153. Uncovering The Greatest Mental Health Fraud In American History w/ Robert Whitaker
Roger K. McFillin, Psy.D, ABPP (00:01.31)
Welcome to the Radically Genuine Podcast. am Dr. Roger McFillin. In an era where truth often seems obscured by a fog of corporate interests and institutional power, the work of independent journalists and ethical practitioners becomes a beacon of light during these dark times. These intrepid seekers of truth stand as the last line of defense against the tide of misinformation that threatens to engulf us all.
Today we find ourselves facing a crisis of epic proportions in the field of mental health. One that strikes at the very heart of scientific integrity and public trust. Despite mounting evidence of widespread fraud and misconduct in antidepressant research, an alarming number of medical professionals continue to operate behind what can be only described as a pharmaceutical iron curtain.
Every day, countless patients are prescribed powerful psychotropic drugs based on studies now known to be manipulated and misleading. This is not merely academic dishonesty. It's a betrayal of public trust with potentially devastating consequences for millions of lives. The story of how antidepressants came to dominate the mental health landscape is one of corporate greed, scientific malfeasance, and regulatory failure.
It's a tale that desperately needs telling and one that cuts to the core of how we as a society approach mental health and human suffering. In times like these, we owe a debt of gratitude to those rare journalists who dare to challenge the status quo, who risk professional ostracism and personal attacks to bring hidden truths to light. Their courage and commitment to uncovering the facts, no matter how uncomfortable or inconvenient, serve as a vital safeguard for public health.
democratic values and medical freedom. Today, we are honored to speak with one such journalist, a man whose relentless pursuit of the truth has shed light on one of the most pressing medical controversies of our time. I'm honored today to have Robert Whitaker on the podcast and American journalist and author who has won numerous awards as a journalist covering medicine and science, including the George Polk Award.
Roger K. McFillin, Psy.D, ABPP (02:23.018)
for Medical Writing in the National Association for Science Writers Award for Best Magazine article. In 1998, he co -wrote a series on psychiatric research for the public globe that was the finalist for the Pulitzer Prize for Public Service. His first book, Mad in America, was named by Discover Magazine as one of the best science books of 2002. Anatomy of an Epidemic?
won the 2010 investigative reporters and editors book award for best investigative journalism. He is up. He is the publisher for Madden America. Many people are quite aware of his work. I hope I'm introducing others around the globe to him for the first time. Robert Whitaker Welcome to the radically genuine podcast.
Robert Whitaker (03:09.982)
Well, thank you for that very nice and generous introduction. It's a pleasure to be here.
Roger K. McFillin, Psy.D, ABPP (03:15.614)
Glad to have you. I first, let's just start off. There might be listeners who are not familiar with you or your work. So if you can just share a bit about your professional background and really how you became what I think is the preeminent critic of contemporary psychiatry.
Robert Whitaker (03:31.296)
Thank you. Yes, I have a very conventional background in terms of how I came to this, you know, to start writing about psychiatry. So I was a newspaper journalist for a number of years. And then eventually within that career, I was moved to the beat of covering medicine and science, which I did for a number of years. Now, I was doing that at the Albany Times Union newspaper. And I have to tell you, one of the things I was writing a lot of features.
And a lot of what you do when you're a features reporter covering medicine and science is you sort of celebrate those two, you know, findings in those two areas. However, I did in early 1992, I began changing my coverage and my thinking, and it was because I did a series on the introduction of laparoscopic surgery for gallbladders. Now, it's always done that way today, okay? But at the time, they screwed it up.
the introduction because the doctors did not get proper training. Why didn't they get proper training? Because there was this competition among medical centers to be the first to have this new way of doing surgery. Plus the makers of the laparoscopic tools would run these weekend training camps where certain surgeons would go, do it on a pig and then come back and do it on a human being and they botched it. There was a number of deaths in New York State.
related to this introduction of this therapy. And what I learned there was the financial influences affecting medicine because there were stocks being sold and stock prices going up by the laparoscopic makers of those tools and this competition of medical centers to be seen as on the cutting edge of science. So all of a sudden I began seeing medicine is not just this pure science, but it had this financial influence.
Go forward, I eventually had a brief time as director of publications at the Harvard Medical School. I had left daily journalism. Now this was interesting for this reason. This was in the mid 1990s real briefly. And at this time was when evidence -based medicine was all the rage. It was being introduced. We sometimes think, evidence -based medicine has always been with us. This idea that clinicians, doctors and others have to follow the evidence really became a...
Robert Whitaker (05:53.93)
under a new wave in the early 1990s, okay, became a term applied. Now, one of the ideas about evidence -based medicine is that doctors can be deluded about their merits of their therapies and you have to have this third party look at things, okay? So, the reason I mention this is, this put me in a position of thinking that...
Doctors can say something is helpful, but maybe it really isn't if you really look at the evidence. it made me not just trust what the experts were telling me, but also what you could be finding in the scientific literature. Now, I actually had no interest in psychiatry per se. My next stage was this. I co -founded a company called CenterWatch. And CenterWatch, looked at the commercialization. Believe it or not, most of our customers were either
doctors or pharmaceutical companies. And what was happening in the late 1990s, even before this, is pharmaceutical companies to get their new drugs approved, rather than hire independent doctors who would design the trials, test the trials, write up the studies, they now had commercialized the testing of new drugs. You had something called contract research organizations. The pharmaceutical companies would...
Robert Whitaker (07:14.768)
They would be the ones that design the protocols, analyze the data, either they would or these contract research organizations, and they basically would write up the results and they would have the academic doctors just sign their name as authors. we had, I co -founded this company that was just looking at this change from an academic enterprise into a business enterprise. It was called CenterWatch. And while writing about that, it became evident that the
testing of new drugs was no longer a scientific enterprise, it was a commercial enterprise, was done, they were designing trials to make the new drugs look good rather than to really test their efficacy and safety. doctors were being, the authors were being paid a lot of money to do this. So this became an experience over a four year period, which I became aware of the way that clinical tests of new drugs were
Commercial enterprises, they were marketing enterprises rather than scientific enterprises. by the way, we got threatened with lawsuits for making this known, but where was the biggest, where was the most visible example of this commercialization? It was within the trials of new psychiatric drugs, the antidepressants and the antipsychotics. So that's I got interested in psychiatry because of that corruption.
and by the way, you would see trials in which the new drugs were being hailed as breakthrough medications, and you could do a freedom of information request and find out that people had died on the drug in the trial, on suicides, and that was never mentioned. Anyway, did make a, I'm obviously going on at some length here, but the important thing is here is I didn't start at this as a critic of psychiatry.
I started at this as wanting to know the evidence base and becoming a critic of the commercialization because I saw it was corrupting the science. And then finally what happened though was this. I did a series for the Boston Globe, which you mentioned was a finalist for Pulitzer Prize in Public Service. I still had a conventional understanding of psychiatric drugs that say for example, antipsychotics.
Robert Whitaker (09:39.798)
they fixed a dopamine imbalance in the brain, okay? And my understanding was because of that, and that's what all the experts told me, that these drugs were absolutely essential for people diagnosed with schizophrenia to stay in those drugs for life, okay? That was my understanding. And one part of the series, in fact, where we were looked at studies in which they had withdrawn antipsychotics from schizophrenia patients to see how quickly they would relapse.
And we said in our series that was unethical because I had been told the drugs were like insulin for diabetes. You would never withdraw insulin from a diabetic to see how fast they became sick again and what were the consequences. So I still, even though I had this sense of corruption within psychiatry on the new drugs, I still believed this larger story about chemical imbalances and drugs fixing chemical imbalances.
Two things happened that made me doubt that story of, and by the way, just to do this, that story of chemical imbalance is a story of great medical progress. Think about what it's telling us. It's telling us that they had discovered the very molecules that cause madness, the very molecule that caused depression, and they could fix it. But while doing that series for the Boston Globe, here's what happened. I came upon two studies that belied that story of progress, and then I got a,
a book contract to write more about what these two studies told about. What were the two studies? One was a study done by Harvard researchers published in 1994 in which they looked at recovery rates over a long period of time in the past century for schizophrenia patients. And what they found was, A, recovery rates for schizophrenia patients had actually declined in the last 20 years in the Western world, in the US and Western world.
and were now no better than in the first third of the 20th century. So we had been told the story of progress, but what the data was saying, there was if anything, things were getting worse. And here was the second kicker. They had twice done studies comparing outcomes. This was the World Health Organization, by the way. Twice done studies comparing outcomes in three developing countries, India, Colombia, Nigeria, for schizophrenia patients, compared to outcomes in the US and other developed countries.
