Dr James Davies is a Senior Lecturer in the Department of Life Sciences at the University of Roehampton, London Online. He is the author of several books, including Cracked: Why Psychiatry is Doing More Harm Than Good, which argued that psychiatry has “put riches and medical status above patients’ well-being”.

Three years on from that book, James joins host, Neil Morrison in conversation on the University of Roehampton Podcast to explain why things have not improved. Here are seven things he claims are worrying about the psychiatry industry. 

  1. The number of anti-depressant prescriptions in England is staggering
    When James wrote Cracked, the number of prescriptions issued in England for anti-depressants stood at 43 million a year. Today, that total is 61 million per year. To put that in context, there are only 55 million people living in England.
  2. But The Verve were right… the drugs don’t work
    An article in the New England Journal of Medicine looked at all the trials conducted into selective serotonin reuptake inhibitor (SSRI) anti-depressants. There were around 70 trials in total – but only half had ever been published.

    “It turns out,” says James, “that the half that had been published showed that these drugs worked a little better than placebos – whereas the other half, which hadn’t been published, showed the drugs work no better than placebos… When you factor in the negative studies, it turns out that these drugs work no better than placebos for most people taking them. That’s around 80% to 85% of consumers.”
  3. The psychiatry ‘bible’ isn’t powered by science
    Since the 1950s, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has detailed all the mental disorders believed to exist. There have been five editions of the book so far.

    But according to James, decisions over whether to include a new disorder, how to define that disorder, and where to set the threshold to determine whether a patient has that disorder, were based on clinical judgements and committee consensus. “They weren’t actually driven by hard data and robust academic research,” he says.

    When consensus couldn’t be reached, the committees simply voted. But James warns: “When anything’s voted into existence, whether it’s a new president, a new political party or indeed a new mental disorder, the likelihood we’ve got it wrong is never far away.”
  4. Links to the pharmaceutical industry are rife
    Of the 29 people who wrote the 2013 edition of the DSM, 21 had financial ties to the pharmaceutical industry. James says: “Research shows that doctors who have financial links to the pharmaceutical industry are more biased in terms of psycho-pharmaceuticals with respect to their educational research and clinical practices.” In producing the 1994 edition of the DSM, 88% of its committee members had financial ties to the industry. James adds: “Conflicts of interest do play a role in biasing narratives.”
  5. Despite costing $88 in the U.S., the DSM is a bestseller. How come?
    On a visit to New York in 2013, James was browsing Amazon. It was six months since the latest edition of the DSM had been published. “I went to the page that documents the bestselling books on Amazon and it turns out, six months after its publication, that the bestselling book in the U.S. was the DSM,” he remembers.

    The next day James met a prominent social anthropologist at New York University. “Don’t you know?” she said. “The DSM is being bought in bulk by the pharmaceutical industry and then dispensed to clinicians up and down the country for free.” James believes this was being done because of the book’s low threshold for diagnosing conditions that need drug treatment, thereby increasing pharmaceutical industry profits.
  6. Guess who funds the NHS’s patient questionnaires to determine depression?
    Two questionnaires are used to determine depression in the NHS: the PHQ9 form and the GAD7 form. Doctors and GPs use these forms to assess whether a patient has depression and, if so, to what degree. Both forms are criticised for setting the bar low in determining whether a patient has a form of depression for which a drug is prescribed.

    James says: “Most people who’ve undertaken these questionnaires, and have been prescribed drugs as a consequence, simply don’t know that the development and distribution of these questionnaires was paid for by, and the copyright is owned by, Pfizer Pharmaceuticals.”
  7. The potential waste in the NHS is enormous
    James is equally concerned about the cost-effectiveness of drug treatments for psychiatric conditions. “We spend over half a billion pounds a year in the NHS on psychiatric medications,” he says. “If most of those medications are unnecessarily prescribed, there’s a lot of savings to be made.”

About this podcast

The University of Roehampton Podcast is produced by the University of Roehampton in collaboration with Roehampton Online. Its thought-provoking approach aims to introduce listeners to researchers, authors and academic experts from the University. Be sure to subscribe, listen and review on iTunes to stay up to date with latest episodes.

Listen to Episode #1 Cracked – Why Psychiatry is still doing more harm than good.

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