Here is the full text and summary of David Healy’s talk titled “Making Medicines Safer For All Of Us” at TEDxAberystwyth conference.
Listen to the audio version here:
TRANSCRIPT:
Two years ago, Jeremy Hunt, when he was the Minister for Health, said that children’s mental health services are the greatest failure in the NHS. Back then, and even more so now, there was a whole range of articles about university students committing suicide in unprecedented numbers.
Distressed teenagers in school had been given antidepressants because they couldn’t access children’s mental health services, and just this week there’s been a whole bunch of reports about a quarter of young women have mental health problems.
This isn’t just a UK issue. Anywhere from New Zealand to the United States, you’ll find the same articles and the same programmes. If you read the articles and watch the programmes, the old media usually say this is a new media issue, which sounds a little bit to me like new plus new equals five, and you have to remember that the old media hate the new media.
When I ask people, people like you, for instance, what they think is going on, the kind of thing that I hear the most often is, well, it’s a quick fix issue. We’ve become a quick fix culture, and that sounds good to me, except for the fact I’m not quite sure I haven’t been sure what a quick fix actually is, until President Trump, a little bit back, came up with an answer for me, which in response to one of the school’s shootings, he said, you know, what we need is a good guy with a gun in all those schools.
There was outrage in response to this, but people were stumped by the follow-up point he made. Well, if you don’t think a good guy with a gun is the right answer, why do you have good guys with guns outside the White House? And of course, guns work. The trouble is, if you multiply them up and spread them too far, like maybe into schools, we figure that they can potentially cause more problems than they solve.
Medicines are a little bit like guns. They’re a fix. They can solve problems, multiply them up too much and spread them, let them leak into the kinds of situations that they shouldn’t be in, and potentially you can cause more problems than you solve, especially if the information that goes with the medicine is fake information.
Most of you will have heard of ghostwriters. Donald Trump’s book, The Art of the Deal, was famously ghostwritten. Footballers and film stars and maybe Tony Blair, the kind of people we think have their books ghostwritten, Gordon Brown were less likely to think that he had it ghostwritten, brainy people we think don’t need ghosts to write things for them.
Well, think again. The greatest concentration of ghostwriting on this planet is centered on the drugs that you take, that your doctor gives to you. Since about 1989 or thereabouts, pretty well all the articles about all the pharmaceuticals that you might be put on by a doctor, even in the most prestigious medical journals, have been ghostwritten. The authors on the authorship line are not the people that wrote that article.
This isn’t necessarily a problem because the ghostwriters are smarter women for the most part who’ve got PhDs who write better than the average doctor. It wouldn’t be a problem if the ghosts and the doctors behind the trial of the drugs and your doctor have access to the data from that trial. But they don’t.
Who does? Well, you might think that FDA who approve drugs in the United States have access to the data. They don’t. You might think that MHRA who approve drugs here have access to the data behind the drugs you’re on. They don’t. You might think that those nice people who write the nice guidelines that tell your doctor which heart drug to give you or gut drug or antidepressant would have the data when they write the guidelines. They don’t. They work from ghostwritten articles.
Now, this is a problem for all doctors. There used to be a gulf between the NHS and private medicine over in, say, the United States, but increasingly the systems are exactly the same. Since about 1989, they’ve been increasingly run by managers. And the first job the manager has is to ensure that doctors keep the guidelines. They’re not doing this to take care of you. They’re doing this so that if anything goes wrong to you, you die or you’re disabled by the treatment, the organization and the manager won’t be held responsible.
If there’s any fuss in the media about any treatment you’re on, politicians worldwide will say everything will be okay provided doctors keep the guidelines. All these people are seeing a rotten apple in the barrel problem. We just need to make sure we get rid of the rogue doctor.
The problem is that you and I are facing a rotten barrel problem. The greatest threat to you is the good doctor who keeps the guidelines, not a person like me who thinks the guidelines are junk. The good doctor that keeps the guidelines is totally in the pocket of the pharmaceutical industry without them having to pay him a cent.
Now let me bring you back to 1989 or thereabouts and the Berlin Wall has just come down and Prozac has just come on the market. It’s the first of what we now call the SSRI anti-depressants. This and the other SSRIs were drugs that were going to make you better than well. They were going to help you transition from the old you to a new enhanced you. They were miracle drugs, about as far removed from, say, the antihistamines that you could think about. I mean, nobody thinks the antihistamines are miracle drugs.
