UK psychiatrist David Healy has attacked current prescription habits of psychiatrists which are strongly influenced by the pharmaceutical propaganda in the fourth 2008 issue of Psychotherapy and Psychosomatics.

Commenting on a paper by Harvard investigators on the psychology of risk and prescriptions of psychotropic drugs, Healy denounces a real crisis in psychiatry at present. In part this stems from the lack of independent studies. Allied to this is a lack of independent access to what data there are and an unsophisticated interpretation of the data that are available, based on conceptual models that seem increasingly inadequate. It is important that clinicians understand the dynamics that impinge on their judgment as it is almost certainly the case that pharmaceutical companies engineer clinical perceptions based on side effect profiles. The basic company position is that clinicians have no thoughts in their minds other than those put there by us or our competitors, and in order to plant a message or dislodge those of competitors companies employ all their sophisticated means.

Consider the dynamics of prescribing within the pediatric mental health field. Over the course of 25 years, the prescribing of stimulants to children has grown exponentially primarily in North America. In this case, clinicians readily juggle incompatible profiles on the one hand amphetamines and cocaine are labeled threats to civilization, while identical compounds are then given to the most vulnerable brains when other options in many cases may be just as good. Or consider the burgeoning prescription of antipsychotics to infants on the basis that they have a bipolar disorder. For fifty years, the antipsychotics were viewed as too dangerous to use outside secondary care and were largely restricted to those with chronic psychotic disorders where the trade-off between hazards and benefits justified treatment. Yet now a new generation of possibly even more problematic antipsychotics is being given to preschoolers, in North America, on the basis that they might have a disorder that most of the rest of the world does not believe happens in children.

Further, the combined data from all randomized placebo-controlled trials of antidepressants recently published by the FDA, show 5 out of 10 subjects respond to active treatment and 4 out of 10 respond to placebo. Clinicians regularly take such data to indicate that these drugs work, when the data suggest that 80% of those apparently responding to an antidepressant would have responded to placebo, and only 1 in 10 people have a specific response to active treatment. Rather than telling someone who responds that they would most likely have done so even if a drug had not been prescribed, clinicians attribute the responses to treatment.

While all we actually have is the appearances of scientific evidence but not the actual data from studies, prescribers do not have the means to overcome stereotypes and practice medicine based on a rational analysis of probabilities. They may claim to be following the evidence, but de facto clinicians are primarily influenced by the eminence of the authorities they listen to or journals they read and the knowledge that many of their peers will be influenced in the same way to the point where it would seem such influence trumps the evidence of their own eyes.

As a result clinical practice is straying ever further from the wisdom enunciated by Philippe Pinel over 200 years ago: 'It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them'. If he stuck to this message, it is doubtful whether Pinel would be on the speaker's bureau for many of today's pharmaceutical companies.