Robert Whitaker (12:05.748)
And one study was two years in length. One was five years in length. The first one was five years in length. And they came to the astonishing conclusion that outcomes were much better in the developing countries. So much so they said that living in a developed country is a strong predictor that if you're diagnosed with schizophrenia, you'll have a bad outcome. Now, and I'm almost done with this long -winded answer, but, then they do the second state and they hypothesize.
Maybe the reason for the better outcomes in the developing countries is that people are more medication compliant. It's a valid hypothesis if the drugs are so essential. So they measure outcomes in the develop, I mean, they measure medication use in the second study. And here's what they found. In the developing countries, they use the drugs acutely, but not chronically. Only a very small percentage were kept on the drugs long -term where of course that's the standard of care in the United States. All of which to say is,
Once I investigated those studies, found out what was really in them, I said, something's wrong with the narrative of progress that we are being told about advances in psychiatry. And that's what I investigated in Madden America. And that's what got started was that we as a society were in some way organizing our thinking around a false narrative of progress.
Roger K. McFillin, Psy.D, ABPP (13:31.21)
Well said. And so that's really important that this story be told about how the narrative was originally created. I want to start, we're going to start with depression and the use of SSRIs. This goes back to 1987. Fluoxetine, which is known as Prozac, was brought to market, approved by the FDA. Kind of starts there. You and I are of a similar era, so we've been able to see the shift in how we
think about and talk about mental health from the 1980s into the 90s and then explodes through the 2000s. Let's go back to 1987. What do we know about Prozac? What's it supposed to be doing? And how does it get approved by the FDA?
Robert Whitaker (14:20.856)
The story of Prozac is a story of marketing, of course. We're starting to hear from psychiatrists that they have discovered that depression is due to a chemical imbalance in the brain, low serotonin. Now we can go into this. They never made this discovery. And they knew that there was this mechanism of action by fluoxetine in which it blocked the normal reuptake of serotonin into the presynaptic neurons, so it ups serotonergic activity.
So that gave them a marketing story. They said, we're discovering that depression is due to too little serotonin, and now we have a drug that fixes that, brings it back into balance, and it's like insulin for diabetes. So that's a marketing message. That is a story of an incredible advance. And next thing you know, fluoxetine is released, and it's been a breakthrough medication. You have 60 minutes.
Prozac is put on the cover of magazines, okay, as a breakthrough medication, and it has this very simple sound bite used to sell it. It fixes a chemical imbalance in the brain, and that fits into a larger narrative that we all believe in, or not all believe in, but it's of magic bullets, and advances in medicine and science, and advances in understanding the brain. Now the problem was, first of all,
If you actually talk to the researchers, they would admit at this time that the low serotonin theory of depression wasn't panning out in fact. That's number one. Number two, if you actually go into the documents, there were all sorts of problems starting with the animal studies about adverse effects, sort of inducing mania, inducing psychosis was shown in the clinical trials.
So much so that if you look at the data in Germany, they concluded that this drug is wholly unfit to be an antidepressant. Because it, by the way, did not show to be any more effective in reducing symptoms than the old tricyclics, by the way. If anything, imipermine was better and it had this serious adverse side effects.
Robert Whitaker (16:33.826)
But that's not the story that was told to us. The story that was told to us was a story of a great medical advance. We heard about breakthrough medications. And then what you, and we can talk about what were the dual forces behind that storytelling. But then what happens in the 1990s, you get these PR campaigns. Now the PR campaigns are actually funded by the makers of the SSRIs, starting with Eli Lilly.
in which they give money both to the NIMH and to individual doctors who are now working for them, academic psychiatrists with prestigious appointments at prestigious universities. They come to us as professors of psychiatry from prestigious universities, but what was really happening is they were serving as, quote, key opinion leaders or key thought leaders for the drug companies, which means they were making all sorts of money to tout new drugs and build
markets for these new drugs. So what happens in the 1990s? They start running PR campaigns to get people to understand, understanding quotes, that depression is due, it's a biological brain disease, it's not what happens to you, it's not a psychological response to difficulties in life, and it's chronic. Okay, before, in 1987 I think it was, or 85, the NIMH did a survey and they asked people,
If you're depressed, what will you do? And you know what most people said? depression will pass with time. It's episodic. And I just need to talk to my friends and maybe my pastor, make changes in my life. And the NIMH and the American Psychiatric Association said, we need a campaign to change that thinking so people understand that depression is a brain disease. It's chronic. And therefore you need to take...
antidepressants and it's a miracle drug. You'll be better than well. You know that was a book that came out by Peter Kramer and it says you will be better than well. And here's the most ironic part in a way. If you look at the data, it wasn't very effective of fluoxetine, had all sorts of adverse effects. And German regulators said this drug is this compound is totally unfit as a treatment for depression. What are we here?
Roger K. McFillin, Psy.D, ABPP (18:32.436)
Yeah.
Robert Whitaker (18:51.786)
researchers are so great in understanding the brain now, the real worry is we can give you a designer population. In other words, a designer personality, whatever personality you want. If you're shy, we can make you outgoing. And there was even some hand wringing over, do we really want a population where everyone is always happy all the time? That's how insane this time was. But all you have to see was it was a marketing triumph. And they did this PR campaigns where they would do screening.
screening campaigns, to screen for this chronic disease, get this miracle drug, and we changed our thinking. We came to believe that antidepressants fixed a chemical imbalance in the brain. That's what happened.
Roger K. McFillin, Psy.D, ABPP (19:35.686)
Arguably the most influential marketing campaign in history. I mean, you make some really great points about the shift from depression being episodic, potentially even something that is transformative, that it is, it reflects that there are things in your life you're going to have to face and even overcome as a gift to now something that you'd externalize that only a doctor
can diagnose, which was that famous Zoloft commercial, the blob. Only a doctor can diagnose depression. Now there's a great book out there by Dr. Peter Bregan, it's called the Anti -Depressant Fact Book, which described how through his own work, through the discovery process in product liability cases,
Robert Whitaker (20:10.424)
Right.
Roger K. McFillin, Psy.D, ABPP (20:28.906)
about how this drug really actually even came to market. In a scientific, safe, and just society, this drug is never approved by the FDA. And people assume that because it has FDA approval, a couple things are true. It's been proven to be effective. So there's strong efficacy that it outperforms a placebo. And that it's safe, and somehow it's been studied long -term. But what we know is those industry -run trials,
We're short term, as well as there's a lot of games that the pharmaceutical companies play just to get their drug to have the illusion that it outperforms a placebo.
Robert Whitaker (21:11.882)
Yeah, I think this is really important to understand. We see the FDA as making an informed decision, a careful decision, that the drug is safe and effective. And we think effective means if you don't get the drug, you don't get better, but with the drug, you get better. It's a binary type thing. Well, first of all, that's not the effective standard, the efficacy standard within...
the FDA and say with the antidepressants if you look at it. First of all, you design the trials in a group of people most likely to respond to the drug. Okay, so you use exclusion criteria for people who have any suicidal intention and the antidepressants have comorbidities. You try to find a very clean group. Okay, that's the first thing you do. Now, the second thing is they're not tested against placebo.
What happens is you take people generally on the drugs already, that's who's entering these things, and you withdraw everyone, okay? Often abruptly so, it's called a washout period. Now what you do is you randomize people either back to drug or you randomize to placebo. So the placebo is a group really going through withdrawal from antidepressants. So it's not even, it's not really...
A real placebo group would be a medication -naive group. That's not what you're doing and it would be done in first episode patients. That's not what you see in industry drug trials. So that's the first thing to know. But the FDA says that's okay. That's number one. And they consider this a placebo group. Second, it's not that the drug really outperforms it, that no one gets better in the placebo group because they do, even though it's a drug withdrawal group. And all you have to
do to meet an efficacy standard is to find two trials, and you can run three, four, or five trials that are negative where the drug doesn't work. But as long as you can show a slightly greater diminishment of symptoms on the HamD scale, then your drug is efficacious. Even though that difference on the HamD scale between the aggregate outcomes between the drug group and the...
Robert Whitaker (23:30.296)
placebo group isn't even clinically noticeable. And even if, by the way, more than half the people aren't even responding to the drug, as long as you have a little bit more remission of symptoms, greater reduction of symptoms, even if it's not clinically meaningful, and even if you had to run several studies to get that results, the FDA will say, okay. And there are documents, and I need to say something, give a hat off to Peter Bregan here. mean, Peter Bregan, because he...
was so often the expert witness in these trials, he got access through the discovery process to these documents that told of all the real results, et cetera, and he made those known.
So in the phylloxidine trials, you don't see anything better than amyloidine. You barely see them beating placebo. And by the way, in the documents, if you have to hit a test, to say, you even have reviewers going like, we don't really know that much about this drug. What are going to be the long -term outcomes? We have no idea. And actually, our standard for approving drugs is pretty pathetic. But we're going to go ahead and do it.
