Medicali$ation of a nation

The revamped Drill Hall Theatre in Mullumbimby is back with a bang next month.  

The Almighty Sometimes is a new Australian play about mental health, autonomy, and the medication of children. 

Without judgement, the play features the story of a teenage girl curious to explore life without her pills. It’s already won multiple honours, including one in the UK and the Premier’s Literary Awards in NSW and Victoria. 

The play comes at a time of on-going debate about medication use among the young, and the wider ‘medicalisation of life’. In Canberra, there’s even a Senate Inquiry underway about ADHD.  

It’s clear many adults and children can benefit enormously from a medical label, and the medication or other treatments that follow. But there’s also a mountain of scientific evidence that too many people are over-diagnosed and over-medicated. Including in the field of mental health.  

Rising prescriptions

We’ve known for some time Australians are among the highest users of antidepressants in the world. Yet, new research from the University of NSW has found those rates continue to rise relentlessly. 

Over the five years leading up to the pandemic, there was a staggering 50 per cent increase in new antidepressant use among Australian adolescents. The pandemic then saw rates grow even further, especially among teenage girls.

And those increases are despite high quality reviews of all relevant clinical trials, showing commonly used antidepressants are barely more effective than placebos. Plus, they carry side effects, including in some cases, rare but serious ones, such as suicidal thinking.   

‘There’s no good evidence antidepressants are helpful for young people, but there is evidence they’re harmful’, child psychiatrist, Jon Jureidini, told The Echo.

‘First of all, it’s a problem of the drugs not being very good’, says Jureidini, a professor from the University of Adelaide, and practising clinician. ‘And second, even if they were good, they’re being used far too broadly’.

So what’s driving this relentless rise in antidepressant use?  

‘It’s the medicalisation of distress’, says Jureidini, a respected academic and critic of pharma-marketing. 

‘This idea that if people are unhappy or troubled, there must be a medical explanation. And underneath it all, there’s the pharmaceutical promotion of drugs as the simple solution to all of life’s complex problems’. 

Industry influence 

As you’re likely aware, very little happens in medicine outside of the long shadows of drug company influence. Travel junkets and lavish dinners have attracted much attention over the years.  

But while it may be more subtle now, if you think the influence-peddling is a thing of the past, you’re mistaken. 

It is still entirely legal, and extremely common, for companies to sponsor the research, the hospital seminars, the medical journals, and the scientific conferences where our prescribing doctors are ‘educated’ about drugs.

One study I did with colleagues some time ago found almost 30,000 such events every year in Australia, where companies offered hospitality to doctors. We don’t know the exact figure today, because Australia’s self-regulatory system of disclosure has been watered down so much.

Sunshine Act

In the United States, they passed a law over a decade ago known as the Sunshine Act, requiring drug companies to disclose every dollar they give to doctors, and all their names. That means we know exactly how much these corporations are still throwing around to influence the way doctors prescribe.  

In the US in 2022, drug companies and device makers made payments and ‘transfers of value’ to health professionals totalling almost A$20 billion.

As it happens, the Sunshine Act – which forces the exposure of that $20 billion – arose from explosive congressional investigations in the early 2000s in Washington DC. Those investigations exposed multiple examples of high-profile doctors not disclosing money from pharma, including in the field of mental health. 

In one notorious case, investigators revealed Harvard professor Joseph Biederman and colleagues had failed to publicly report millions of dollars of payments from drug companies. Biederman is famous for his research on drugs for children diagnosed with ADHD and bipolar disorder.

Importantly, Australia has never held similar parliamentary investigations. And we have no Sunshine Act to throw light into the dark shadows of pharma influence. 

There is the current Senate inquiry into ADHD, but that’s another story, and another column, coming soon.

In the meantime, we can look forward to the stage-lights coming on in the newly revamped Drill Hall Theatre, and the return of that bright magic of live theatre.

♦ Dr Ray Moynihan is the author of four books on the business of medicine. The Almighty Sometimes opens at the Drill Hall October 13.