Well, in actual fact, Prozac and the other SSRIs are antihistamines.
They were less effective and more expensive than the older anti-depressants we had.
So how were they made into miracle drugs? Well, the answer was lack of access to the data from the trials that brought them on the market and the articles were ghostwritten up to hide the problems that they could cause, the fact that these drugs can cause you to commit suicide, can cause you to commit homicide, that 80% of the people who take them for any period of time are not going to be able to get off them easily, that they wipe out your ability to make love, and that 20 years after you’ve halted the drugs, you still may not be able to make love properly. All of this was concealed by the ghostwriting.
A few years after these drugs came on the market, there were a few reports from enthusiastic doctors saying, when I give these drugs to children, they work wonders for children too. Now, when we see reports like that, the response usually is, well, doctors can be paid to write these enthusiastic reports, so what do we need to do is we need to do a clinical trial.
And if the trial is negative, we don’t use the drugs. There have been 30 clinical trials of this group of drugs in young people who were depressed. Every single trial, negative. Now, it’s not just that, but in the trials, there’s a doubling or tripling of the rate of children going on to suicidal events on the treatment compared with non-treatment. This was written out of the script.
What happened to sales of these drugs? Well, besides oral contraceptives, the SSRI group of drugs are the most commonly taken drugs by teenage girls. How does this happen? Well, before we found out about the ghostwriting and the negative trials and things like that, what had happened was Prozac had been approved for young people by FDA and the States and MHRA here. That’s only done on the basis that FDA and MHRA have positive trials, two positive trials of any of these drugs that they approve.
I’ve just told you that all the trials were negative. FDA and MHRA know this. The NICE guidelines recommend for teenagers who are depressed that you can give Prozac and maybe other SSRIs. They know there is not a single positive trial. It’s not just the case that the SSRIs are the most commonly taken drugs by teenage girls, but the use of these drugs generally is exploding. This group of drugs, plus related drugs, if you go to universities over in the United States, 50 percent of the students are on one or other of these drugs, and the ones who are most commonly on them are medical trainees. The people you depend on not put you on a quick fix to solve your problems, they’re the ones who are most likely to be taking a quick fix.
Now, how does this apply to any of you? Well, everything I say about the antidepressants for young people applies to every single drug you may be on. Back around 1989, you and I were probably on just one drug for a short period of time, an antibiotic, for a week or two. Now 50 percent of you over the age of 45 will be on three or more drugs every single day of the year. 50 percent of you over the age of 65 will be on five or more drugs every single day of the year.
And if you’ve got a good doctor who keeps the guidelines, you’re going to be on more drugs every single year you live, so by the time you get into your 70s, you’re going to be on 10 or more drugs. If we don’t have the information that makes these drugs safe, that’s a problem.
What you have to remember in all this is that companies aren’t in the business of making you well, or better than well, they’re in the business of making sure that their sales of a drug this year are better than last year. They’re in the business of trying to transition their drugs from poisons to sacraments.
Sacraments are a quick fix. Poisons aren’t. You might think the word poisons touch strong, but it used to be said that the art of medicine is bringing good out of the use of a poison. You have to remember that a medicine is a chemical, which is always risky, plus the information that we need in order to make that risk as safe as we can make it.
Over the last 30 years, the information has been degrading in quality the whole time. Donald Trump, again, introduced this to fake news a few years ago, and the general impression you get from the old media is really people who are a little bit dim out there who are taken in by fake news.
Well, doctors have been consuming only fake news for the last 30-odd years or so. Where does this leave us? Well, modern medicine began roughly 200 years ago. It began with people like Philippe Pinel, who famously said, it’s great to have a fix for our problems, but it’s an even greater art to know when not to use that fix.
Over the course of the last 200 years, year on year, your life expectancy improved, until two years ago, when in the United States, it began to fall, not just stopped speeding up but began to fall, and here it has stalled, so that the situation now is, the life expectancy we thought you had two years ago, it’s less now than we thought it was two years ago, whether you live in the United States or Europe.
Allied to that, this would have changed the climate of healthcare. Our services are addicted to the idea that the treatments we give you work wonderfully well and are free of harms, and they’re a quicker and cheaper fix for the problems you have than having someone engage with you and try and solve those problems in a less risky way.
When I say change the climate of healthcare, you’re probably going to think global climate change, but you know, we can’t see the sea levels rising out there yet. We can see your life expectancy falling.
