Robert Whitaker doesn't mince words in arguing that the American medical establishment has failed in its treatment of people with schizophrenia in his new book, "Mad in America" (Perseus; 304 pages; $27).
The book's subtitle lays out his scorching indictment: "Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill."
"Why should living in a country with rich resources, and with advanced medical treatments for disorders of every kind, be so toxic to those who are severely mentally ill?" Whitaker writes in the book's preface.
The answers he finds are harrowing. Whitaker describes early methods of controlling the insane by removing teeth, ovaries and intestines; dunking them in freezing water; spinning them on mechanical devices until they grew weak and nearly passed out; electroshock therapy; forced lobotomies; and the assault of so-called miracle drugs such as thorazine with dangerous side effects and poor results. Whitaker, 49, a former Times Union medical writer who now lives in Cambridge, Mass., expanded a 1998 series of articles he co-wrote for The Boston Globe that received a prestigious Polk award for medical writing and was named a finalist for the Pulitzer Prize.
"This book is the result of a long educational process, in which I've learned that money plays a big role in influencing medical treatment and the public doesn't get the whole story," Whitaker says by phone from Cambridge.
Bolstered by a historical overview of horrific methods used to restrain the insane across the United States in the 19th and early 20th centuries, Whitaker builds to a crescendo of outrage against large pharmaceutical companies and their tactics in the 1980s and 1990s to capture a lucrative market for new antipsychotic drugs.
Whitaker shows how "big pharma," as it's known, skewed clinical trials, obscured dangerous side effects, hired sham scientists to report results and encouraged patients to take powerful drugs that increased their delusions as fodder for research.
While Whitaker's book has come under attack by some psychiatrists and those who work for the drug multinationals he criticizes, advocates for the mentally ill have praised the work.
David Oaks, director of Support Coalition International, an advocacy group for people with mental illnesses, called Whitaker's investigation "a dose of truth therapy" about the "secret underside of the psychiatric establishment."
Whitaker, who was assigned the medical beat after joining the Times Union in 1989, didn't start out looking for trouble.
"At first, I wrote a lot of gee-whiz, pro-science pieces," Whitaker says. "But then I started seeing how the bottom line really drives medicine and that a lot of fabrications were being woven around clinical trials to protect profits."
Whitaker wrote an award-winning series at the [Albany, NY] Times Union in 1992 about bungled operations by inadequately trained surgeons. That led to a Knight Science Journalism Fellowship at the Massachusetts Institute of Technology in 1993.
He returned to the Times Union briefly in 1994, but left later that year to become director of publications at Harvard Medical School. He departed Harvard to start up Center Watch, a journal that covered the business of clinical trials in the development of new drugs.
"That's when the influence of corporate money on the process and science of testing drugs became painfully clear," Whitaker says.
Using investigative journalistic techniques, Whitaker exposed a drug research corporation that was employing Enron-esque subterfuge to hide losses and inflate earnings. Whitaker's reporting helped eventually to send the president of that failed company to jail.
Whitaker honed his research skills and developed a thick skin at the helm of Center Watch. "I had a lot of angry CEOs screaming at me and threatening lawsuits because negative publicity caused their stock price to drop," Whitaker says. "Our badge of honor among analysts was that we weren't just an industry mouthpiece."
An article for Fortune magazine about Zonagen Inc., a biopharmaceutical company that produced a drug for male sexual dysfunction, received the National Association of Science Writers' award for best magazine article in 1998.
"We laid out how the public was being misled about the drug trials to pump up the stock price," says Whitaker, who co-wrote the story with Fortune staff writer David Stipp.
That same year, Whitaker sold his stake in Center Watch to devote himself to researching and writing "Mad in America," his first book.
During his Center Watch days, Whitaker stumbled upon psychiatric research in which American scientists gave the mentally ill chemical agents intended to heighten their psychoses. More digging revealed that outcomes for people with schizophrenia in the United States have actually gotten worse in the past 25 years. Schizophrenia outcomes in developing countries such as India and Nigeria are better than in the United States.
Whitaker's main goal in writing "Mad in America" was to take a fresh look at the suffering of more than 2 million Americans diagnosed with schizophrenia and to spur a national debate about how best to bring them relief.
The Times Union (Albany, NY)
March 3, 2002 Sunday