidence, it’s assumed to be a defective brain function. 

And the most common, the most influential hypothesis was it a functioning dopamine pathway in the brain? But there’s evidence that actually long-term administration of amphetamines actually interferes with the dopamine functions of the brain. So if you haven’t got a chemical imbalance to start with, you might end up with what you’ve been put on the medications. 

Dr Martin Whitely: [00:16:48] But the most I mean, I think the most powerful research that shows how much evidence shows how problematic the diagnosis is the ADHD-like birth day defect of the ADHD relative age effect. And that is all around the globe. 

Children who are the youngest in their classroom, usually classes are organised in a one year group. So they’ve got kids that are 11 months younger than their classmates all around the globe. Those children are much more likely to be put on ADHD drugs than they’re all the classmates.

Dr Martin Whitely: [00:17:26] If you take in research I did in Western Australia amongst primary school children aged from years one to year five. So ages five to 10, the kids that were born in June, which is the last month of the school year in. Were twice as likely to be put on ADHD medications as the kids born the previous July, and this then led a research that showed this thing happens all the way around the globe. 

It happens in North America. It happens in Europe. It happens in Asia. There was a whole bunch of studies that have been done that we reviewed and more done subsequently that showed that this ADHD like birthday effect or relative age effect.

Dr Martin Whitely: [00:18:11] It didn’t matter if it was in the high prescribing jurisdiction of the US or in a lot of prescribing jurisdictions like Finland and the Scandinavian countries, the relative effect was still the same. 

So this idea that you could sort of, they over-diagnosed in the US and if we could just get follow what they do in sensible Finland and sensible Sweden and the way they do it over there, we would wipe out the misdiagnosis just doesn’t stack up, because even in those countries, this relative age effect with the most sensible explanation is that teachers are misinterpreting a child’s immaturity as if they have a, you know, a biochemical Brindabellas. 

And they just don’t diagnose ADHD, but they provide key evidence that’s used to diagnose ADHD. As that was my experience as a teacher. We got those checklists we had to take off. That was key. That was key information for the diagnosis.

Dr Martin Whitely: [00:19:10] And they’re often the first to suggest that the child be diagnosed with ADHD. So I think that’s the clearest evidence that there is something fundamentally wrong with the diagnosis. But it was interesting, the response of the ADHD industry to this policy.

I mean, substantially they ignored this research because it doesn’t fit the narrative, but those who did engage with it, said, well, what that means is that the oldest children in the class are being underdiagnosed and undertreated and we need to be diagnosing more of them and medicating more of them so they’ll spin it.

Dr Ron Ehrlich: [00:19:45] Well, you mentioned that you and possibly even me may have got a diagnosis of that when we were growing up. But actually, adults are coming in for their own here now as well. aren’t they?

Adult ADHD

Dr Martin Whitely: [00:19:57] Yeah. If at all, to tell the truth, I’m mostly concerned about children because it failed to tell the truth about the diagnosis and they told the truth about the medications, which frequently they have not. I mean, often they’re told I have a bike and brain imbalance and that their response to actually medications is unique to them because of the idea that ADHD and we’ll talk about that a minute. 

But if they told the truth, I think they’ve got the power for informed consent and if they want to accept a label and they want to accept a daily low dose of amphetamine habit, and they don’t do it in a way that mothers that’s their business because they have to have informed consent.

Dr Martin Whitely: [00:20:40] But the problem is the validation of ADHD by these adults who embrace the label and embrace the daily use of the drugs. Trickles down to children and they use it to argue, well, you know, look at these kids, we need to be treating these kids. Well, kids don’t have the same capacity for informed consent. Kids are victims in this. And in a sense, everybody else benefits. 

The pharmaceutical industry makes a lot of money. Doctors who specialise in it get a quick and lucrative speciality. As a teacher, I can tell you when I talking pastures my kids were well, lots of kids were medicated that was easy to control. I just thought they said nothing. So I was a beneficiary of it, I guess.