How are we going to solve the problem? Well, in fact, you can do more to change the climate of healthcare back to what it should be than most of us feel we can do for global climate change, and in the course of doing this to the healthcare climate, you can maybe help with the global climate change too, because it’s the same set of forces driving both sets of changes.
What you can do to borrow from the pharmaceutical industry who have come up with this phrase, which you hear the whole time, at least over in the States, ask your doctor. What you need to do is the next time you go to your doctor and he or she is going to put you on some pill, ask your doctor if access to the data behind this pill could be good for you and for her, and perhaps suggest that you don’t want to be put on a pill where she doesn’t have access to the data. This will be a tremendously scary moment for you and for her.
You will feel the weight of those interest groups who don’t want to see change, and they’re the same interest groups who don’t want to see us do anything about the global climate change. There’s another ask you can do, which is if you’ve got a relative or a friend who’s in a residential home or a care home or in their home or living with you, ask them how many pills they’re on. Chances are, after over the age of 70, it’s 10 or more, and there’s increasing evidence that if we can cut that down from 10 or more to 5 or less, that you’re going to increase your expectancy.
You’re going to make it less likely that they’re going to go into hospital again, and in many instances you’re going to see them reborn in front of your eyes. The politicians who say, here, talk about the NHS the whole time and the cost of the NHS and how are we going to finance the NHS, it’s the same over in the States and it’s the same globally.
When asked what the problem is, they tend to say it’s the elderly. We have no option but to give them more and more treatments. They give the impression that they’re giving them more and more care. They’re not. They’re giving them more and more quick fixes which are causing the problem rather than actually solving it.
How do I know this? Well, they’re doing exactly the same thing to our kids. There’s a very famous Simpsons cartoon which you can Google, just Google, Google Bart Simpson and this is the worst day of my life, and what you’ll see is a very hang dog Dan Beast Bart who looks like he needs a quick fix, an anti-depressant maybe.
And then on the next panel you’ll see Homer Simpson saying, no, this is the worst day of your life so far. Now this is bittersweet humour, well, to me it’s bittersweet humour which seems to point to something we’ve lost that we need to regain. You’re not going to regain it, listening to me talking here, we’re going to regain it if some of you go out there and ask your doctor if you can have access to the data that you should be entitled to and that you think she has.
Thank you.
Want a summary of this talk? Here it is.
SUMMARY:
In his talk titled “Making Medicines Safer For All Of Us,” David Healy addresses critical issues related to the pharmaceutical industry, medical practices, and the safety of medications. He touches upon various key points:
1. Children’s Mental Health Crisis: Healy begins by highlighting the alarming state of children’s mental health services and the increasing number of university students committing suicide. He emphasizes that this issue is not limited to the UK but is a global concern.
2. Quick Fix Culture: Healy challenges the notion of a “quick fix” culture as the primary cause of these issues. He draws an analogy between medicines and guns, suggesting that both can solve problems but can also create more significant problems when misused.
3. Ghostwriting in Medical Research: Healy reveals that a significant portion of medical research articles on pharmaceuticals are ghostwritten. These articles are often published in prestigious medical journals, and the listed authors may not have written them. This practice is widespread and raises concerns about transparency.
4. Data Access: He explains that even regulatory bodies like the FDA and MHRA do not have access to the data behind drug trials, which is essential for evaluating a medication’s safety and efficacy. Instead, they rely on ghostwritten articles.
5. Rise of Polypharmacy: Healy notes the increasing trend of patients, especially the elderly, being prescribed multiple medications simultaneously. This polypharmacy can lead to health risks and adverse effects.
6. Pharmaceutical Industry Interests: He underscores that pharmaceutical companies are primarily interested in boosting drug sales, rather than focusing on patient well-being. They aim to transition drugs from being seen as poisons to sacraments, emphasizing their quick-fix nature.
7. Impact on Healthcare Climate: Healy argues that the climate of healthcare has changed, with doctors prioritizing drug prescriptions over holistic care. This shift has contributed to stagnating or declining life expectancies in some regions.
8. Call to Action: Healy encourages patients to ask their doctors for access to the data behind prescribed medications, challenging the current lack of transparency. He believes that patients can play a crucial role in changing the healthcare climate by advocating for safer, more informed practices.
In conclusion, David Healy’s talk sheds light on the complex issues surrounding pharmaceuticals, medical research, and healthcare practices. He emphasizes the need for transparency, patient involvement, and a shift away from quick-fix solutions to ensure the safety and effectiveness of medications.
