*A timeline for neuroleptics*
"The case against antipsychotic drugs: a 50-year record of doing more harm
than good," by Robert Whitaker, author of *Mad In America: Bad Medicine, Bad
Science and the Enduring Mistreatment of the Mentally Ill *.
Published in the journal Medical Hypotheses (2004)
1883 Phenothiazines developed as synthetic dyes.
1934 USDA develops phenothiazines as insecticide.
1949 Phenothiazines shown to hinder rope-climbing abilities in rats.
1950 Rhone Poulenc synthesizes chlorpromazine, a phenothiazine, for use as
*Clinical history/standard neuroleptics*
1954 Chlorpromazine, marketed in the US as Thorazine, found to induce
symptoms of Parkinson's disease.
1955 Chlorpromazine said to induce symptoms similar to encephalitis
1959 First reports of permanent motor dysfunction linked to neuroleptics,
later named tardive dyskinesia.
1960 French physicians describe a potentially fatal toxic reaction to
neuroleptics, later named neuroleptic malignant syndrome.
1962 California Mental Hygiene Department determines that chlorpromazine and
other neuroleptics prolong hospitalization.
1963 Six-week NIMH collaborative study concludes that neuroleptics are safe
and effective "antischizophrenic" drugs.
1964 Neuroleptics found to impair learning in animals and humans.
1965 One-year followup of NIMH collaborative study finds drug-treated
patients more likely than placebo patients to be rehospitalized.
1968 In a drug withdrawal study, the NIMH finds that relapse rates rise in
direct relation to dosage. The higher the dosage that patients are on before
withdrawal, the higher the relapse rate.
1972 Tardive dyskinesia is said to resemble Huntington's disease, or
"postencephalitic brain damage".
1974 Boston researchers report that relapse rates were lower in
pre-neuroleptic era, and that drugtreated patients are more likely to be
1977 A NIMH study that randomizes schizophrenia patients into drug and
non-drug arms reports that only 35% of the non-medicated patients relapsed
within a year after discharge, compared to 45% of those treated with
1978 California investigator Maurice Rappaport reports markedly superior
three-year outcomes for patients treated without neuroleptics. Only 27% of
the drug-free patients relapsed in the three years following discharge,
compared to 62% of the medicated patients.
1978 Canadian researchers describe drug-induced changes in the brain that
make a patient more vulnerable to relapse, which they dub "neuroleptic
induced supersensitive psychosis".
1978 Neuroleptics found to cause 10% cellular loss in brains of rats.
1979 Prevalence of tardive dyskinesia in drug-treated patients is reported
to range from 24% to 56%.
1979 Tardive dyskinesia found to be associated with cognitive impairment.
1979 Loren Mosher, chief of schizophrenia studies at the NIMH, reports
superior one-year and two-year outcomes for Soteria patients treated without
1980 NIMH researchers find an increase in "blunted effect" and "emotional
withdrawal" in drugtreated patients who don't relapse, and that neuroleptics
do not improve "social and role performance" in non-relapsers.
1982 Anticholinergic medications used to treat Parkinsonian symptoms induced
by neuroleptics reported to cause cognitive impairment.
1985 Drug-induced akathisia is linked to suicide.
1985 Case reports link drug-induced akathisia to violent homicides.
1987 Tardive dyskinesia is linked to worsening of negative symptoms, gait
difficulties, speech impairment, psychosocial deterioration, and memory
deficits. They conclude it may be both a "motor and dementing disorder".
1992 World Health Organization reports that schizophrenia outcomes are much
superior in poor countries, where only 16% of patients are kept continuously
on neuroleptics. The WHO concludes that living in a developed nation is a
"strong predictor" that a patient will never fully recover.
1992 Researchers acknowledge that neuroleptics cause a recognizable
pathology, which they name neuroleptic induced deficit syndrome. *In
addition to Parkinson's, akathisia, blunted emotions and tardive dyskinesia,
patients treated with neuroleptics suffer from an increased incidence of
blindness, fatal blood clots, arrhythmia, heat stroke, swollen breasts,
leaking breasts, impotence, obesity, sexual dysfunction, blood disorders,
skin rashes, seizures, and early death. *
1994 Neuroleptics found to cause a swelling of the caudate region in the
1994 Harvard investigators report that schizophrenia outcomes in the US
appear to have worsened over past 20 years, and are now no better than in
the first decades of 20th century.
