March 16, 2010
Who is Patrick McGorry and what does he promote? He’s a psychiatrist just named Australian of the Year for his work in “youth mental health reform.” What does that reform consist of? What he calls a “new form of climate change.” It sure is.
[See TIME Magazine Article "Drugs Before Diagnosis?"]
He not only promotes youths being put on antipsychotics and antidepressants, cited by international drug regulatory agencies as causing hallucinations, hostility, personality change, life-threatening diabetes, strokes, suicide and death, McGorry goes a giant step further—drug them before they’ve even developed a “psychiatric” disorder.
The Association for the Accreditation of Human Research Protection Programs (AHRPP) likens such concepts to “performing mastectomies on women who are at risk of—but do not have—breast cancer.”[i]
The UN Committee on the Rights of the Child has expressed “serious concerns” about child drugging and Senate investigations in the United States have found high profile psychiatrists who were pharmaceutically funded and using fraudulent research being among the heaviest promoters of psychiatric drug use on children. While the rest of the world is experiencing serious alarm at the rampant use of deadly psychiatric drugs on children, McGorry pushes full steam ahead to increase the amount of children being needlessly subjected to psychiatry’s most powerful drugs—antidepressants and antipsychotics.
His theory and practices are so controversial that even his colleagues in the United States have backed away from it. And a parallel study done in the United States based on the same theory that McGorry uses was considered an abject failure—even by the investigators themselves. Other psychiatrists have criticized McGorry’s pre-drugging practice as unethical and harmful to adolescents. More on that later.
This is especially so as the “symptoms” McGorry and cohorts invented to “pre-label” youths as potential candidates for psychosis and “schizophrenia” (to start with) are, according to one U.S. psychiatrist, “remarkably common…adolescence is a period of life that is normally marked by tumultuous changes in personality.”
- A d v e r t i s e m e n t
And what was the first thing he did to capitalize on his winning his “Australian of the Year” award? He demanded the Australian government hand over another $200 million to fund more of his centers where he can drug more children. Worse, the government is entertaining the idea.
Yet, for who ever nominated him—apparently an “anonymous supporter”—due diligence wasn’t done on what McGorry advocates.
A cursory look at his research shows that while behavioral symptoms are evaluated and, on a hunch, drugged to see if they “prevent” the onset of a “mental” disorder, there’s no mention of the teens being given full and searching physical exams to first rule out undiagnosed and untreated medical conditions that may be causing it. Yet dozens of physical conditions can manifest as behavioral problems.
- Australia, like the U.S., has recently seen major media and legislative exposure of the conflicts of interest between psychiatrists and the pharmaceutical industry. McGorry has received unrestricted research grant support from Eli Lilly, Janssen-Cilag, Bristol Myer Squibb, AstraZeneca, Pfizer, and Novartis.
- He is also a paid consultant for, and has received speaker’s fees from all or most of these companies.[ii] His recent report on “early intervention” for young people acknowledges AstraZeneca, Janssen, Eli Lilly, Novartis, Sanofi, Bristol Myers Squibb and Pfizer.[iii] [Since 2001, the U.S. Federal and state governments have recovered more than $4 billion from many of these companies that settled criminal or civil charges of fraud and misleading advertising filed against them.]
- Even Big Pharma is bowing out of psychiatric drug research. In February, the CEO of GlaxoSmithKline said it was dumping antidepressant research because it is too hard to prove that antidepressants work because “patient improvement is measured by subjective mood surveys” and not by any blood or biological test used to confirm medical diseases. AstraZeneca followed with the head of development, Anders Ekblom, announcing it would no longer research and develop drugs for depression, bipolar, anxiety and schizophrenia, saying the decision reflects the unpredictable and risky nature of clinical trials to assess medicine working on the brain. [emphasis added]
- Yet, despite the unpredictability and risk of these drugs, McGorry wants to go full steam ahead, increasing the funding to increase the number of children being placed on them.