And now with fluoxetine, there's another kicker here. There were something like 52 patients that developed psychosis or mania on the drug, okay? Which is a bad adverse effect. Now when the FDA gets that, they say, this could kill our approval of this drug. And then they work with the Eli Lilly to basically hide or hide that
adverse effect to re - and they get re - re characterized as return of the disorders basically the way it's it's hidden.
Roger K. McFillin, Psy.D, ABPP (25:19.114)
From my understanding is the drug got approved first and then the FDA was overwhelmed with calls about some dangerous responses to the drug. And then this is the time where now George Bush the first is in office and Dan Quayle is his vice president. And George Bush used to be a board member, served on the board of Eli Lilly, and Dan Quayle was from the state of Indiana.
where Eli Lilly was located and they had a number of members on their staff who formerly worked for Eli Lilly. And so they wanted to kind of reopen an investigation into with the patient data from the original Prozac approval. And they found that Eli Lilly executive hit a report that demonstrated 38 % of Prozac patients experienced these stimulating effects.
nervousness, anxiety, agitation, insomnia, all the way to becoming suicidal. That was hidden. And in order then to actually get the drug to outperform a placebo, they started adding in a benzodiazepine from what I understand. So I want to make sure that the audience understands the games that were played just to get this drug originally to market.
Robert Whitaker (26:35.631)
That's true.
Robert Whitaker (26:45.56)
Yeah, first of all, is, this happens, so the drug gets approved in 1987, right? And what you're talking about when this threatened to become known, I think was in 1992, 1991, roughly, because there were suicides and all this agitation. Now let's go back to the testing of the drug. And this goes back all the way to the animal tests, and then in the very early, like phase one and phase two tests, there was this agitation, as you say, which really...
seemed also to be threatening intomania, that sort of thing, manic episodes. So as you said, they said, if this happens in the clinical trials, you can prescribe a benzodiazepine to calm the agitation. Now, you're no longer testing fluoxetine, you're testing the combination, right? And benzodiazepines, as everybody knows, they can sort of chill you out, right? must, et cetera. And there was a later...
court case, and I think Peter Bregan may have been the expert witness in this course case, where someone said, yeah, this addition of benzodiazepines makes the whole testing of fluoxetine scientifically worthless. I'm glad you brought this out. It's been a while since I talked about this. But yeah, even fluoxetine was not tested by itself when they had this way to cover up this adverse effect of agitation, et cetera. And I think
This might even have showed up in the very phase one studies, which are on healthy volunteers, but it definitely showed up by phase two and this is what they decided. Now, maybe my memory is wrong, but I thought there was initially a communication between Eli Lilly. Your larger story of how the government got involved is all correct in 1992 and all those financial pressures. But I thought if I remember correctly in terms of
emails between one of the reviewers and Eli Lilly saying, these particular 52 people in the clinical trial data that show up as psychotic, this is a problem for us. And I thought they worked with them at that time to basically recategorize those case report forms. That's what I think happened. And then it bursts out because of what happens when the drug goes on the markets, just as you say.
Robert Whitaker (29:05.624)
There's all sorts of problems, people being manic, people committing suicide, committing acts of violence. And now it gets brought forward and it becomes a public hearing. what you then talked about is the political gamemanship that involved the FDA that saved Phloxetine's reputation.
Roger K. McFillin, Psy.D, ABPP (29:25.194)
And I was in graduate school throughout the early 19 or throughout the early 2000s. And what you heard all the time was if somebody is provided an antidepressant and Bob, still hear this today and they experience that stimulation effect, even mania, that means they had an underlying bipolar disorder. I still have to correct doctors who come onto my podcast to say, no, that's not true. That's spin. And that's part of the whole narrative here.
about how when you have an adverse effect of the drug, how they can change the narrative to some other underlying mental illness or exacerbation of an additional underlying illness that they now have to treat with more pharmaceuticals.
Robert Whitaker (30:12.088)
So you're really getting into the scope of the betrayal here. And it's not just by the pharmaceutical companies, it's by the American psychiatrists at prestigious universities. So you go back to the 70s. There was an understanding that antidepressants in Memphrabren, for example, could cause a manic episode.
and that this was one of the risks. It would increase the risk that you converted from unipolar depression to bipolar depression. And I think this goes back to the early 80s when you have psychiatrists in United States investigating this or writing about this. And they decide to say, is not... And they even said, maybe we can use antidepressants as a tool for uncovering undiagnosed bipolar.
So they said exactly what you said, rather than causing, inducing psychosis, a drug effect, they said with unipolar patients, what the drug is doing, it's making known, making visible to us an underlying bipolar disorder. And they even talk about maybe we can use antidepressants as a diagnostic tool to see if someone really has bipolar disorder.
But the point is, these people didn't have organic manic episodes, these people with unipolar depression. They didn't have it until they were given a stimulating drug that is shown that can cause mania, can induce mania, etc. But that's an example how the profession, the psychiatric profession in essence, voted to protect its drug rather than to protect the patients.
And now it's well known that antidepressants can induce mania. By the way, there was a big Yale study, I think it was in 1998, looking with fluoxetine, or least the SSRIs. And they looked at unipolar patients treated with antidepressants versus those without antidepressants. And it doubled the risk that a person would convert to bipolar. And the number to harm in that particular study was 24. So one out of 24 patients treated with an antidepressant
Robert Whitaker (32:31.832)
would convert to bipolar who otherwise wouldn't have had a manic episode. Now, think about this. If you have one out of 25, right, and you have a million people given antidepressants, how many people are going to be now newly bipolar due to the antidepressant? Well, it's like 40 ,000 people, right? And so what happens in the 1990s? You see an explosion in bipolar cases.
both among the young and adults given antidepressants with the increased use of antidepressants. So it's an iatrogenic, iatrogenic mean treatment caused, explosion of quote bipolar illness. Now when you get diagnosed with that, that's a very serious state disorder. Now you get mood stabilizers, you often get antipsychotics, you really become a chronic patient.
Roger K. McFillin, Psy.D, ABPP (33:25.706)
1998 comedian Phil Hartman was murdered by his wife in a murder suicide. The was Brie Hartman. What preceded that was her being introduced to the drug Prozac. Her family ended up filing suit against Pfizer, which settled out of court as almost all of these do. And you also start to see unprecedented cultural events like school shootings.
after teenagers have been prescribed these drugs based on these narratives, based on what was created. And still when we look at the late 1990s going into like 2000, before the turn of the century, there's still skepticism out there about the efficacy of some of these drugs. There's the narrative, but they're not widely prescribed in primary care settings like they are now. And in academic circles, there was at least a discussion
about saying, hey, these are approved on very short term industry run trials. We need to know more about what these drugs actually look like in clinical practice. You know, because there's the understanding that the drug companies are trying to get that drug to market. So there's a very selective population, but what about the general population? Right? So there's this trial. And I can't underscore to the audience how important this trial is.
to where we are today. It's called the Sequence Treatment Alternatives to Relieve Depression Trial, the STAR -D trial. I'm gonna hand it over to you to tell this story about why this trial was touted as a gold standard for antidepressant efficacy and still justifies antidepressant drugs today. And then we'll kind of go on and what has occurred over the past 14, 15 years.
Robert Whitaker (35:21.226)
Yeah, this is really worth focusing on. It's a story of extraordinary betrayal, a story of extraordinary corruption. It's a story of extraordinary harm, and it's story of an extraordinary media failure. I want to just go back real quickly to one thing you talking about, homicide and what happened.
The very first case where someone was on Prozac and killed somebody was the Westbecker case. You remember this case, by any chance? Okay, and what happened was it was becoming evident that maybe Eli Lilly was gonna lose this trial and it was gonna be seen as drug induced. What they did is they sent, all sorts of money to the families of people who had been killed by Westbecker to settle the case.
Roger K. McFillin, Psy.D, ABPP (35:51.881)
I've read about it.
Robert Whitaker (36:10.218)
And one of the things was they would hide the fact that there had been all this money paid to settle the case, okay? And that they would be allowed to say that there had been no finding that the drug was the cause of this, okay? So they bought off the defendants in this case. And it was so corrupt that the judge, when he really found out that there was this conversation or this agreement, because the judge wasn't informed about it between the...
Eli Lilly and the plaintiffs, he tried to throw out his own agreement to the assailant. All I'm saying is it goes back to this thing in which there is this corruption in terms of the public narrative to protect the drugs over and over again, which now leads us to the STAR -D trial. Now, when the STAR -D trial was mounted in the early, it begins to be formed in the late 1990s. And why was it formed? What did the NIMH say?
The NIMH said, we really don't know how effective these drugs are in real world patients. That's the first thing, because the industry funded trials are done in a select group of people such that like 85 % or something, 60, 70, 80 % of the ordinary population are not eligible for, because of inclusion exclusion criteria to participate in clinical trials. So they said, this is going to be the study that tells us about real world outcomes. That's number one.