1995 "Real world" relapse rates for schizophrenia patients treated with
neuroleptics said to be above 80% in the two years following hospital
discharge, which is much higher than in pre-neuroleptic era.
1995 "Quality of life" in drug-treated patients reported to be "very poor".
1998 MRI studies show that neuroleptics cause hypertrophy of the caudate,
putamen and thalamus, with the increase "associated with greater severity of
both negative and positive symptoms".
1998 Neuroleptic use is found to be associated with atrophy of cerebral
1998 Harvard researchers conclude that "oxidative stress" may be the process
by which neuroleptics cause neuronal damage in the brain.
1998 Treatment with two or more neuroleptics is found to increase risk of
2000 Neuroleptics linked to fatal blood clots.
2003 Atypicals linked to an increased risk of obesity, hyperglycemia,
diabetes, and pancreatitis.
 Cole J, Klerman G, Goldberg S. The National Institute of Mental Health
Psychopharmacology Service Center Collaborative Study Group. Phenothiazine
treatment in acute schizophrenia. Arch Gen Psychiatry 1964;10:24661.
 Gilbert P, Harris M, McAdams L, Jeste D. Neuroleptic withdrawal in
schizophrenic patients. Arch Gen Psychiatry 1995;52:17388.
 Shorter E. A history of psychiatry. New York: Wiley; 1997. p. 255.
 Hegarty J, Baldessarini R, Tohen M, Waternaux C. One hundred years of
schizophrenia: a meta-analysis of the outcome literature. Am J Psychiatry
 Holden C. Deconstructing schizophrenia. Science 2003; 299:3335.
 Weiden P, Aquila R, Standard J. Atypical antipsychotic drugs and
long-term outcome in schizophrenia. J Clin Psychiatry 1996;57(Suppl
 Harvey P. Cognitive impairment in schizophrenia: its characteristics and
implications. Psychiatr Ann 1999;29: 65760.
 Stip E. Happy birthday neuroleptics! 50 years later: la folie du doute.
Eur Psychiatry 2002;17(3):1159.
 Brill H, Patton R. Analysis of population reduction in New York State
mental hospitals during the first four years of large scale therapy with
psychotropic drugs. Am J Psychiatry 1959;116:495508.
 Brill H, Patton R. Clinical-statistical analysis of population changes
in New York State mental hospitals since introduction of psychotropic drugs.
Am J Psychiatry 1962;119:2035.
 Council of State Governments. The mental health programs of the
forty-eight states. Chicago: The Council; 1950. p 413.
 Rusk H. States map a new attack to combat mental illness. New York
 Epstein L, Morgan R, Reynolds L. An approach to the effect of ataraxic
drugs on hospital release rates. Am J Psychiatry 1962;119:3647.
 Scull A. Decarceration: community treatment and the deviant, a radical
view. New Brunswick, NJ: Rutgers University Press; 1984.
 Schooler N, Goldberg S, Boothe H, Cole J. One year after
discharge:community adjustment of schizophrenic patients. Am J Psychiatry
 Prien R, Levine J, Switalski R. Discontinuation of chemotherapy for
chronic schizophrenics. Hosp Community Psychiatry 1971;22:203.
 Gardos G, Cole J. Maintenance antipsychotic therapy: is the cure worse
than the disease? Am J Psychiatry 1977;133: 326.
 Bockoven J, Solomon H. Comparison of two five-year follow-up studies:
19471952 and 19671972. Am J Psychiatry 1975;132:796801.
 May P, Tuma A, Dixon W. Schizophrenia: a follow-up study of the results
of five forms of treatment. Arch Gen Psychiatry 1981;38:77684.
 Carpenter W, McGlashan T, Strauss J. The treatment of acute
schizophrenia without drugs: an investigation of some current assumptions.