A Closer Look at McGorry’s Brave New World
- In 1996, Patrick McGorry and fellow pharmaceutical company-funded researcher Alison Yung set up a clinic in Australia to monitor young people considered at a “high risk” for developing psychosis. They invented a subjective method for assessing symptoms that, while not based on science—claimed to predict early onset of psychosis or schizophrenia called prodromal (early symptoms), and drugged the teens and young adults. In other words, gave them toxic chemicals for a mental disorder they did not have.[iv]
- The theory wasn’t McGorry’s alone, but he decided to test it in a world-first trial that had psychiatry’s skeptics and even psychiatrists themselves aghast. The Australian program inspired the development of similar programs worldwide.[v]
- A follow up study was conducted in 2002, funded with an unrestricted grant from Janssen-Cilag pharmaceuticals, and supported by psychiatric-pharmaceutical front groups NARSAD and Stanley Foundation, as well as several Australian agencies. McGorry and colleagues said that risperidone (Risperdal)—made by Janssen—reduced the risk of “transition to psychosis” in young people.[vi]
- Risperdal has been linked to diabetes and, more specifically, Type 2 diabetes. Other serious side effects include Neuroleptic Malignant Syndrome (NMS), a potentially fatal syndrome involving muscle rigidity, and irregular blood pressure and pulse.[vii]
- McGorry’s friend and colleague, Yale University professor of Psychiatry, Dr. Thomas McGlashan, conducted a parallel study (1997-2003), the results of which were published in the American Journal of Psychiatry. Eli Lilly funded the experiment. Sixty adolescents, who did not meet any criteria for a diagnosis of mental illness, were prescribed Lilly’s antipsychotic Zyprexa (olanzapine).[viii]
- The experiment failed to demonstrate any significant benefit of Zyprexa, and 54.8% of adolescents prescribed the drug compared to 34.5% on placebo refused to complete the study (the 20% difference indicating substantial intolerable safety problems with the drug).[ix]
- Even McGlashan later admitted to The New York Times in May 2006 that, “the drugs were more likely to induce weight gain than to produce a significant, measurable benefit….” Those on medication gained an average of about 20 pounds. The entire process changed Dr. McGlashan’s thinking.[x]
- In fact he distanced himself from McGorry in a TIME Magazine article the same year on McGorry titled, “Drug Before Disorder?” “There may be gold in the early-intervention hills,” McGlashan conceded, “but the data are not plentiful enough and the findings not replicated enough for us to recommend anything more than further research at this point.”[xi]
- Undeterred, and buoyed by an Australian government $A54 million funding of a National Youth Mental Health Foundation, McGorry plowed on to expand his unproven and potentially risky methods to the early diagnosis and treatment for “a range of mental health problems in young people: substance abuse, personality disorders, bipolar—the whole lot, really.”[xii]
- Richard Warner, MB, DPM, director of Colorado Recovery in Boulder, Colorado, and professor of psychiatry at the University of Colorado, completely debunks McGorry’s theory, writing: “Medicating at the earliest appearance of symptoms, without thought for the natural history of the condition, may lock the person experiencing a brief psychosis into a long-term career as a psychiatric patient.”[xiii]
- Further refuting McGorry’s theory, Honorary Professor Anthony Pelosi from the Department of Psychiatry, Hairmyres Hospital, East Kilbride, wrote, “So far, evidence from randomized trials does not support the use of psychological therapies or drugs as preventive interventions.”[xiv]
No Science to “Pre-Disorder” Screening
- Dr. Warner counters any idea that science drives McGorry’s pre-disorder assessment: “As for the claim that we can prevent psychosis by intervening before the illness has become fully evident, this effort requires effective screening to detect those at risk.” Something that McGorry clearly doesn’t have.
- “Patrick McGorry and colleagues at the PACE clinic in Melbourne…report that their screening instrument is capable of 80 per cent accuracy in their clinic. But the instrument is not that accurate in routine use. In the PACE sample, 35 per cent developed psychosis within one year. Probability theory tells us that if the same instrument were used to screen a general population sample…it would be correct only seven per cent of the time.”
- “In fact, in another Australian clinic, the PACE instrument only achieved nine per cent accuracy. False-positive rates of the order of 70 to 90 per cent are clearly unrealistic for intervening with medication or other forms of treatment.”