Dr Martin Whitely: [00:21:29] And I’m going to be honest and it’s controversial aside, but sometimes parents get to get an easy answer. They get to stop looking for the underlying problem. And they also get told by the ADHD industry that it’s an idea which the experts, this is not your fault, you know. This is not bad parenting. This is not your fault. 

Your child has a biological condition. And sometimes it is the responsibility of parents to put boundaries in place and to help children and to find out what some of them, some kids do have real problems and to find out what is going wrong in their lives so everyone else has the potential to benefit. But the evidence in terms of children that they benefit is very weak. And in fact, the long-term evidence indicates that they did worse on ADHD medications. 

Dr Ron Ehrlich: [00:22:19] You alluded to the response to the medication. Tell us a bit about that, because that’s used diagnostically almost.

ADHD Medication

Dr Martin Whitely: [00:22:27] Well, this is the great asexual fraud of ADHD. And that is this argument that the response to a low dose of orally administered amphetamines is unique to those with ADHD. That is a lie. The vast majority of people who take ADHD medications orally and in low doses will become more narrowly focussed.

It happens to the vast majority of that. It’s idiosyncratic. Some people will have very little effect on. Some people will become psychotic, but most people will just know their focus. Right? 

Dr Martin Whitely: [00:23:08] So when you’re told your problem is you have ADHD, which causes you to have a lack of focus and you take this medication, you become more narrowly focussed and you can sort of focus on that boring, repetitive task in front of you. The idea that this is a response unique to ADHD that is diagnosed with ADHD is just rubbish. It’s a lie. 

And it’s at the core of the marketing of ADHD. And it’s you know, it needs to be exposed for the reason for that is that like. It’s illegal to do so, but if you were to take a couple of dexamphetamine tablets, you know, the effect that would have on your behaviour would probably be to narrow your focus. And I wouldn’t say any more.

Dr Ron Ehrlich: [00:23:56] That’s all right. And no one’s listening. No one’s listening. You can say whatever you like.

Dr Martin Whitely: [00:24:03] That’s a universal effect. And that is the core lie if you like. I mean, there’s a lot of half-truth and exaggeration involved in the marketing of ADHD. But the core lies to argue that the response to ADHD medications is diagnostic, but it’s repeated over and over and over again. 

And it’s almost as if what they’re literally ADHD and amphetamine deficit disorder, because that’s what they say, that without it an adequate vitamin equivalent in your body, you are distracted and dysfunctionally distracted, etc. stuff. 

Dr Ron Ehrlich: [00:24:39] And at 25 billion dollars a year, that’s quite a force to be reckoned with. Well, it is. And I think we could also say that there are many professional reputations and many professional careers and reputations built on it. Absolutely not going to be surrendered lightly.

Professional reputation hinged on ADHD Industry

Dr Martin Whitely: [00:25:01] No, absolutely, I mean, I’ll take the last year for which we have data in Western Australia, there was one psychiatrist who prescribed up to 2074 patients in a year. Wow. So now do the maths, do the maths and figure out how much that cyclocross would earn. I mean, it would be a spectacularly healthy income. 

It is an industry you’re up against and it’s a 25 billion dollar. That’s only just the value of drug sales. It doesn’t take into account the value that you get for diagnosing, the value that researchers get. It doesn’t take into account that ADHD trainers and lifestyle coaches and all the rest of it. I mean, it’s a phenomenally large industry and up against it, there’s no counterbalancing economic force.

Dr Martin Whitely: [00:25:48] I mean, the people are credit for take ADHD are basically amateurs like I’ve done all of my research. And in fact, some of it’s been quite impactful research and using publicly available information and none of it, you just cannot get funding. 

To ratify the agreement and even when you didn’t have a success, when we did that study, that showed that the idea actually that if it was a worldwide effect, that did get a big head of publicity internationally, not just in Australia, but it happens for Diatta. And meanwhile, every day, 365 days a year, the ADHD industry rolls on and it uses its massive multi-billion dollar resources to market to market the condition.