Am J Psychiatry 1977;134: 1420.
 Rappaport M, Hopkins H, Hall K, Belleza T, Silverman J. Are there
schizophrenics for whom drugs may be unnecessary or contraindicated. Int
 Mathews S, Roper M, Mosher L, Menn A. A non-neuroleptic treatment for
schizophrenia: analysis of the two-year postdischarge risk of relapse.
Schizophr Bull 1979;5:32232.
 Bola J, Mosher L. Treatment of acute psychosis without neuroleptics:
two-year outcomes from the Soteria Project. J Nerv Ment Dis 2003;191:21929.
Autism 'Linked to Mercury Vaccine'
By Rosie Waterhouse (UK Times)
Mercury in vaccines for babies and infants could be the cause of a steep rise in cases of autism in children around the world, according to a growing number of scientists.
The increase in reports of autism in Britain, America and some other countries coincides with a growth in the number of inoculations given to young children, say the researchers.
Many of the vaccines contain a preservative called thiomersal, which is 49.6% mercury - a substance known to have neurotoxic effects, especially in infants whose brains are still developing.
Symptoms are similar to those displayed by autistic children.
Autism is a spectrum of disorders that range in severity from bizarre, violent behavior to an inability to communicate or interact socially, along with repetitive patterns of behavior.
Estimates of the prevalence of the syndrome in Britain range from 10 cases per 10,000 of the population with "classic" autism, to 9.1 cases per 1,000 showing some signs of autistic behavior.
The National Autistic Society estimates that there are about 500,000 people with autism in Britain, 120,000 of them children. According to one recent study, there has been a tenfold increase among children between 1984 and 1994.
The new possible explanation of the rise has emerged after a two-month review of all the available information by The Sunday Times. Several groups of academics and researchers in America and Sweden are investigating similar theories that a combination of factors is to blame.
They include a genetic predisposition, the cumulative effects of mercury in vaccines lowering the immune system, with the controversial measles, mumps and rubella (MMR) triple vaccine being a possible trigger.
The US Institute of Medicine is so concerned that officials have organized a two-day meeting in July to discuss the "hypothesis" that thiomersal and mercury in vaccines are linked to autism.
Boyd Haley, chemistry professor at the University of Kentucky, has been asked to submit a paper. "Thiomersal is extremely toxic. The preliminary data is convincing and does indicate that vaccines are the most likely suspect for causing autism," he said.
In general, the researchers argue, the cumulative effects of mercury impair brain development and damage the child's immune system and gastrointestinal tract, resulting in hypersensitivity to toxic environmental substances.
This build-up could lead to autism or a form of mercury poisoning - whose symptoms are similar. In addition, researchers believe, the MMR triple vaccine, usually given at 18 months to two years, could trigger autism because the damaged immune system cannot cope with three live viruses at once.
Only some children exposed to mercury will develop symptoms. Researchers believe this indicates that there may be a genetic predisposition. This theory was reinforced by a study published this month that showed that in 99% of autistic children a family of proteins essential for disposing of mercury and other heavy metals is missing or "disabled".
The proteins, called metallothionein (MT), are the main way in which the body counters heavy metal. The study, by the Chicago-based Pfeiffer Center, a health research institute, found that of 503 autistic patients 499 showed an MT "dysfunction".
The number of vaccinations given to babies and children in Britain and America has increased significantly.
In the United States the number given before the age of two has risen from 8 in 1980 to 22 now.
In Britain in 1970, most children received diphtheria, tetanus, polio, whooping cough and BCG for tuberculosis; about half were also immunized against measles. In 1972 rubella was added; MMR in 1988, Hib (Haemophilus Influenza type b), against a form of meningitis in 1992, MMR as a second dose in 1996, and meningitis C in 1999.
The MMR first dose is given between 12 and 15 months, with diphtheria and tetanus and the second dose of MMR at three to five years.
MMR does not contain thiomersal, though other child vaccines do. Thiomersal was introduced in the 1930s as a preservative and went into common use without review by America's Food and Drug Administration (FDA) because it was assumed to be safe.