Number two, first of all, over the short term. And then we're to see if we can keep people well. Because as you said, those trials are short term. They're six weeks. But we're maintaining people on these drugs and it's seen as chronic for six months, nine months, 12 months. So does this is a form of care that works? And they said this.
This is so important that the results from this trial will be widely disseminated, immediately disseminated, and will guide our clinical care, meaning clinical care in primary care settings as well. Now, in 2006, you get the publication that summarizes... let me just tell you the design of the trial, because the design of the trial, wasn't placebo control. It's supposed to mimic real -world care. So people come in...
Robert Whitaker (38:32.824)
They all get an antidepressant, I think with Citalopram. Now, if they don't remit on that first one, remit meaning the entry requirement was that you had to have a score of 14 on the Hamd scale. And if you got below seven, you were seen as remission and you're whisked away into the follow -up study, the one -year follow -up study. But if you don't remit on the first, now you can try a second time and they'll try three different drugs. They'll randomize the three different antidepressants.
If that doesn't work, you get another try. And then you get a third try. If that doesn't work, you get a fourth try. And the idea behind this is we're trying different types of drugs. You can eventually find one that will work in real clinical settings. And what do we hear in October of 2006? That that is indeed the case. 70 % of all patients of the 4 ,041 patients who entered the study remitted
and just got well. Symptoms gone. They were cured 70%. Now this is fantastic news. And by the way, I'll tell you a little story. One day I'm in my gym, okay, where I play tennis, and I'm in the locker room and I hear two doctors talking. And they say, thank God for the Stardee. We finally got evidence that if we just keep trying, we'll find one that works and it will cure people. And that's the message that went out.
that went into New York Times, the New Yorker talked about it. This is evidence that this is far more effective than placebo. And this guided our clinical care. And even as late as 2022, you would be reading and saying the New York Times about how that study produced a 70 % cure rate. Okay? Now here is the betrayal. It's astonishing. The only way to say it's astonishing. Nothing like that actually happened in that study.
If the protocol had been followed, only 35 % of those who entered the study, and we can talk about how they inflated things, would have been judged remitted under the standards. You had to have a Hamd score of more than 14, which is just moderate depression, and you had to get below, I think it was seven or below, to be in remission, which doesn't mean your depression is all the way gone, actually, but it's reduced.
Robert Whitaker (40:58.36)
And even equally important, how many people that then remitted about 35 % and were whisked into the follow -up trial stayed well in the year -long follow -up. And in this year -long follow -up, was to look like ordinary clinical care. They could change the doses, they could do whatever they wanted to try to help you keep you well on an antidepressant and in care. So what was the bottom line result?
Out of the 4 ,040, the actual results, out of the 4 ,041 patients who entered the study, only 1 ,508 ever admitted. And of that 1 ,518, only 108 were still way well and in the trial at end of one year. So the documented stay well rate was 3%, which anybody who knows the natural recovery rate from depression at the end of one year,
Well, it's much higher than that. And I'll tell you an NIMH study what they found at the same time of what was the stay well rate for unmedicated patients. Now, the 3 % rate was hidden, never even mentioned. And if you go to the final report, it's included in a graphic, but you can't make sense of the graphic. And now we can talk about how does this corruption get revealed?
and how long in fact it's been known. So maybe we'll go into that. But that's just to understand the largest antidepressant trial ever conducted, the one that was supposed to guide our care, we, the people of the United States and around the world in essence, were told of a 70 % cure rate when in fact there was only a 35 % remission rate even after four tries. And even more compelling, almost no one's...
got well, stayed well, and in the trial. Everyone else either never remitted, remitted and relapsed, or dropped out. That's the big picture of the betrayal. And then we can talk about how it was done.
Roger K. McFillin, Psy.D, ABPP (43:01.354)
Okay, so that's worth repeating. Little story. It was 2008, I believe I was working at a student run clinic at Temple University in Philadelphia, Pennsylvania, psychiatry on the clinic, spent about an hour reviewing that paper, justifying the use of not one SSRI. But if your client is still struggling,
to continue them on trials of SSRIs upward of four or more in combination with any form of therapy. From their perspective, it closed the book on concerns. It absolutely closed the book on concerns and this is scientific misconduct. We're gonna stop there. That's 35 % of people went into remission.
Generally speaking, if you're going to have a placebo controlled trial, which this isn't, you're going to see that or higher numbers of people going in remission. So you are placing people at risk for serious adverse drug reactions when the drug itself is certainly no better than doing nothing. I don't wanna say doing nothing, because placebo tends to have an effect or response. There's reasons for that, right?
And people are not given this information. Now the 3 % stay well rate is important for us to have a discussion. Because right now, primary care doctors are prescribing drugs to children, adolescents and adults and they're saying the same thing. You need to stay on the drug for one year, one year minimum. And I can only assume that this is related back to this type of kind of rhetoric that comes from this type of study.
Robert Whitaker (44:55.744)
Yeah, listen, we're getting into a place where we talk about fraud doing unbelievable harm to children. And there's no evidence of efficacy, even efficacy in children for these drugs. And then we can talk about there's another bit of fraud that went on that rejuvenated or brought back the prescribing of prozectic kids. It's called the TAD study.
corruption in that study as well. And I know because what happened in the real, now we're going off, there's so much corruption around the antidepressants. Because if you actually dig in, you read about drugs that aren't really effective, that's number one. Number two, people don't stay well on them. It's pretty clear they increase the long -term chronicity of the disorder, they increase the risk of treatment resistant depression becoming fourth.
have side effects of sexual side effects, that sort of thing, and mania and psychosis, all sorts of adverse effects without any real benefit over the short term in the aggregate. And with the kids, it's even worse. With the kids, there's no trials really that showed they were effective, even as they were showing that they increased the suicide risk. And then just real quickly in that TAD study, if you actually dig into the data, 17 of the 18 suicide attempts were people on fluoxetine.
But that's not what they actually reported. They reported there was no excess risk. So anyway, we can go into this is this is the study that star Ds go back to there that did govern our thinking, your thinking, my thinking. Well, my thinking was already diverging, but our use of these drugs and it also did make it more likely to be prescribed to kids. And with the kids, it's just a tale of harm done.
Roger K. McFillin, Psy.D, ABPP (46:51.262)
Yeah. And there's additional marketing that starts to occur where these pharmaceutical companies realize that to increase the customer base, they have to get these prescribed in primary care settings. And they push these screening measures in primary care settings that were actually constructed by the drug companies themselves.
Robert Whitaker (47:17.698)
Right.
Roger K. McFillin, Psy.D, ABPP (47:17.852)
And that is going to increase the number of people who identify as depressed. And then you use the fraudulent studies and the pharmaceutical marketing to try to influence the prescribers to prescribe the drug. And then you work with often what are propped up nonprofit organizations that also push this information.
And then they influence the major medical organizations. So a great example of this is the treatment guidelines for adolescent depression that is pushed by the American Academy of Pediatrics. I went through all the data that they were using to justify antidepressants. They cherry pick studies. They don't include the totality of the research. They don't include the harms, the concerns.
And it is nothing more than institutional corruption at its highest level. And now I have conversations with pediatricians who say, Roger, what am I supposed to do? I have a, an adolescent who's saying they're suicidal. That may or may not be the case. I don't have the time to necessarily evaluate that. I'm going off a screening measure that's developed by Pfizer that clearly
has issues around construct validity. And I have these guidelines that state that an antidepressant Prozac for teens who are depressed and suicidal is a frontline treatment. he believes that's true or not, if he does not prescribe the drug and something happens to that adolescent, he can be held liable for failure to follow the guidelines, the standard guidelines that exist in his field.
Bob, this is where we're at.
Robert Whitaker (49:20.216)
Yeah, what you just talked about and presented gets to the larger story about what has happened to us as a society since 1980 when the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual and adopted a quoted disease model for diagnosing and treating mental disorders with depression, anxiety, et cetera.
You can't understand what has happened unless you see it through the lens of institutional corruption and money. Because what you see here is, and what you're getting at is, this was a story about building markets for drugs. It's not a story about medicine advancing. It's a story about building markets for drugs. And you have the chemical imbalance story, which tells us we have a disease in the brain. Then you get, now let's go back to kids. Do you know what the thought was with kids by up to 1990?
were moody. They had ups and downs. They didn't actually experience clinical depression. So what happens? Well, in the early 1990s, there was now several SSRIs in the market. And what do drug companies do? They've already got a target audience of adults. They got to expand it into other populations. So now you see them saying, hey, the kids aren't getting drugged. They aren't getting medicated with antidepressants. So next thing you know, have a...
prominent psychiatrists, child psychiatrists saying, we used to think that kids couldn't get depression, but now we know they can. And what they do is they develop whatever sort of diagnostic tools that will take that moodiness that kids can experience and translate it into clinical depression. They're making them patients, candidates for these drugs. Now going forward, what you have is you have the corruption of the literature, you have the corruption of...
