reviewed by Mira de Vries
The title suggests that Pharma is
immoral. As Sheller explains well, the real source
of corruption is the unholy alliance between Big
Business and Big Government, shutting out the
interests of the individual consumer. He details
how it works by describing the relationships
between politicians and producers of drugs.
Sheller's way of fighting pharma fraud is through
the courts. This book chronicles his successes and
The main, though by no means only, drug discussed
by Sheller is Risperdal (risperidone in case
you're taking a generic form), a supposed
antipsychotic widely prescribed off-label to just
about anybody who is disliked. Although he
mentions other somatic adverse effects such as
weight gain, stroke, and involuntary movements, he
focuses on gynecomastia. This is the development
of female breasts, an effect experienced according
to Sheller by 12.5% of men and boys on this drug.
Sheller wrongly claims that Risperdal is the only
drug in its class that has this effect. He makes
no mention of the mind-changing
lost affect and cognitive degeneration. Nor does
he mention physical addiction
permanent changes to the central nervous system
rendering safe withdrawal after a certain period
impossible. These effects occur not to 12.5% but
to 100% of the people who take this or a similar
Sheller rails against Risperdal's manufacturer,
Janssen, for under-reporting the incidence
of gynecomastia on the package insert. What
difference does the package insert make? Who reads
it? Risperdal is usually administered by force.
Victims are routinely injected while held down or
handcuffed by police. Other people who are
prescribed Risperdal are the elderly, the
intellectually disabled, children, and the
incarcerated. They are drugged into a stupor for
the convenience of nursing home staff, caregivers,
teachers, or warders. In the United States foster
children are targeted. Parents often agree to
administering Risperdal because they are lied to
that it will alleviate their child's disability.
Sheller mentions the elderly and the children, but
nowhere in the book touches on the subject of
coercion by court order.
Psychiatrists who prescribe Risperdal don't read
the package inserts either. What would be the use?
Every drug in their formulary is equally harmful
but they have to prescribe something because
that's what they are paid to do.
Sheller's proposals for protecting the public from
Pharma ring familiar. They amount to compelling
the cat to guard the cream. It won't work. For
example, he calls for new laws
to regulate the
widespread practice of prescribing drugs
off-label. After all, if a drug hasn't been
proven safe for a particular use, then it
ought not be prescribed for that use.
But then in the very next sentence he contradicts
life-or-death instances, however, or if a
physician is convinced beyond any doubt that
it is the right drug to prescribe to their
patient at that time, then the physician
ought to be permitted to prescribe it.
How could a physician be "convinced
beyond any doubt that it is the right drug to
" if it hasn't been proven safe
(or effective) for that particular use?
Furthermore, every physician is always convinced
that he is doing the right thing or that the
situation demands it, particularly in psychiatry
which has no treatments that are safe or
Sheller does briefly mention non-pharmaceutical
interventions, ironically, only regarding somatic
- How do the risks and
benefits of a new diabetes drug ... compare
to a change in diet and moderate exercise?
- Does a new cancer treatment
extend a patient's life or simply mask the
symptoms of disease?
When it comes to psychiatry he upholds, even
encourages, belief in drug solutions:
- most [pharmaceuticals] do what they claim to do
when taken as prescribed;
- [lives were damaged even
of] patients who legitimately
needed to be treated with the drug;
- Janssen ... took away the
rights of the children to safe and effective
drugs for their ailments.
Psychiatric drugs never do what they claim to
do; no one legitimately needs to be treated by
psychiatric drugs; and there are no safe or
effective drugs in psychiatry, including child
psychiatry. The risk of gynecomastia is for
I admire Sheller's work because it illuminates
that drug approval is in reality an old boys'
network. Too bad that at the same time he fuels
the false hope that psychiatry is more than sham
Superstitions die hard. We will probably never
totally eliminate the belief in a pill for every
ill. But we could tackle Big Pharma by breaking up
the marriage with Big Government. For that we have
to shrink government.