Whitaker Responds to NYT Article

Submitted by admin on Thu, 03/30/2006 - 23:42


Posted on Mar 31, 06

Here is an email we received from Robert Whitaker, author of the groundbreaking book Mad In America, in response to the recent New York Times article by Benedict Carey about non-drug treatment of schizophrenia. In it, Whitaker points out that the doctor who is quoted so strongly against non-drug approaches is a highly-paid drug company consultant...

Date: Thu, 23 Mar 2006 10:12:09 -0500
From: Bob Whitaker

The story by the New York Times just cracks open the door a bit on a
question that psychiatry has avoided addressing at all costs: If you
take people newly diagnosed with schizophrenia, and treat them either
with drugs or with a placebo, which group will do better over the long

Now Bola, as he reviewed the data, could only find seven studies since
the introduction of neuroleptics that could be seen as well designed,
and with a total of only 623 subjects, that addressed this question. And
the placebo group in these studies is of this sort: Patients are not
immediately put on the drugs. Those who don't get better after a period
of time (3 to 6 weeks) are then put on the drugs. So you could say that
the placebo group, over the long term, involves selective use of the
drugs. Now here are the results form the seven studies:

Wirt and Simon, 1959: This one involved 80 first-admission patients
treated in a VA hospital, and it found that one year later, the
drug-treated group had somewhat better social functioning and slightly
lower work ratings. I should note that when I wrote Mad in America, I
skipped this study because the NIMH, when it conducted its first big
study in the early 1960s, basically concluded that all earlier studies
were poorly designed, lacked statistical significance, etc.

The NIMH collaborative research study: This is the 1960s study which
found that while drug-treated patients at six weeks fared better than
placebo patients, at one year a smaller percentage of the placebo
patients had been rehospitalized. So even on the target symptom of
psychosis, patients treated initially without drugs (and some never got
drugs) did better.

The next was the May study, also done in the 1960s, which is a very
complicated study because it had four arms: electroshock, drug,
psychotherapy without drug, and placebo. Again, over the short-term, the
drug-treated patients, in terms of remission of psychotic symptoms, did
better than either of the two groups treated without drugs. And over the
long-term, the psychotherapy patients didn't do well, and so this study
became to be cited as showing why you couldn't treat patients without
drugs. However, and this point is never noticed, 59% of patients in the
placebo group--no drugs and no therapy sessions with a
psychiatrist--were successfully discharged in the initial study period,
and this group "functioned over the (long-term) at least as well, if not
better, than the successess from the other treatments." In other words,
3 of every five patients, if treated with placebo (but not with
psychotherapy), got well enough to leave the hospital, and it was this
group that arguably had the best long-term outcomes of any group in the

Now the remaining four studies Bola looked at were all more recent
studies (1970s to 2000), and all involved providing the placebo patients
with some sort of environmental support (rather than just giving them no
drugs in a hospital setting.) And in each of these studies, the group
treated experimentally--as Bola reported--did better. They had lower
relapse rates and higher social functioning. Moreover, if you look at
those studies, somewhere between 37% and 65% of the patients treated
initially without placebo never went on the drugs during the follow-up
periods, which I think ranged from one to five years.

So what does this body of research actually show? It shows that if you
treat first-episode patients without drugs in a supportive environment,
these patients--as a group--will do better over the long term, even on
the target symptom of psychosis. And of course those patients who never
go onthe drugs--37% to 65% of the patients--will not suffer all the
physical side effects from the drugs, the emotional and this group will
be the best functioning group as well. That's what all four
experimental programs have reported.

It was good and even brave, given the prevailing wisdom in society about
drugs and schizophrenia, that the NY Times dared to suggest that some
people so diagnosed might do better without the drugs. But the article
only hinted at the real story here, and that is that the science shows
that such experimental care, which involves not immediately putting
people on drugs so you can see who might do well without them, would
provide better outcomes than what we see today with our drug-everybody

I should note that Bola, in his article, didn't frame the question quite
this way, as it would have been too radical. Instead, he framed it as a
question of whether newly diagnosed people can be treated without drugs
for a period of time in order to do "research." And so he concludes that
yes, you can. What is scandalous, of course, is that we have this body
of evidence showing a better way, and we can't even discuss it. It's
considered beyond the pale, or as Dr. Lieberman would have it, "nuts."
He, of course, has been a big-time consultant for the drug companies,
and in so labeling this notion "nuts," is not speaking about what the
science shows, but what ideas money will support.


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