Harmful Drug Outcomes
- Further, the antipsychotic drug interventions McGorry suggests as one intervention approach are dangerous. “Given the expected number of false positives, the potential for harm is significant,” Dr. Warner stated.[xv]
- Dr. Pelosi concurs: “[M]ost patients who enter these specialist programs will unnecessarily receive potentially dangerous treatments. Data are emerging from the clinics of early intervention enthusiasts that illustrate nicely what they have been warned about for years. When psychiatrists referred selected patients to a schizophrenia prodrome clinic, about half went on to develop a psychosis. After teachers, college counselors, and families were encouraged to refer young people with possibly prodromal symptoms directly to the same clinic for the same care plans…almost 90% were receiving unnecessary ‘preventive’ interventions.”[xvi]
- Dr. Jerald J. Block, a U.S. psychiatrist, writing in Bioethics Forum, says that “preventive pharmacology” (what McGorry is practicing) is “ethically questionable territory” because the treatments given “frequently have side effects and complications” and you are potentially harming people. Further, the symptoms used to identify them as at risk of schizophrenia are “also remarkably common…adolescence is a period of life that is normally marked by tumultuous changes in personality.”[xvii]
- He says, “[I]t is unclear how the quality of one’s life will be affected during and after one year of getting daily neuroleptic,” especially for a condition you haven’t even developed. “Forming and solidifying new relationships occupies much of the time in adolescence and young adulthood. As neuroleptics affect cognition and emotionality, we might expect [an antipsychotic] to influence one’s ability to build relationships, for better or worse.”[xviii]
- Moreover, Dr. Warner points out, if left untreated, the person exhibiting so-called “prodromal” symptoms is likely to recover without drug treatment. “The Soteria projects in California and Berne, Switzerland, and a multi-center study in Finland demonstrated that medication is not essential for good outcome.”[xix]
Despite the Failure, Keep Lobbying for the $
- Dr. Pelosi points out that when the leaders of the early intervention movement are pinned down, while they accept the criticisms against them, “this has not stopped their skilful lobbying of politicians, journalists, patients, and carers with upbeat messages about the prevention and attenuation of schizophrenia.”
- Which is precisely what McGorry is doing now—using his award and unquestionably unscientific theories to advocate for more funds.[xx]
Australia’s Joseph Biederman?
- McGorry has been equated with America’s Dr. Joseph Biederman, the psychiatrist who came under U.S. Senate Finance Committee investigation for failing to disclose more than $1.6 million he’d earned in consulting fees from drug makers while conducting research for universities. Biederman was on the Advisory Board of Eli Lilly, which manufactures antipsychotics and antidepressants. The New York Times said that Biederman helped to fuel a 40-fold increase from 1994 to 2003 in the diagnosis of pediatric “bipolar disorder” and corresponding increase in children taking antipsychotics.
- How much McGorry may have impacted on pediatric and youth prescriptions of antipsychotics and antidepressants in Australia is unknown, but certainly warrants a closer look. As do the outcomes of his studies and what, if any, influence the drug companies that funded him may have had.
- Australia’s Therapeutic Goods Administration (TGA) has received reports of 26,506 adverse reactions linked to antipsychotics, including 477 deaths. That’s since they were introduced over many years. By January 2009 there were 36,804 adverse reactions reported to the TGA linked to antidepressants, including 217 deaths, of which 4 were from the 10 to 19 age group.
- But add to that the Food and Drug Administration’s adverse drug reaction reports (ADRs) during a five-year period alone (2004-2008) and the magnitude of where the potential risk of this “Drugs before Disorder” practice is heading. For antipsychotics, there were 91 deaths for those under 18. For antidepressants, there were 321 deaths, of which 251 were suicides. As these reports represent between one and ten percent of the ADRs, that figure could be as high as 3,210 deaths, and for antipsychotics, nearly 1,000.
Australia’s health care system ranks well internationally, and preventative measures may seem the way to enhancing it; however, the last thing the country needs, then, is a psychiatrist banner heading the idea that children and youths should be gotten to early and drugged on the precept that they might become mentally ill. Rather, they need proper medical—not psychiatric—care and educational solutions. The last thing they need is $200 million of taxpayers’ dollars funding what could be a lifetime sentence to taking mind-altering drugs.
Someone needs to care for Australia’s children and youth, but it’s definitely not Patrick McGorry.
[vi] Arch Gen Psychiatry, Vol 59, Oct. 2002, http://www.meb.uni-bonn.de/psychiatrie/zebb/literatur/mcgorry.pdf.
[xiv] Anthony Pelosi, “Head to Head, Is early intervention in the major psychiatric disorders justified? No,” BMJ 2008;337:a710, http://www.bmj.com/cgi/content/full/337/aug04_1/a710.
[xvii] http://www.ahrp.org/cms/index2.php?option=com_content&do_pdf=1&id=386; http://www.bioethicsforum.org/ethics-of-preventive-psychopharmacologic-treatments.asp.
[xviii] http://www.ahrp.org/cms/index2.php?option=com_content&do_pdf=1&id=386; http://www.bioethicsforum.org/ethics-of-preventive-psychopharmacologic-treatments.asp.
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