Textbooks? Why are the textbooks corrected? Because the people writing the textbooks, in fact, are getting money from the pharmaceutical companies to be their key opinion leaders. Plus, the American Psychiatric Association, as a trade organization, became committed to a disease model. And under this disease model, what is their product? It's drugs. It's prescribing drugs. So can they start telling about the adverse effects or that people are becoming more chronically impaired on these drugs or suicide risks are higher? They can't.
Robert Whitaker (51:49.068)
do that with otherwise they're like General Motors saying like our cars aren't they're harmful they're dangerous they're not going to do it and there's a long history you can chart now you can detail how the interests of the American Psychiatric Association once it adopted this disease model and said we'll become psychopharmacologists that's what they even called themselves right
So they have to tell a story of drugs that work and of their own advances in science. Drug companies say, this is fantastic because our interests are in line with them. We'll get these people to be our spokespeople, our key opinion leaders who teach other doctors about this narrative of progress and become the spokespersons that the mainstream media calls up when there's experts. And so what we get in totality is a false narrative of progress.
A false narrative that comes to us in the guise of science. And then, but here's the tragedy of what you've done and certainly what has motivated me for now for 20 years is that narrative of science is belied by the science itself. So if you look into the research, you find that the chemical imbalance story, hypothesis didn't pan out. You find in fact though that the drugs create the very imbalances hypothesized
to cause the problems in the first place. And then you see over and over again, what do you see? You see clinical trials are biased by design to make the new drugs look better. You see a hiding of adverse events. You see then that the really sort of rather lousy outcomes in the clinical trials by the drug companies get translated into like this hype when they're presented to the public. And then you see over and over again.
where studies done by the NIMH that don't confirm that industry field view, they're hidden. They don't show up in the abstract, they're not communicated to other practitioners, even though over and over again you find the unmedicated groups doing better and the medicated patients doing poorly. Now, let's go back to Stardegis for a second, right? 3 % stay well documented rate. Do you know the NIMH did fund a smaller trial at this time? What is the...
Robert Whitaker (54:09.272)
one year recovery rate for unmedicated patients. And what they found was that over the course of a year, after one month, only 23 % had gotten better. Not so great. But what they found in the unmedicated patients, they kept on getting better. And at the end of one year, the stay well rate, the well rate at the end of one year was 85%.
Roger K. McFillin, Psy.D, ABPP (54:32.01)
All right, this is so important. And there are young people that reach out to me who are in school who are listening to this podcast. It's so important that you listen to what was just said. That important data, published studies, things that are really critical to us in making informed decisions are kept from you. They are cut from you. But when we talk about the corruption of the Stardee trial, there's been published papers
H. Edmund, is it Pigote? Am I saying his name correctly? Pig it. Okay, 2010, 2023, right? And many in between this is published research, people often ask, I need to see more of the data, right? Okay, you guys sound great. You're communicating well, you're articulating these points, you seem credible. But I need to see some of the sites and here at my center center for integrated behavioral health, we're passing these studies out. Because I do have psychologists who
Robert Whitaker (55:05.225)
Pigot, think is how you pronounce it. Yes.
and many in between.
Roger K. McFillin, Psy.D, ABPP (55:31.306)
are really kind of born of the mindset that the medical establishment and the scientific literature and the evidence -based movement is designed to protect patients. And they can't even begin to fathom the level of institutional corruption that exists. But we're at a new time right now because the veil has been lifted. Post -COVID has allowed this to happen, where now the trust in the medical authority has decreased dramatically because they've been caught in their lies.
And that's why I think your work right now is more critically important than ever that people start following that in America. People start reading your books because you've done the work. is a, it's compiling, investigatively, research over decades that tell the story. Many of the people that are working in this field right now, some of them were born, you know, after 1990, you know.
or even later, they're in school right now, they only know these narratives. So Bob, what I'm interested in to know is what is the response of the psychiatric medical establishment to your work and to the STAR -D trial misconduct?
Robert Whitaker (56:31.362)
That's right.
Robert Whitaker (56:45.317)
Yeah, those two separate stories in a way, the reaction to my work going back to Madden America and then Anatomy of an Epidemic. First, of course, you get attacked, ad hominem attacks, you know. There'll be everything like he's biased, he's just a journalist. Someone will say you're a Scientologist. mean, that's the first thing. They'll try to delegitimize you.
Now, what you want to see as a journalist is, okay, where am I wrong? And by the way, all I'm doing is doing their own research. I'm not doing the research. I'm just citing their research. And by the way, in these books, I quote what they say in their own findings, okay? Because one of the things I did discover quickly, if you just call someone up, an expert, they start spinning it to you as the reporter, their own findings. So I just went to the documented...
reports over and over again as I tell these stories. Here are the findings. Here's what they actually said about them in their published reports. And by the way, that's why I can never be said to be misquoting them. It's written, right?
Anyway, I just lost it. what's been the reaction? So the first is to delegitimize you. And by the way, so many people just, they're so lazy, they're prescribers, they don't go to the real research, right? They just say, well, am I going to believe this guy or I'm going to believe the experts? And what's in my textbook? That's the first thing. Now, anatomy of an epidemic did cause a stir even within the field. Now, the reason was,
We do have these, know, when we talk about efficacy, when the powers that be talk about efficacy, they're usually referring to the industry funded trials. Okay, but there have been long -term studies, okay? And what I did in Anatomy of an Epidemic was put together a puzzle. And it begins with, what is the natural capacity to recover? And what do we see over time that tells us about how these different classes of psychiatric drugs are changing the long -term course of these problems?
Robert Whitaker (58:55.734)
And unfortunately, what you see over and over again, and there's many different types of evidence you bring together to tell this narrative that I did in Anatomy of an Epidemic, is that unfortunately in the aggregate, these drugs, and it's true with stimulants, it's true with antidepressants, it's even true with antipsychotics, they increase the likelihood people will become chronically symptomatic and more functionally impaired. And it's absolutely consistent. And by the way, when I did this, I tried to find long -term studies
that belied that finding. And what you find is that what psychiatry relies on for long -term evidence is relapse studies where they take good responders to drugs, they yank off one part, and they say, look at that group relapses more, and that's evidence of long -term efficacy. But in fact, that is not. That's an evidence that in a group of good responders, don't yank people off abruptly. But I think that was...
As you mentioned in your introduction, that did get the investigative and reporters, investigative reporters and editors award for best investigative journalism in 2010. That gave it a certain legitimacy, right? And believe it or not, I was, I have since been invited to give talks around the world basically, like in 20 countries and grand rounds at psychiatric departments, including a temple medical school. I was brought there multiple times.
Now, it's often, if the audience is composed of psychiatrists, here's the response. One is open hostility. This can't be true. And why is this guy here? But then others, there's a worriedness that like, well, we really haven't been thinking about long -term outcomes. And then third from the younger residents often is like, why wasn't I taught this? Why didn't I know these studies? But then comes this question.
And this goes to what you talk about. And I've even had practicing psychiatrists tell me this. Okay, I think you're right. Now tell me how I'm going to practice. Because standard of care is to give these medications. How do I go into work now? How do I communicate this to the public, especially since most of the public comes believing that these drugs are miracle pills. So they feel themselves in a bind and then you'll find that people who
Robert Whitaker (01:01:23.736)
professionally start doing what you're doing. Unless you have a good protective cocoon around you, they get isolated because their other members of their department don't want this gadfly saying that these drugs can harm.
Now here's, so there were attacks on me, of course, after Anatomy of an Epidemic. One of the biggest attacks occurred like five minutes after the book was published. It was a review published in the Boston Globe and five minutes after the Boston Globe went online, it suddenly was online and it's disseminated. Now who is doing this? It's a sleep doctor who works closely with psychiatrists in the Harvard Medical School group of hospitals.
He's never written a review before and in this review, he says, he likens me to a dictator in South Africa who by virtue of denying AIDS was a real disease, had caused hundreds of thousands of people to die. And that's what Bob's book will do if it gets any attention. And boy, that killed attention for that book. Newspapers didn't run reviews. I got some radio talks canceled and what...
Save the Book was really a grassroots thing. People reading this going, well, really what is going on? It led to the creation of a foundation for excellence in mental health care to do further research of this sort. I actually helped that foundation get started, further research into long -term outcomes. And now here's what you see 14 years later.