Dr Ron Ehrlich: [00:26:39] This is part of a bigger problem, and that is that good health may make sense, but it doesn’t make dollars. And it is. And unfortunately, and I think this is something that we deal with in health care advice when we are marketed to say we’re buying a car or a phone or any commodity we know we are being marketed to. So it’s not confusing. I don’t get confused. Oh, my God, should I buy Toyota or? They said it was the best. Mazda said this was the best. I’m totally confused. 

You just know you’re being marketed to all the time. Yeah, I think one of the hard things, and I think this is true of both health practitioners and patients because a lot of health practitioners are really busy. They don’t realise that they are being marketed to.

Marketing of pharmaceuticals

Dr Martin Whitely: [00:27:27] Yes. And I think I mean, my basic training, my first degree. And first off, I had dozens of accounts like my training in accounting and economics. Right. So you’re trying to as an economist, you’re trying to understand that what drives most things is self-interest and what drives business is profit maximisation. So when you start from that expectation, it all makes sense.

 None of this actually make any, you know, an economic statement and none of it. If you take that model, it makes perfect sense. Yes. Makes perfect sense that they would seek to increase their markets. It makes perfect sense that they would say to medicalize the problem in pharmaceutical. That’s the problem because it’s the most profitable response.

Dr Martin Whitely: [00:28:13] So you need to, we need to start. I’ve just finished writing a paper that’s going to be called ADHD: It’s an industry, not an illness. And I watch it and it compares the argument for ADHD illness model, which has got increasingly weak. I mean, they’ve stopped I started off thinking it was caused by problematic. You know, it was a homogeneous condition caused by problem that was not with and had one cause. And it was to do with brain chemistry. 

Now they’re saying, oh, it’s a heterogeneous condition and it’s got multiple, multiple pathways, all hypotheses. But so they’ve got less certain about the cause as the markets have exploded. So perhaps it’s time just to understand that this is a really, really profitable industry and that — 

Dr Ron Ehrlich: [00:29:03] Let’s just put it into a broader perspective here because the science in medicine is essentially funded. I think my understanding of it, maybe you have an idea of how much industry funds the science in medicine. I think it’s around 60-70%. I even think that’s conservative. What do you think?

How the Science Industry is funded by medicine

Dr Martin Whitely: [00:29:22] Look, I don’t know. But it’s not just the industry. It’s patient welfare groups. So patient support groups. Two thirds globally, there was a study done. This is all research, but it’s done about 15 years ago. But two thirds at the time, two thirds of patients’ support groups were funded by the pharmaceutical industry. Now, I’m not suggesting that the people that organised those support groups don’t believe what they’re saying.

Dr Ron Ehrlich: [00:29:46] Absolutely not.

Dr Martin Whitely: [00:29:47] But they get amplified, their voices amplified if they sell a product. It’s a problem in research and I know that first hand, you know, it’s a problem in in key opinion leaders, key opinion leaders who have close ties to the pharmaceutical industry get promoted and that’s happened in Australia, some very notable case.

Dr Ron Ehrlich: [00:30:13] If industry funds the majority, a good deal of the science and support in medicine, it’s worth remembering that in a company’s fiduciary duty is to its shareholders, not to the public, not to the public. So if you had a choice between do I make a better return to the shareholder or do I improve public health, it’s almost a no-brainer. Excuse the pun. In this case, it’s almost a no brainer. It has to be the shareholder by law. 

Dr Martin Whitely: [00:30:42] Of course, of course.

Dr Ron Ehrlich: [00:30:44] That’s what I thought we might just pause for a commercial there at one point. But listen, we talk about imbalances and we’ve talked about ADHD, but mental health is a problem, as we’re increasingly being told. It’s a growing problem in the by-line of your book. Give us the by-line of your book. 

Book: Overprescribing Madness and current state of play of depression and the use of antidepressants

Dr Martin Whitely: [00:31:04] What’s driving Australia’s mental illness epidemic?