In America, researchers found some infants who are being vaccinated using multidose vials with thiomersal can receive 62.5 micrograms of mercury per visit.
This is 100 times more than the intake considered safe for the average six-month-old by the US Environmental Protection Agency.
In June 1999 the FDA discovered that: "Infants who receive thiomersal-containing vaccine at several visits may have been exposed to more mercury than recommended by Federal guidelines." The following month the European Agency for the Evaluation of Medicinal Products (EMEA) issued a statement saying: "Cumulative exposure to ethylmercury [found in thiomersal] . . . could lead to a potential cause for concern."
In May last year, a scientist from the US Centers for Disease Control and Prevention (CDC) gave a presentation, based on a study of the Vaccine Safety Datalink Project - a database of 400,000 children - with evidence of harm. Dr Thomas Verstraeten of the CDC found the screening analysis suggests "statistically significant associations" between certain neurologic developmental disorders - such as attention deficit disorder, and speech and language disorders - and exposure to mercury from thiomersal-containing vaccines before the age of six months.
As a result, the EMEA issued another statement last June, saying: "For vaccination in infants and toddlers, as a precautionary measure it would be prudent to promote the general use of vaccines without thiomersal. Moreover, the use of thiomersal-free vaccines should be recommended for newborns."
Neither of these EMEA statements received national newspaper publicity in Britain, and at least 10 thiomersal-containing vaccines for children are still in use as drug manufacturers are permitted to finish stocks.
Jane Maroney El-Dahr, an immunologist at Tulane University medical center in New Orleans, said: "It is important for me to emphasize that the message is not to not vaccinate children, but to make sure that vaccines are thiomersal-free."
The health department said: "Thiomersal has played an important role as a preservative in vaccines.
Because thiomersal contains mercury, both European and American regulators have recently recommended that vaccine manufacturers phase out its use wherever possible as a precaution. They have not recommended the withdrawal of any vaccines.
Dr. Mercola's Comment:
Imagine that, giving a newborn baby a substance that is highly toxic to the central nervous system.
I have seen hundreds and hundreds of autistic children and have reached the conclusion that many, certainly not all, had the root cause of their illness the hepatitis B vaccine they were given on their first day of breathing air.
The central nervous system of a newborn infant is particularly susceptible to toxic influences. This is one of the reasons why the hepatitis B vaccine is such a problem. If it were given later in life, like many other countries do, it would not be as much of a problem.
This is especially tragic as there is virtually no legitimate indication to give this vaccine at birth. The only infants that may benefit are those born to women infected with hepatitis B.
PAROXETINE, SUICIDE AND PLACEBO
PAROXETINE, SUICIDE AND PLACEBO
The Seroxat/Paxil story is far from over, in spite of the monumental
admission this week by GlaxoSmithKline (GSK) that depressed adults treated
with paroxetine might be six times more likely to exhibit suicidal
behaviour than matched adults treated with placebo. There is a whole new
chapter to be written, but it will take more than this to sort out the
underlying problem: the management of drug health and safety issues is in
some ways intensely poor.
Charles Medawar This new, improved analysis of the risk of
adult suicidality is mostly of data from clinical trials conducted 10 years
ago or more. The main thing new is that this was the first independent
analysis based on a blinded re-evaluation of the raw data. When the UK drug
regulators, the MHRA, ran their 'independent' investigation of SSRI
antidepressants, in 2003-4, they relied not on the raw data, but on
summaries and analyses the manufacturers had prepared.
The limitations of this approach are evident from our on-going
correspondence with the MHRA about the true nature of the so-called
'placebo suicides' reported in paroxetine-versus- placebo clinical trials.
Briefly, both the MHRA and the European regulators (EMEA) accepted the
company's claim that, in these trials, three people on placebo committed
suicide, compared with only one person on paroxetine. This was a key
finding and central to the regulators' enquiries, but an inherently
implausible result. Moreover, it was based on brief summary evidence
provided by a company then (and still) under investigation for suspected
concealment of related evidence. Nevertheless, EMEA, the MHRA and its
Expert Working Group saw no need to examine the raw data.