There was one study they tried to say I got wrong was the Martin -Harrell study of long -term outcomes for schizophrenia patients, which found the recovery rate for people who stopped taking their antipsychotics, this is schizophrenia patients, was eight times higher over the long -term for them than for the medicated patients. And they said, although that's just correlation, not causation, it's a difference in the baseline severity. You can put that to, that's not what happened. You can see. Anyway, eventually Martin -Harrell...
Robert Whitaker (01:03:30.744)
And Thomas Job said, Whitaker's the one who got it right. That's what our data showed. Okay? So the very thing used to attack me eventually, Martin Harrell, those things said, no, Whitaker got it right and even cited me in some of the final things. So where are we now 14 years later? You know what you see in major people saying? Yeah, we don't really have, number one, evidence that antidepressants are effective over the long term. We don't have evidence that antipsychotics are effective over the long term.
This is at the very high levels of research sort of that never gets published or never gets talked about. So there is an admission in essence, A, that they lack evidence these drugs are beneficial. B, you see things, editorials and things like the British Journal of Psychiatry believe that we need to rethink our use of antipsychotics. We need to rethink our use of this. It just doesn't get out into the general population. Plus there have been now more long -term studies. They've all confirmed.
Antidepressants increase the chronicity of disorders. Believe it not, antipsychotics lower recovery rates. Stimulants provide no benefit over the long -term and there are harms associated with stimulants for ADHD. So that's out there. There's a growing, the evidence for this narrative that I told in Anatomy of an Epidemic is just growing stronger and stronger and stronger. And yet, and this goes with the Stardew study, the mainstream media never
tells us about this.
Roger K. McFillin, Psy.D, ABPP (01:05:02.302)
Yeah, and they won't because the pharmaceutical companies basically fund their existence. And with the advertising dollars, I mean, there's no way that they're going to be able to do any of the investigative work that you're able to do. I want to go back to some other things that you said, because I think they're really important. So first of all, this narrative that the disease model in itself did legitimize psychiatry. It was a dying profession. you, where was their area of specialty going back to the eighties as we start to evolve?
It's not in therapy, you have psychologists, have social workers, counselors who trying to perfect that art in a lot of ways. you know, there's this burgeoning neuroscience field as well, where the best and the brightest who are interested in the brain are going in this direction. So they kind of legitimize themselves as a medical profession and medical specialty by aligning with the pharmaceutical companies. And that still exists today. Because if you're
If everything that you're promoting, you're discussing, you're revealing this research, everything we're talking about today becomes public knowledge, it decimates the profession. It eliminates the public trust in psychiatry at all. The prescribing of these drugs decreases dramatically. The product liability lawsuits probably increase as well.
And maybe there's some situations because I've talked to psychiatrists where using a drug in emergency status as an emergency medicine short term has some positive effects, stabilizes something. No one's arguing against that. Today's discussion though, we're talking about antidepressants, which are widely prescribed in primary care settings. 85 % of these drugs are being prescribed by doctors who aren't even specialists in this area. And they're being prescribed way beyond just a mood problem. They're being prescribed for pain.
irritable bowel post COVID. My goodness, it's becoming widely applied to almost everything. And it's dangerous. And we're worsening. And it's interesting, we're having this conversation today just about as if just one drug is prescribed to somebody. That's what I never see that at all anymore in clinical practice. People come into my center, they're on three, four upwards of seven psychiatric drugs. And we're talking about adolescents.
Roger K. McFillin, Psy.D, ABPP (01:07:20.786)
are being prescribed that it's a profession that is out of control. And we're not being hyperbolic in our discussion of this. It is an illegitimate authority that is doing mass harm. And this is a human rights issue. I wouldn't be putting myself out there on the airwaves like this. I wouldn't put myself at risk professionally at risk, unless the work was put in and the evidence is clear.
And I know the same you would not put yourself, you wouldn't dedicate your career to this unless you are so absolutely sure based on the evidence. But we're not getting the psychiatrists to have these critical discussions. They're not actually even willing to have debates about this. I'm putting it out there. Come on to my podcast. Let's talk about the Stardew study. Let's talk about the history.
of these trials, how these drugs came to market, the very well known harms. And I want to answer your very important question that you said before, a psychiatrist comes to you and says, I agree with you, I know this, what do I do? Right? So now it puts his family at risk. This is how he makes a living. He might have hundreds of thousands of debt in the medical school, and he's relying on a burgeoning practice that's going to make at least a quarter of a million dollars a year. And
his specialty is diagnosing and treating these, these people with psychiatric drugs based on a faulty model and faulty evidence. Well, here's the answer to that, sir. Things you are a medical doctor, and we are having robust evidence that talks about the various medical problems, including metabolic illness, nutritional deficiencies that manifest themselves in psychiatric symptoms. We're
We're a country where over 60 % of us are dealing with some chronic health condition. Obesity is skyrocketing. Our kids are sick. And we're prescribing drugs. We're doubling down on an intervention that's going to worsen their health in the long term, including metabolic illness. And I can't believe I'm saying this, but we prescribe a drug that's going to increase the likelihood of a suicide event.
Roger K. McFillin, Psy.D, ABPP (01:09:49.46)
to suicidal children. That's the country we live in.
Robert Whitaker (01:09:55.776)
Yeah, you were prescribing it to kids who even are not suicidal, but are having some mood things and they become suicidal. That's what the evidence shows. Here's, you know, what's tough about this, it's tough for outside people to really grasp the entirety of this corruption and how it developed and so on, because it seems too impossible. But
You spoke about psychiatry. This is what gives them a place in the marketplace. And if you go back to the 1970s, people were seeing, even among themselves, said, we're fighting for our survival because our therapy is not seen as any better than their therapies, psychologists, counselors, et cetera. And you even see them saying like,
What gives us an advantage in the marketplace? It's our prescribing powers compared to psychologists, et cetera. So when they published DSM -3, it's as a disease model, it's done for purposes of the guild because who's going to, if you have a disease model, got to, he's going to make drugs the first line therapy and who has power over the drugs, is psychiatrists, the prescribers, right? So what they're doing is they make a conception.
that gives their prescribing powers value, but unfortunately they didn't have the evidence to support the story they wanted to tell about a disease model. Now what happens is once you commit to telling a story, which they did in the 1980s, and that story starts to benefit you, your domain, your domain of authority increases, money's flowing to the APA, money's flowing to individuals, cognitive dissonance is going to set in and you're going to start looking at
The way you view the world is going to be to try to see whatever evidence that supports what you're doing and you're gonna find when you get long -term outcomes Ways to dismiss that all the time. Well, you know that person's biased etc so this sort of institutional cognitive dissonance sets in even though I think at some start the point with star D is You can't even use cognitive dissonance to dismiss that fraud
Robert Whitaker (01:12:10.114)
But cognitive distance sets in and I think what happens to the psychiatrist, forget the primary care doctors, I don't think they're just trying to get patients out of their waiting room, basically.
What happens with a doctor is they attribute anybody getting better to the drug, to the treatments, and if someone doesn't get better, they attribute it to the disease. Now the fact that you have all your patients on three to four, five, six, seven drugs tells you in fact that the paradigm of care isn't working. Because if the single drug worked, you wouldn't have them on three, four, five, six drugs, right? They get on that because one drug doesn't work, causes side effects, and they do this sort of...
shaman, know, like witch doctory stuff, then throw the brew in.
But the, and one of the things when we talk about long -term outcomes, it does, there are some people that seem to do okay on that. And that's what's going to sit in the psychiatrist's head. Those that are doing okay. Cognitive dissonance is a powerful, powerful thing. Even though I think at the top, the real researchers know what they're doing. Okay. Anyway, what you just described here is a betrayal.
that has transformed our society. It's changed how we raise our kids. And look at our kids going, how unresilient they are so much now. They're so primed to worry about when, what way are they failing? What way aren't their moods right? That sort of thing. So something like over 50 % of college kids now see a counselor during to college. Something like 25 to 30 % arrive with a diagnosis and a prescription.
Robert Whitaker (01:13:54.552)
So this narrative of science has changed how we view ourselves, how we raise our kids, how we spend our healthcare dollars, how we respond to difficulties, and it has produced any sort of public health outcomes, not just in the United States, but everyone that's adopted this paradigm of care has seen their burden of illness, of psychiatric disorders rise. Of course, we've seen suicides rise now for 20 years.
So it is, it's a tragedy of extraordinary dimension because it is affecting us all. It's a new philosophy of being, this whole chemical imbalance story and needing drugs. And everywhere you look over the long -term, it tells of lives diminished, lives lost, greater functional impairment. You hear about people no longer being able to feel sort of emotionally numb, sexually numb.