Dr Ron Ehrlich: [00:31:09] That’s right, and depression is a very big part of that, and anti-depressants are a very big part of the solution. Tell us a little bit about the picture of this for.

Dr Martin Whitely: [00:31:23] About one in six Australians is on some in any given year. About one in six Australians takes psychotropic medication. And the most commonly prescribed medications are anti-depressants, about one in eight Australians. So over 3million Australians taking antidepressants in any given year. So that’s there was research in 2015. That’s behind the last one. 

Australians with the second highest per capita users while making a presence in the world, so even ahead of Americans at that stage. So we’re rolling up there in terms of any antidepressant use.

Dr Martin Whitely: [00:32:09] Now, does that make sense when you look at Australia and our natural advantages and our economic prosperity? Does that make sense now? Even a self-reported happiness index is Australians do well. We self report as being right up near the top in terms of how happy we are. How do you reconcile that? How do you reconcile a stable country, economic prosperity, rule of law, inclusive society? 

And I mean, we’ve got a problem for the rest of the world with them pretty well. How does that reconcile with their use of antidepressants? And to my mind, it simply doesn’t. We have been told and you alluded to it would be increasingly getting a message that it’s OK to be mentally ill. In fact, it’s very common to be mentally ill. And there’s nothing wrong with that message per se. 

Dr Martin Whitely: [00:33:02] But the second element of the message is: Just go and get help. You know, like if you’re feeling any of these symptoms, it might not be normal. Go and get help. 

Well, that would be fine if the evidence is that the help actually helped, but particularly for antidepressants and young people, which is an area of research and I’ve been involved in, the evidence is not good. If you go back to 2004 and 2007, the US Food and Drug Administration put a black box warning out for any depressed use by people aged under twenty five. 

It said that antidepressant use basically roughly doubled the risk of suicidal thoughts and behaviours in people aged under twenty-five. So not actual suicides, but suicidal thoughts and behaviours which we know is the precursor of suicide.

Dr Martin Whitely: [00:33:57] I did this research that looked at the Australian response to the FDA warnings and the TGA in Australia. The Therapeutic Goods Administration did a good job and is doing a great job with COVID, I think. But I’m not so complimentary about its job with antidepressants, at least historically. The first signs of improvement. They did follow the US lead, but the warnings were very softly worded in Australia. 

But nonetheless, there was a straight after the warnings were put out, there was a significant decrease in antidepressant prescribing to young people, about a 30% drop, and a small decline in the suicide rate amongst Australians aged under twenty five.

Dr Martin Whitely: [00:34:43] But beginning in about 2009, it was a very organised and backlash against the antidepressant. Black box warnings, the suicidal warnings and played out in America and applied in Australia and some very prominent suicide prevention experts arguing that anti-depressants reduce the risk of youth suicide. So since then, 2009, as outlined in that research between 2008 and 2009, there was a 66 percent increase in the per capita adjusted for population, the per capita number of Australians aged under twenty eight. They took anti-depressants —

Dr Ron Ehrlich: [00:35:31] A 66% increase?

Dr Martin Whitely: [00:35:32] 66% increase in the per capita. Right. So the increase was actually greater than that with population growth. So the increase is probably around 75% of the per capita increase. 66%. And over that same period of time, there was steady growth. 

And over that same period of time, there was basically a steady growth, a massive jump there and a little bit. But there was a 49% increase in the per capita suicide rate in Australia aged under twenty-five. So the very thing that the US FBI had warned about. Well, they warned about suicidal ideation. But suicidal ideation. Think about —

Dr Ron Ehrlich: [00:36:11] Yeah, think about it before you do it. 

Dr Martin Whitely: [00:36:13] Had this kind of translation in Australia and even despite that evidence, some of the same thought leaders that said, I don’t know, the US FBI got it wrong. They’re still singing the same song. They’re still saying antidepressants are integral to the reduce the risk of suicide in young people. 