Those data are now in the public domain and they demonstrate that
the three 'placebo suicides' were no such thing. Now it is up to the
regulators to respond to our complaint that they have systematically
deceived others as well as deluding themselves.
Meanwhile, the enormity of GSK's recent admission has yet to sink in
- as it was clearly never meant to do. How long will take for the media to
recognise that the risk of suicidal behaviour in depressed adults on
paroxetine - officially and emphatically denied for many years - may be
twice as high as the risk for children? So far, the media have been thrown
right off the scent, led to believe that this new finding is just a blip
that mainly reflects the sensitivity of young adults - and therefore just a
firmed-up result of a risk that was very tentatively trailed by the
MHRA / EMEA a couple of years ago:
"There is no clear evidence of an increased risk of self-harm and
suicidal thoughts in young adults of 18 years or over. However, given that
individuals mature at different rates and that young adults are at a higher
background risk of suicidal behaviour than older adults, as a precautionary
measure young adults treated with SSRIs should be closely monitored."
(Expert Working Group report, p. 119)
In fact, GlaxoSmithKline made no statement to prescribers in the UK,
but left it to the MHRA and the Commission on Human Medicines - the parrot
that rose from the ashes of the CSM. "What is the issue?" asks the Chairman
of the CHM: "The MHRA has been made aware of a new analysis of Seroxat
clinical trials which suggest that adults, particularly young adults with
depressive illness, may be at increased risk of suicidal behaviour when
treated with Seroxat." The thrust of the MHRA/CHM alert statement was that
their 18-month 'expert', 'independent' investigation of SSRI
antidepressants (2003/4) had been up to scratch:
"I am writing to inform you about the new analyses of paroxetine
clinical trials that are being published by the manufacturer of Seroxat,
GlaxoSmithKline .These new analyses examine the risk of suicidal behaviour
in clinical trials in the adult population, and were conducted as part of a
review by the US FDA. The new analyses highlight the importance of
monitoring all patients treated with SSRIs for worsening of their symptoms
or mood changes but do not alter the prescribing advice for SSRIs issued in
December 2004 following the review by the CSM Expert Working Group on the
Safety of SSRIs."
Here is a fine example of the Conspiracy of Goodwill at work -
everyone united around a seemingly altruistic cause, but also for ulterior
and self-interested motives. The underlying theme here is that that failure
to treat depression is potentially far more dangerous than the drugs
themselves might prove to be - and therefore that bad news about drug
treatments for depression should so far as possible/credible be suppressed.
There is of course some truth in this, but it is much less than half
of the whole. Yes, some people swear by paroxetine and other
antidepressants and have found them hugely enabling and indispensable. On
the other hand, the evidence clearly shows that two-thirds of all
prescriptions are written for 'mild' depression - and only about 3% for
'severe' depression - yet there is no good evidence that antidepressants
are effective when depression is 'mild'. Most people prescribed
antidepressants therefore have no expectation of benefit, but run
It only prolongs the agony - and compounds the impression of
regulatory incompetence - that the MHRA / CHM / CSM and EMEA refuse to warn of
15 May 2006
For every pill they invent another ill by Mary Wakefield
For every pill, they invent another ill
By Mary Wakefield
It had never occurred to me, before last week, that big pharmaceutical companies might actually be evil. I knew they could be a bit iffy - bribing doctors, failing to mention horrible side-effects, fudging the science - but I always imagined them to be fundamentally well-intentioned.
On Monday I read a new book, Selling Sickness, by an American journalist called Ray Moynihan, and am determined never to be so naive again. Drug companies, it turns out, are not on our side at all. They're misanthropic on an epic, Bond-villain scale. Instead of looking for ways to defeat illnesses, they spend their time trying to create them. Instead of selling cures to the relatively small pool of sick people, they find it more profitable to convince healthy folk that they are unwell. It's creepy and, in a sick way, it's also rather brilliant.