It's a tragedy and at the heart of it is a lack of informed consent and not medical freedom. So it violates our very, the principles we supposedly hold dear. And then finally, we can go to the STAR -D fraud because what for me personally is the STAR -D
trial and the revelations of the fraud, which by 2023 were published in the British Medical Journal. And by the way, one of the authors was Jay Amsterdam, who's one of the premier investigators, psychiatrist who investigated the chemical imbalance story. Yes, exactly, Philia. This was a moment of the Rubicon moment.
Roger K. McFillin, Psy.D, ABPP (01:15:34.184)
Yeah, Philly, right? Penn. Yeah.
Robert Whitaker (01:15:43.638)
Are they going to double down on the fraud or are going to finally say, God, we have to retract this because the evidence is overwhelming. We committed fraud. Those investigators committed fraud. They violated the protocol in very conscious ways to mislead the public. And they didn't retract it. That's the moment they say it's okay to deceive the American public. And for what? It's evil. And what I still can't understand, there's been efforts by the authors of that
Roger K. McFillin, Psy.D, ABPP (01:16:06.25)
It's evil.
Robert Whitaker (01:16:12.952)
Ed Pigott, J Schnapp, to get the mainstream press to correct this. And they're not. No one has picked this banner up, even though it got, it wasn't just, so 2010 is when we began writing about it because it was in a published journal. You could see it. And the last one was they had patient level data, they reanalyzed and they were able to say, here's how this protocol violation changed the denominator. Here's how added, this protocol violation added remission rates.
So it's all laid out. How can you not retract that study? How can you as a profession, this is published in American and Madden America, we mounted a campaign to send petition to the American Psychiatric, Journal of American Psychiatry to retract that study. They didn't even respond to us.
Roger K. McFillin, Psy.D, ABPP (01:17:02.058)
Yeah, and you do a great job in your 2023 article on that in America where you're outlying this, where two things that you bring attention to, one of them, which we didn't talk enough about is the financial conflicts of interest that exist. And the second one is how the protocol violations are absolutely intentional. You know that they reviewed that data and then they had to make decisions.
Robert Whitaker (01:17:25.58)
Yes.
Robert Whitaker (01:17:32.182)
Yes.
Roger K. McFillin, Psy.D, ABPP (01:17:32.348)
in order to justify the treatment that they do and revelation, like this revelation of the actual response rates was going to destroy their profession. And it was going to destroy the use of the entire narrative that we discussed. So it was clear scientific misconduct. They clearly intentionally frauded the public.
Robert Whitaker (01:17:56.406)
Yes, they were cognitive. There's no way this was done without that intention. It was intentional fraud.
Roger K. McFillin, Psy.D, ABPP (01:18:05.824)
And they haven't really denied that, right, from what I understand?
Robert Whitaker (01:18:09.336)
actually they have. The authors, first of all, the authors, here's the thing we see it as in it was funded by the NIMH. However, there was some funding that was delivered for the trial itself from the pharmaceutical companies. But even more important is if you actually look at the investigators, they were all taking money from the drug companies to be their key opinion leaders, virtually all of them, not everyone. So now they have a double thing. So by the way, if you go in and you look at what they said they expected.
Roger K. McFillin, Psy.D, ABPP (01:18:11.146)
they have.
Robert Whitaker (01:18:38.904)
They expected a 70 % remission rate after four things. And because they will tell us that our drug is working, right? They didn't get that. now if they say only 35 % remitted, if they tell us that, and they tell us that only 3 % stayed well, are you going to take this drug? You the public, I mean. What does that do to our public conception of antidepressants? And if you're a primary care doctor and you learn that only 3 % stayed well,
and only 35 % ever remitted, meaning that 65 % of outpatients suffered all the hazards related to antidepressants, to sexual dysfunction with no benefit. Are you gonna be so keen to prescribe that? So this was a Waterloo moment, know? How are we going to go forward? And what they did was intentionally do protocol violations so they could come up with what they're expected.
remission rate was or their forecast was. And we can go through, but it's absolutely intentional. what they did, the main authors of this fraud, they tried to say that Pigott and Amsterdam were applying post -Hawk criteria to come up with their 35%. That's a lie. They did not do this. They just applied the protocol.
Roger K. McFillin, Psy.D, ABPP (01:19:56.778)
That is a lie.
Robert Whitaker (01:20:00.022)
And by the way, they got the protocol through a Freedom of Information Act. And we have all these documents up on Madden America, if you want them, by the way. You can go read the protocol. You're absolutely right. This is a moment psychiatry is dividing, the road divides in two here. Either we go down this thing where we prescribe antidepressants willy -nilly and we end up with people on three, four, five drugs, or we say, this isn't working.
Roger K. McFillin, Psy.D, ABPP (01:20:00.255)
Yes.
Roger K. McFillin, Psy.D, ABPP (01:20:26.824)
Yeah, when you go down this rabbit hole, as I have, there ends up being different phases in your development. At first, you are under the assumption that there's positive intent, that people are doing the best that they can, and we just need better science. And then you start moving a little bit forward into your process here and realize, wait a second here, there's pretty widespread corruption.
There's a narrative that's being sold. The narrative isn't accurate, but we see people getting better in clinical practice. There has to be some benefit to this. There's no way there can be this large scale conspiracy. So you start investigating a little bit more. And like me, you start asking the very difficult questions and you realize the emperor has no clothes, that they can't answer them, that the knowledge isn't there. You just sometimes assume
that someone has a white coat on, that they're a physician, that they've acquired a lot of this knowledge. And then you go a little bit further and then you get to a point where you have a conversation like this and you analyze the STAR -D trial and you understand, no, it's intentional. It is intentional scientific misconduct. They're defrauding the public and this is sociopathic evil behavior. And the bedrock of this found
of this entire medical specialty is built on lies and corruption. And it is now an absolute public health concern. And we have to be able to publicize this, we have to scream at the top of our lungs at the top of our rooftops and get as many people on board as possible. Because now there's not really it's not really questionable anymore. And you see this when Dr. Joanna Moncrief, she posted her 2022
systematic umbrella study on the serotonin theory of depression, something that was never justified scientifically at any point in time, but you still go to the WebMD website and they're still putting the same rhetoric out there that depression is related to key neurochemicals, right? And so what happens, you you have large scale publications like Rolling Stone that start to attack her as if she's a Scientologist.
Roger K. McFillin, Psy.D, ABPP (01:22:51.184)
Or you end up hearing various psychiatrists who are on the payroll for big pharma saying we've known this all along. And now the social engineering continues and the narrative begins to shift a little bit. And they say, we know these drugs work, we just don't know why, right? And then a lot of people who are out there in clinical practice are saying, but I've seen people get better. And I want to answer to that.
I have the answer to it. I've spoken about it. I've written about it. And this is so scientifically lazy and dumb. I can't believe that I have to communicate it to people who have medical degrees. So first of all, there's something called post hoc ergo proptohoc fallacy. This is why we have scientific trials after this, therefore because of this. So people see someone get better in a period of time. And Bobby did a great job in the beginning is talk about traditionally these
These episode these conditions are episodic people. There's natural recovery. They get better in time. Because maybe they start facing what they have to face. They solve the problems that are in front of them. Emotions are temporary. And so that's an important piece. The other thing is these doctors don't understand two things. The placebo groups get better. So you can't attribute it to the drug.
And depending on the age range, could be 35 to 60 % of people get better on the placebo drug. So it's not the drug, it's other factors that can lead to improvement. And the third piece is what doctors have to understand, is you have a position in our society as the authority, and patients are passive, and they want to please you. So I see patients who start taking the drug, stop them.
because they feel horrible until the doctors are taking it and feel better. I see patients in clinical practice who say they have to lie to their psychiatrist. Why do they lie to their psychiatrist? Because they feel worse and they know the psychiatrist is going to just add another drug or increase the dose. And that is part of the medical system that we have right now is that patients actually lie to people in order to get out of being part of the treatment. And this is real.
Roger K. McFillin, Psy.D, ABPP (01:25:08.948)
There's lots of legitimate reasons why you see someone getting better and has nothing to do with the drugs at all. And that's why science is so important because it does protect patient welfare and why you have to be able to understand this with critical analysis and communicate it to people transparently, honestly, because the dangers are significant. They are not rare. They are not rare.
Robert Whitaker (01:25:38.29)
Yeah, I think that, yeah, this is a lot about... You're sort of getting on the clinician's illusion because the clinician is primed to see his patient get better. And I believe most of the prescribers, they do want to do well. I do that, but they don't really know the research. And I'm talking even about prescribers, psychiatrists who are prescribing, et cetera. Because as we said, you have to dig into the studies to really see this, to find this, et cetera.
But basically they get through school, is like medical school is like being inducted into a tribe. You're told you know, but they don't really and they're really like being primed to just accept whatever the conventional wisdom is within their profession. Okay. And follow that. So most people, and this is what they obviously the general practitioners do. They do want to see their patients get better. That's number one. The fraud is coming from the people who are really
forming this narrative, right? That's where the huge, that the very top is coming from.