Now, the data we had was population data. We didn’t have to study specific data. So I’m not you know, you can’t say you’ve proved causally that this is absolutely certain that this is happening. But on the balance of evidence, you’ve got Randomised Controlled Trials are done by the drug companies that say it increases the risk of thinking about it.

Dr Martin Whitely: [00:36:58] And then in Australia, you’ve got a massive increase in prescribing and many more young people doing it. And it’s pretty compelling evidence enough to actually change what you’re doing, but not for some of these key opinion leaders, both in Australia and internationally.

And, you know, surprise, surprise, some of those capabilities have very close or have ongoing financial ties to the pharmaceutical industry and the antidepressant manufacturers. But nonetheless, these are the voices that are dominating the Australian debate about how we should respond to suicide.

Dr Ron Ehrlich: [00:37:39] I mean, I know that it’s often said the correlation doesn’t mean causation. But you’d have to suspect that if a drug was given in suicide, rates went up and when it was withdrawn, suicide rates went down. You’d have to consider that that was important at the very least.

Dr Martin Whitely: [00:38:00] If I could ever forget all of that. The onus is on those that promote the product to prove their case. Now they have, in fact, the evidence is all pointing the other way. Right. But even that doesn’t seem to matter. 

What is the standard response to say to a young person exhibiting depressive symptoms in Australia and saying, you know, expressing anxiety in Australia, trip to the GP? Prescribed an antidepressant, and there are even reports of some GP, absolutely feeling the pressure that if they don’t do something I prescribe that if that happens, they could be charged with negligence. So it’s completely counter. It’s not just counterintuitive. It’s countered the evidence, the compelling evidence in there.

Dr Ron Ehrlich: [00:38:56] Yeah, but, you know, another point you made in the book that I thought was very interesting, and that is that 90% of prescriptions for anti-depressants occur in the general GP’s office. And when we think about the average consultation period being somewhere between seven and 15 minutes. 

Yes, for consultation at the best of times, let alone into the complexities that mental health would throw up to you. Of course, as a GP, you would look to thought leaders for guidance here. And again, I think we’re coming back to the idea. Are we seeing marketing? 

You know, is this a Toyota Corolla or is this a Mazda? What should I be having? I look to the thought leader in health care to tell me. Who are some of the thought leaders in health care that are advising GPs to prescribe? And if they don’t, they’re being negligent.

Who are the health leaders responsible for the overprescription

Dr Martin Whitely: [00:39:49] I’m going to be very careful.

Dr Ron Ehrlich: [00:39:51] All right. Let’s not let’s not… We’ll get people to read your book. 

Dr Martin Whitely: [00:39:56] I’ll be very careful.

Dr Ron Ehrlich: [00:39:57] Yes, let’s be respectful.

Dr Martin Whitely: [00:40:00] Professor Ian Hickie is undoubtedly the, you know, it’s been described as Australia’s depression guru. He has done more than any other individual for the increased recognition of depression in the country. 

Now, Professor Hickie has extensive ties, financial and commercial relationships, which are date out in the book. Yes, the pharmaceutical industry has been the research has been a paid advocate for four particular brands of anti-depressants.

Dr Martin Whitely: [00:40:36] So when we hear Professor Hickie talk, and I won’t go through that, you know, the book does a more complex than, oh, than doing this talk. But, you know, when we hear that and we hear Professor Hickie as he’s trotted out on the ABC is, you know, the mental health expert as you sort of frequently is, we don’t it doesn’t come with that information. 

We don’t know that this is a person who has asked us to go to various drug manufacturers. And we should and we should, because it doesn’t mean we should discount everything that somebody says. But we should be aware of that. We should be aware that commercial ties and, you know, it’s difficult to reconcile professionally he is one of those who were promoting the use of antidepressants as a suicide prevention measure. 

And when he was confronted with the evidence from our paper and basically says, rubbish, this is not true, antidepressants reduce the risk of suicidality. Everybody knows that. So, you know, he’s one of the others who are probably less influential in that field but is very dominant in the mental health debate in Australia.