Here's a textbook example of how the disease-mongering works, courtesy of GlaxoSmith Kline. A few years ago, GSK needed to find a new application for one of its anti-depressants, Paxil, in order to extend the patent. What to do? Easy - invent an ailment for it to cure.
They found a brief mention of a little-known nervous condition - Social Anxiety Disorder - in a psychiatric journal somewhere, and hired a PR firm to turn it into a star. The symptoms of SAD - feeling nervous, sweaty, shy at parties - don't amount to much more than the symptoms of being alive, but it was marketed with a serious ad campaign and a catch-phrase: "Imagine being allergic to people."
The PR company rounded up patients, experts, a celebrity sufferer and then presented the SAD story to the press. A new disease? With a famous name? How could an editor could turn it down. The New York Times ran a long, serious feature and American Vogue followed suit.
Instantly, of course, thousands of people decided that they suffered from SAD. Doctors prescribed Paxil, GSK thrived and the PR company won an award for "Best PR Programme of the year".
All week I've been rootling around on the internet, finding out about disease-mongering, and from what I can gather it's a growing, multi-billion-dollar business across America and Europe. Drug companies invent and publicise new "lifestyle disorders" every day, and the public obligingly develop the symptoms and pop the pills.
As all hypochondriacs and pharmaceutical companies know, you only have to read a list of unpleasant symptoms to begin to suffer from them. It's the reverse placebo effect. Once a big drug company has wheedled a disease into the papers, they've as good as sold the cure.
On Wednesday, a PR girl called Charlotte cold-called me to enthuse about vodka. "It's a new brand called Diva," she said. "It's the world's most luxurious drink. Each bottle costs up to £20,000."
Charlotte sounded friendly and so keen to share the exciting news that I stayed on the line and chatted. What do I get for my twenty grand? I asked. "Well," said Charlotte, lowering her voice, "it's a very special product. Each customer tells the vodka company what their favourite precious stones are, and then the vodka is filtered through them into the bottle."
Does that make it taste different? "No," said Charlotte. Then she perked up, "but it looks pretty. I'll send you the press release then you can read all about it."
She did, and I discovered that Diva vodka is by far and away the most fabulously silly product I have ever come across. Each gem is apparently placed inside the bottles by hand by a team of men and women with severe disabilities. "Due to the colours and the vibrancy of the gems, this will be stimulating work," says the press release. "The disabled adults will work only with their favourite colours and every bottle of Diva will have a signature gem from the person who filled it."
There's not much of a bright side to New Orleans at the moment, but the odd cheering fact does leak into the papers. My colleague Dot Wordsworth points out in this week's Spectator that for New -Orleaneans, a sidewalk is (or was) a banquette. And it makes me very happy every day when I remember that the man in charge of the city's cops is called Police Superintendent P. Edwin Compass III.
- Mary Wakefield is assistant editor of the Spectator
This is the real Drug Abuse by Jacky Law
It's a medical scandal. The pharmaceutical giants are making billions by persuading us we have illnesses that only their products can cure.
This is the real Drug Abuse
by Jacky Law
Drugs companies commonly sponsor patient self-help groups, which help spread the word about drugs via the internet and other media. Then again, examine the treatment of depression.
When GlaxoSmithKline's anti-depressant drug, Paxil (called Seroxat in Ireland) was approved for the treatment of general anxiety disorder (GAD) in the U.S. five years ago, very little was known about the condition. Only one in a 100 people in the U.S. was diagnosed with it each year.
But at the time of the drug's launch in April 2001, news reports suggested that as many as ten million Americans were suffering from an unrecognised disease that had symptoms such as restlessness, fatigue, irritability, muscle tension, nausea, diarrhoea and sweating.
On the same day, a patient group called Freedom from Fear released details of a telephone survey which revealed that 'people with GAD spent the equivalent hours of a full-time job' worrying.
Surprise, surprise - the media contact for the survey was an account executive at GlaxoSmithKline's PR firm.
GAD is not the only condition that the drug is licensed to treat. Indeed, most Prozac-type anti-depressants are used for a whole range of conditions such as painful periods, depression, panic attacks, irritable bowels, incontinence, shyness or social anxiety - anything, in short, that has some kind of anxiety at its root. Critics say the truth is the drugs are a triumph of branding which cynically play on people's morbid fear that there must be something wrong with them.