But second, you're all also like there is this, that's number one. So two, they're primed to see any change as beneficial to the treatment, right? As you mentioned, which really is really key, patients do want to please their doctor. So they know that's not gonna be as happy in the interview if they say like, doctor, this drug is fucking me up, excuse me, screwing me up. So there is this interplay where they do want to please their doctor for sure.
Which by the way, maybe part of the placebo effect as well in those trials is just everyone's trying to please their partner, their doctor. By the way, again, I wanna go back. That's not a placebo group. That's a drug withdrawal group. actual natural healing things I think would be better than this. But anyway.
Robert Whitaker (01:27:32.082)
So, and then, anyway, the point here is this that you're getting at is.
There is a reason we need to be driven by science and not a marketing narrative because it's easy even for practitioners to fall within that narrative and see what they're doing is helpful and then attribute everything that's bad to the disease, cetera. They start operating in their own way within that false narrative of science. if you have a natural recovery rate, this I think is really important to understand too. If you have a natural recovery rate for your
intervention, not to do harm. It has to better that natural recovery rate, right? But clinicians today, they don't see that natural recovery rate. You do because you're seeing people off, but clinicians today, they don't see that, right? Because they don't have anybody that's coming to them, not on the medications really. So they don't see the long -term course of these disorders, this capacity for recovery. And that is part of the clinician's illusion. And that's part of the blindness.
that now exists within American medicine. They don't see these natural capacities to recover from psychiatric issues. But if we had on a science, if we had this stuff being revealed and written about in them, so let's say if the New York Times picked up this study about the Stardee study, that it was fraud and we've been misled, that would resonate, right, throughout the profession. That would change minds. And that study was retracted.
So I think there's a real media failure here too, but the biggest thing here to try to understand this is there were corrupting, there was an institutional corruption that led to this false narrative of science. And then once they began telling it, they had to double down, double down, double down. They just had to keep it going no matter what happened. And you can see, you can see with the stimulant study, you can see with the TAD study, they just couldn't bear to tell us the truth.
Robert Whitaker (01:29:35.798)
Because if they told us the truth, as you would say, made these known, their whole edifice, that whole narrative collapses, and then what are they left with? I'm talking about the guild.
Roger K. McFillin, Psy.D, ABPP (01:29:47.536)
fundraising for a nonprofit that I recently started called the Conscious Clinician Collective. And what's happened to me over the past three years is I get overwhelmed with emails from harmed patients, from parents of kids who are struggling and they're asking for referrals. They're asking who can we trust, who can we talk to. We're getting pushed these drugs by the medical professionals.
We don't want to put our kid or our family member on all these drugs, but we can't really find somebody who can give us accurate information. Do you know anybody? So I decided to start the Conscious Clinician Collective, where right now we're fundraising to develop a database, a website, where you can type into your locality and try to find somebody who attests to what we call the conscious clinician.
Compact which is really a declaration It's a declaration around informed consent and medical freedom and talking about the institutional corruption and why you deserve to get accurate information And the thing about informed consent is it's not just about risks and benefits of a particular intervention It's also about alternatives and you know, that's the that's the unfortunate story here is there's safer alternatives for people to recover when they hit hard times or they really struggle or someone in their family member decompensates in some way
You know, and you did such a great job in the beginning of just comparing, you know, globally, you know, with cross culturally and where our Western narrative, you know, has, has worst outcomes, you know, being in a developed country like ours. And there's a great book by Ethan Waters, who I had on my podcast, which crazy like us, which talks about the globalization of this, there are other ways. And we're stopping the conversation really.
having to defend what standard, defend that there are other options because the standard narrative is so powerful. So we end up fighting against the standard narrative and trying to protect people from harm that we're not really talking enough about alternatives. I wanna change that. That's a conscious clinician collective. We need your help in being able to donate everyone who's listening. The other important thing about this conversation today, and I thought it was,
Roger K. McFillin, Psy.D, ABPP (01:32:11.718)
a great story. And this is the power of podcasting because we had the time today to have you on and really tell the story in a way that I think people are going to be able to listen to this and understand it. Now, I'm going to post links to papers, published studies on this, on the show notes. They're going to be available to you. I'm speaking right now really to people who are in school. And I know there's a lot of you out there who listen to this. It's going to be up
to you to challenge the narrative. They're going to push evidence -based medicine on you in programs. But understand that that's a biased narrative. mean, they're selling you, as you know, stories that fit the corrupted institutions. They're not selling you science. So to be a champion of science, you have to be able to allow for discourse, critical analysis.
You can't just be a passive acceptance of what they tell you as truth. That's part of the takeaway from today's very critical talk. Have conversations with professors. Challenge what's in the medical textbooks, the guidelines. Listen to these conversations. Share this episode. These are important conversations. Some podcast episodes outperform CNN, the nightly news.
This is where people are getting information. Robert Whitaker is not going to be interviewed on CNN or NBC Nightly News. And he should have been like he should be a household name in American culture. Now, you know, someone like me who's in this field, you're certainly one of the most influential people and you're a journalist. I mean, that shows how corrupt the entire mental health industrial complex is.
It requires someone outside of the system to be able to investigate it. And the only reason I'm really able to have these conversations is because I'm independent. I have a flourishing practice. I'm the owner of it. I'm beholden to nobody but my God, you know, and my integrity. And so that's all I care about. So we can have these conversations. I'm going to post today's episode on X. I usually don't do that. It's usually the video is behind a paywall on my sub stack and
Roger K. McFillin, Psy.D, ABPP (01:34:34.526)
The audible version is available to everybody on major platforms, but this one is going to be posted on X. Because we need have more people to hear the story today because you did such an excellent job of communicating the narrative. There's no one better out there who can communicate this, articulate these points, and back it up with science. So the books are very important, but they're just a foundation.
They get you to start questioning the narrative and the work has to be done by us, the professionals. I'm a clinical psychologist, the standard is high. The ethical standard is high around informed consent. I have a personal responsibility to all of my clients, everyone who listens to this. I'm also accountable to my profession, my license. And the problem that exists with so many people in my field, colleagues, is that
informed consent and high ethical standards are nothing more than talking points. It takes a lot of work. If you're going to make the decision to be a therapist, to be a psychologist like me, well, then you have the responsibility to evaluate the science in totality and develop some degree of understanding with it, about it, to articulate it to those you serve. And we're not seeing that. We're seeing counselors, social workers, psychologists referring their clients en masse.
to primary care, to psychiatrists, to be put on antidepressants. And really, I mean, that's just the beginning. Once you start on one drug, it's just a cascade of other symptoms, side effects, adverse reactions that are gonna lead you to more and more drugs. So Bob, I wanna provide you the last word here on today's conversation, kind of promote anything that you wanna promote, access to what you're putting out there so people can have this information.
where people can find you.
Robert Whitaker (01:36:32.94)
Yeah, I think the most important thing you said is people need, you really to make this transformation, to understand the problems with the narrative, what the real science is saying, they need to do their own homework. They need to have access to this. So what we do at MAD in America, one, we have a science team that is constantly doing reviews of new articles that tell of really how that
conventional narrative is belied by the evidence. So you can review, and we have an archive of that. can go review the, you can keep up with the science. And we have, if you go up to our maddenamerica .com, you'll see on our menu bar, it says drugs. And then there's a dropdown and you can now go drugs, anti -psychotics or antidepressants, click on that. And there's a review of this evidence base. Okay. And with links to the studies where they can find these outcomes.
So they can inform themselves and become convinced of themselves. This indeed is what the research is telling us and showing us. And I've been, as you mentioned, doing this a long time, the only way people really can make this transformation, this understanding that there was this false narrative and then this is what the science is really telling us, you have to become familiar with the research itself, like you did. And now it sort of all of sudden comes clear to you.
And again, the final word is to understand this is, this is a story that conventional scenario is a story of marketing. It's a story that fit well for economic interests, both for the guild and for the pharmaceutical industry. Unfortunately, science was telling us a different narrative. And the narrative is telling us as how that conventional narrative isn't true. It's a false narrative. And on any sort of public health, big scale thing, it's doing harm to us as a
as a people. And it's not just happening here. It's actually a false narrative that was exported around the world as Ethan Waters informed you when you had him on the air. And I want to thank you for having me on the air. This lengthy discussion, is a discussion that the public, our society needs to have.
Roger K. McFillin, Psy.D, ABPP (01:38:45.386)
It was an absolute honor having you on the Radically Genuine Podcast. And I certainly just want to thank you for all the work you do and for a radically genuine conversation.
Robert Whitaker (01:38:56.226)
Thanks for having me, Raj, it was really a pleasure.
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