Dr Martin Whitely: [00:41:44] Professor Patrick McGorry, former Australian of the Year, the darling of the ABC, but has again extensive historical ties to the pharmaceutical industry, has done a great job in raising awareness of the mental illness, but has really had a very controversial history in terms of some of the programmes that he’s promoted, particularly in the area of psychosis prevention.

Dr Martin Whitely: [00:42:12] Professor McGorry has many times to find one of the most prominent ones is his theories around early intervention for psychosis and preventing the onset of psychosis, the onset of schizophrenia, where he has detailed in Time magazine as early as 2004. I think this article appeared in 2006 where he has advocated and experimented with the use of antipsychotic blood as having psychotic people perceived to be at risk of. 

Going on to develop psychotic conditions now, even Professor McGorry acknowledges the vast majority of those that are identified as being an ultra-high risk of becoming psychotic never do. And his critics argue that it’s well over 90% never did go become the false positive. Right. 

Dr Martin Whitely: [00:43:08] According to the available evidence, is somewhere between seven and 10 or something, somebody up to nine and a half in 10. And yet we had experimentation with antipsychotics, which are particularly heavy drugs, heavy-duty drugs, and not given out lightly. 

And I don’t want to minimise ADHD medications, but the heavy, heavy-duty than a dexamphetamine. And yet they’re given to people in the belief that they might go on to become psychotic. So this is controversial stuff and it doesn’t see the light of day. 

And there’s a video there is a training video that was produced by Professor McGorry that is actually available on the Internet, on a website that I’ve got that shows how they diagnose those at ultra-high risk. To me and as a non-psychologist but to other people with psychiatric training, it’s very flimsy evidence. And again, there’s no it’s not an objective scientific test. It’s all based on, you know, at high risk.

Dr Ron Ehrlich: [00:44:16] So it’s seen as a chemical imbalance of the brain. But yet there is no diagnostic criteria or objective test to show that imbalance?

Dr Martin Whitely: [00:44:28] Or hypothesis takes the place of the hypothesis, gets elevated to the truth. And this is not a criticism of us to uniquely or necessarily the alcohol industry hypothesis. In the case of ADHD, the diet may not bother us. So, you know, but they all get elevated as if they demand the truth. And whilst the drug companies tend not to tell direct lies, there are well-resourced voices. 

And again, I’m not talking directly about those two individuals, but there are well-resourced voices, including elements of the consumer mood that constantly repeat these myths and lies like the lie about ADHD drugs being a diagnostic test. So, you know, it’s about the point you made about being marketed to and it’s Toyota. And you need to know that you have these drugs.

Dr Ron Ehrlich: [00:45:24] Yes, I know. I actually it’s a story I think we talked about this before we started, but it’s a story I’ve personally been interested in, professionally been interested in for the last 30 odd years. And my conclusion is that it’s very difficult sometimes to tell the difference between evidence-based marketing and evidence-based medicine. But that’s another story. 

Let’s go a little bit on the positive side here, because you do finish with where to from here and you come up with 15 or so recommendations. If you have to pick out two or three major or four, you could pick out five if you like, man, but pick out some reforms that you think are central to this. I would say, you know, public disclosure would be a big one.

Recommendations

Dr Martin Whitely: [00:46:06] That’s the thing that runs through all of them and the TGA (Therapeutic Goods Administration) has done a really good job with COVID because with and the reason they’ve done a really good job with private vaccines, in my view, I’m not an expert, but in my view, they’ve done a really good job because they’ve kept us informed because and I haven’t been able not to do that because everybody’s watching. Everybody’s going to take these products. 

Everybody knows that it’s relevant. And the safety and efficacy of the vaccines are relevant to them. So the fact that we know that the side effects, that blood clots that happen with AstraZeneca and they happen very rarely and 100000 cancer or whatever it is, isn’t is how every medicine should be regulated. But it’s not how medicines are regulated.