U.S. bioethicist, Carl Elliot, says if a company is the sole manufacturer of a drug which tackles social anxiety disorder, it is clearly in its interest to broaden the definition of the disorder.
Indeed, Paxil's product director, Barry Brand, confirmed this attitude when he told the magazine Advertising Age: "Every marketer's dream is to find an unidentified or unknown market and develop it. That is what we were able to do with social anxiety disorder."
Of course, in some cases, these conditions are real sources of suffering and drugs clearly have a role to play. But the public are not necessarily best served by products which only deal with the symptoms rather than the cause and which marginalize all non-pharmaceutical approaches.
A former editor of the New England Journal of Medicine, Dr Marcia Angell, has pointed out how the diagnostic criteria for 'abnormal' levels of blood pressure, cholesterol, obesity and bone density have all changed over the years to expand the markets for disease. This is a long and sophisticated process but it essentially involves drugs companies conducting studies into the dangers of, say, high blood pressure, and then pushing for revised guidelines on what is safe, thus creating a new market of patients who need treatment.
Human metabolic syndrome is another area that has been exploited by the drugs companies. It covers a cluster of common disorders, such as obesity, high cholesterol and raised blood pressure.
Not recognised before 1998, it is now said to be approaching epidemic levels with no less than 115 million sufferers world wide and each component part is an example of 'disease' being a much more fluid concept than one might have supposed.
High blood pressure (hypertension) was once defined as blood pressure above 140/90. An expert panel then introduced something called prehypertension in 2003, which embraces readings between (120/80 and 140/90).
"Overnight, people with blood pressure in this range found they had a medical condition," says Dr Angell.
But it is the cholesterol-reducing drugs market that best shows how the boundaries have changed. The drugs lower levels of bad cholesterol and have been shown to prevent heart attacks and save patients' lives.
Collectively, they earn more than 24billion euros a year and companies compete intensely for a greater share of this market. As they do studies to show the value of their drugs, miraculously, the cut-off point for high cholesterol has gradually lowered. "Once it was reserved for blood cholesterol levels over 280mm per deciliter," says Dr Angell. "Then it fell to 240. Now most doctors try to knock it down to below 100".
Because the patents on all drugs eventually expire, new heart drugs to raise levels of good cholesterol are being developed. Their success will be partly determined by how much 'normal' levels of good cholesterol can be raised.
The idea that people's health is not as good as it ought to be is conveyed in surveys that show what is normal and what is not.
Ray Moynihan, an Australian journalist, who has examined the issue of drugs firms 'inventing' diseases to boost their profits, looked into another tactic used by pharmaceutical companies - questionnaires.
They are widely issued to the public with the result that people are made familiar with diseases or ailments they never knew existed - and become more concerned about their own health.
One broadly circulated questionnaire produced results which showed that 43 per cent of women sampled thought they couldn't have sex properly.
Intriguingly, Mr Moynihan found the questionnaire's authors had links with Pfizer, which, at the time, was testing Viagra on women. The study had asked 1,500 women, aged 18 to59 if they had experienced any one of a list of seven problems for a period of at least two months over the previous year.
One area concerned a lack of desire for sex and another anxiety about sexual performance. Nothing was asked about the length of the woman's relationship with her partner, which is a major factor in most people's sex live.
In subsequent trials, the women given Viagra reported an improvement in their sex life - but an even greater improvement was noted by those who were given a placebo.
Nevertheless, surveys such as these have resulted in female sexual dysfunction being established as a disease and many lucrative treatments are in the pipeline to deal with it.
But such drug products totally disregard the existence of alternatives such as bunches of flowers and other token of appreciation that have improved women's sexual responsiveness over the centuries and which can work out better and a lot more cheaply.
But of course, these sensible solutions don't sell drugs.
Daily Mail, 13th April 2006
Jacky Law is the author of Big Pharma:How the World's Biggest Drugs Companies Control Illness