Dr Martin Whitely: [00:46:55] I’m going to shorthand this but how medicines are regulated in Australia is that the pharmaceutical companies do the research, they own the research. They have intellectual property. When they make an application to get a drug onto the market in Australia, they get to cherry-pick the results of which they pass on to the Therapeutic Goods Administration, who require and I’m short-handing this basically, that they show they have evidence that shows efficacy and safety and that that evidence is repeated. 

So from the pharmaceutical companies’ perspective, if you’ve got 50 studies, 40 which are bad and two which are good, you show them the two of which are good, and you don’t show them the 40 out of which are bad.

Dr Ron Ehrlich: [00:47:42] And Martin that does happen. Yeah, that’s exactly what does happen.

Dr Martin Whitely: [00:47:46] Yes, and there’s evidence of that happens. But also at the other end, the reporting of adverse events is voluntary. So we don’t have this sort of data we have for AstraZeneca, not what we have is voluntary reporting. 

So if GP, as you know, he’s passionate, you know passion has been put on on Strattera, which is an ADHD drug with the black box warning for suicidal ideation, whether they report the adverse events, whether they report children are self-harming or whatever or, you know, antidepressants or any other drugs with any other age, whether that actually ends up at the TGA is anybody’s guess.

Dr Martin Whitely: [00:48:35] But there is research that was done. This old research was done to this night. But it showed that for serious adverse events, it was only about 2% get reported to the TGA. So we’ve got no idea, no accurate post-market surveillance of these medications, and have no idea about what’s going on, what the true risk-benefit profile is. So if I had one message, it would be let’s resource the TGA to do the sort of job it’s done with the type of vaccines where actually requires independent open data. 

So if you’re with the drug company that isn’t prepared to show you all the evidence, it’s got it and licence it. And if they lied, serious criminal penalties for the directors and serious fines and let’s have for serious adverse events like suicides and strikes and psychosis and, you know, blood clots and serious ones, not serious adverse events.

Dr Martin Whitely: [00:49:37] Let’s have mandatory reporting. You know, let’s have the capacity to develop a proper and let’s have the whole thing done openly. So all of the information exposed on a website and the government’s got powerful leaders to pull with this. Funds, these drugs for the Pharmaceutical Benefits Scheme, right. 

So these are powerful economic levers it can put. And if the government if the companies want to access public funds through the Pharmaceutical Benefits Scheme, these are the conditions we should put on it. So that that sort of open disclosure and having proper reporting, I think is and I think we’ve seen it with the and people get used to it. If they knew what the truth was, they’d be better informed. 

Dr Martin Whitely: [00:50:27] Look, it’s quite interesting to watch the COVID debate because people getting all concerned about the one hundred thousand incidents with AstraZeneca. Well, the side effects of some very commonly used medications are far, far, far more frequent than that. And that they’re incredibly serious, as serious as blood clots. But people got no idea.

I think I mistakenly think that we have this regulator that does a good job. And, you know, most of the time it doesn’t have the resources to do it. And also, it doesn’t have the imprimatur. It doesn’t have the government saying do this properly, do it publicly. So that be my major, major reform thrust, I think.

Dr Ron Ehrlich: [00:51:10] Hmm. Well, Martin, I think I want to thank you today for joining us and sharing with us all your insights and also for writing this quite incredible book that’s very timely. Thank you so much. 

Dr Martin Whitely: [00:51:24] Thanks, Ron. I really enjoyed it.

Conclusion

Dr Ron Ehrlich: [00:51:29] Now, of course, mental health is a big issue. There’s no doubt about that. And it’s a complex issue. And as I said, I thought Martin’s book has been really worth a read. I mean, it’s a difficult read from cover to cover, but there is just so much so it’s so dense with information. 

And if you’re a health practitioner particularly, or if you’re, you know, suffering from mental health and you want to make some more informed choices, then I would recommend it to you to provide a more balanced view. Brilliantly referenced. I think you should probably read it electronically because the hyperlinks to the research, the last 50 or 60 pages of the 280-page book are references. So the last 60 pages.

Dr Ron Ehrlich: [00:52:20] Also, I think it worth going back and listening to that moment when Martin said in 2004, the FDA put out a black box warning to say that anti-depressants prescribed for people under the age of 25 should carry a black box, warning that suicidal thoughts accompany the medication. And so it should be approached with extreme caution. Now, that is a really important statement. And so this is why this book is so important. 

Because it sheds light and provides references. It’s not just a shoot-in-the-dark discussion. And just to put this into perspective now, there are some other great books out there which, as I said, I’ve been following this since I first read. Well, I’ve been following it since the mid-80s when I was challenging some of the things that were being recommended to me in my own profession. 

Dr Ron Ehrlich: [00:53:18] But one of the first books I read on this was Dirty Medicine by Martin Walker in 1995, a long, drawn-out book about how the pharmaceutical industry undermines the natural health industry and then other books like The Truth About Drug Companies, written by Marcia Àngell, who happened to be the editor of one of the most prestigious journals in medical journals in the world, the New England Journal of Medicine. 

And when she wrote a few editorials about how Big Pharma was corrupting health care, she was dismissed. And so she wrote a book and that’s worth a read.

Dr Ron Ehrlich: [00:54:00] And then there was also Overdosed America by John Abramson from Harvard University. And then there was also this just off the top of my head, Denis Healey or David Healy, rather, a UK psychiatrist, Pharmageddon. 

And then, of course, Ben Goldacre, terrific book in 2012, Bad Pharma. And in that book, interestingly enough, just to give you an idea of the difference between independent and industry-funded studies, because let’s take statins as an example. Some of you may be on cholesterol-lowering drugs statins.

Harvard University did a study which showed that industry-funded studies showing that statins reduced deaths in all-cause mortality, they call it, were 20 times more positive than independent studies. So on statins, they were 20 times more positive than independent studies. And when it came to anti-depressants, they were four times more positive than independent studies. 

Dr Ron Ehrlich: [00:55:13] Now, of course, the pharmaceutical industry is not going to lie down and take this. So they organised research to be done by none other than the London School of Economics, the LSE, a very prestigious organisation, to look at whether industry-funded studies would have found different outcomes to independent studies. And when it came to statins, their conclusion was there was no difference. And that’s how research appears in the science of medicine, which can be very confusing.

However, when you go in and look at that study by the LSE, the Harvard, let me go back to Harvard University, asked the question, look at studies which say statins improve health outcomes. They make life longer. You don’t you will die later if you take a statement. 

That was the question. Do statins have an effect on all caused mortality, 20% more positive for the industry than independent? Then the LSC comes up and says, we’re going to explore whether industry-funded studies are more, ah, different to independent studies. Our conclusion is no.

Dr Ron Ehrlich: [00:56:29] When it comes to statins. And when you look at the study, the question they asked was, do statins lower cholesterol industry-funded studies? Totally agreed. Independent studies? Totally agree, because there’s absolutely no argument that statins lower cholesterol. 

The question is, does that make a difference to all-cause mortality? But you had to read the article to understand that actually the conclusion they drew was very different from the Harvard University question. So suffice to say, the drug companies’ fiduciary duty is to their shareholder. That is, by law, their main responsibility.

And the fact that it may or may not impact, you would hope that firstly it impacts in a positive way on public health. And secondly, you would hope that you didn’t kill anyone that would that would be important. But if you if you’ve kind of tick those two boxes, then, you know, your next benefit is to your primary responsibility is to your shareholders. And that is a conflict of interest.

Dr Ron Ehrlich: [00:57:42] As I said, good health makes sense, but it doesn’t make dollars. And that’s why on this podcast, I have explored the role of the chemical, food, and pharmaceutical industry in all levels of health care, and I might add, agriculture as well to that. 

Anyway, I hope you’ve enjoyed it. I’ve found that stimulating. We will, of course, have links to Martin’s book Overprescribing Madness. It’s an important read. And I had this finds you well. Until next time. This is Dr Ron Ehrlich Be well.

 

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.