Anatomy of an Epidemic (6 page)

At the end of the interview, Nathan shows me his drawings. He is into sharks and dinosaurs, and after I tell him how much I like his artwork, he seems almost to blush. He has been quiet most of the time I have been there, and even a little subdued, but we shake hands as I get ready to leave, and he seems, at that particular moment, to be a very sweet and gentle kid.
Jason and Kelley Smith live on the west side of Syracuse, about thirty minutes distant from the Oates family, and when I knocked on their door, it was their seven-year-old daughter, Jessica, who answered. It appeared that she had been waiting for me, and once I had my tape recorder on, she plunked down on the couch between her mother and me, ready to pipe in with her side of the story. “Jessica,” her father says a short while later, “has a lot of charisma.”

Jessica’s behavioral problems began at age two when she was sent to day care. When she got angry, she would hit and bite the other children. At home, she started having “night terrors” and all-out meltdowns. “The mildest thing would trigger her and she would be off,” her mother says.

The Smiths turned to their local school district for help. The district recommended that Jessica go to a “special ed” preschool in north Syracuse, and when she continued to behave aggressively at that school, they were told to take Jessica to the Health Sciences Center at the State University of New York for a psychiatric evaluation. There they saw a nurse practitioner, who immediately concluded that Jessica was “bipolar.” The practitioner explained that Jessica had a chemical imbalance and recommended that Jessica be put on a cocktail of three drugs: Depakote, Risperdal, and lithium.

“It blew my mind, especially the thought of putting her on antipsychotics,” Jason says. “She was
four
years old.”

He and his wife left that consultation not knowing what to do. Kelley works for Oswego County’s family service agency, and she knew of many troubled children who had been put on psychiatric medications. In that setting, the county expected parents to comply with medical advice. “There was part of me that thought maybe Jessica is bipolar, that’s what it is,” Kelley says. Moreover, SUNY Health Sciences told the Smiths that the center wouldn’t see Jessica again if she weren’t medicated. All of this pointed to following the center’s advice—the “experts are telling you that you need to do this, and that it is biological,” Jason says—but he had previously worked as a pharmacy technician and knew that drugs could have powerful side effects. “I was scared out of my mind.”

Kelley used the Internet to research the drugs that had been recommended. However, she couldn’t find any study that told of good
long-term outcomes for children placed on such drug cocktails, and even the short-term side effects, she remembers, “were scary.” Meanwhile, Jessica’s pediatrician told them she thought it would be “absurd” to put Jessica on psychiatric drugs; Jason and Kelley’s families also thought it would be a mistake. Jason remembered how a few years earlier talk therapy had helped him address his own “anger management” issues, and if he had been able to change with out the use of medications, couldn’t Jessica change her behavior too?

“We just didn’t want to accept [the bipolar diagnosis]. Jessica is such an outgoing child, and we like to think she is gifted,” Kelley says. “And she had made so much progress from the time she was two years old. We just couldn’t see giving her the medications.”

They made that decision in 2005, and three years later, they say, Jessica is doing well. She gets mostly A’s in school; her teachers now think that her earlier bipolar diagnosis was “crazy.” While she does sometimes quarrel with other kids and will lash back verbally if another child teases her, she knows that she can’t hit anyone. At home, she still has the occasional meltdown, but her emotional outbursts are not so extreme as before. Jessica even has her own advice on how all parents should handle such tirades: “They should say [to their child] ‘come here,’ and then they should rub them on the back so they feel better and so they can’t have a meltdown, and so when they stop having a meltdown, that’s what they will remember.”

Before I leave, Jessica reads to me the book
The Little Old Lady Who Was Not Afraid of Anything
, and more than once she jumps to the floor to act out a scene. “Even with her behavioral issues, everybody loves her,” her father says. “And that’s what we were afraid of, with the medication, was that it would totally change her, and her personality. We didn’t want to impair her faculties. We just want her to grow up to be healthy and to succeed in life.”

Two different families, two different decisions. Both families now saw their decision as the right one, and both believed that their child was on a better path than he or she otherwise would have been. That was heartening, and I promised to check in with both families
later, toward the end of my reporting for this book. Still, Nathan and Jessica were clearly on different paths, and as I drove back to Boston, all I could think about was how both sets of parents had needed to make their decision, on whether to medicate their child, in a
scientific vacuum
. Did their child really suffer from a chemical imbalance? Were there studies showing that drug treatment for ADHD or juvenile bipolar illness is beneficial over the long term? If you put a young child on a drug cocktail that includes an antipsychotic, how will it affect his or her physical health? Can the child expect to become a healthy teenager, a healthy adult?

It may seem odd to begin an investigation of a modern-day epidemic with a visit back to one of the great moments in medical history, but if we are going to understand how our society came to believe that Thorazine kicked off a psychopharmacological revolution, we need to go back to the laboratory of German scientist Paul Ehrlich. He was the originator of the notion that “magic bullets” could be found to fight infectious diseases, and when he succeeded, society thought that the future would bring miracle cures of every kind.

Born in East Prussia in 1854, Ehrlich spent his early years as a scientist researching the use of aniline dyes as biological stains. He and others discovered that the dyes, which were used in the textile industry to color cloth, had a selective affinity for staining the cells of different organs and tissues. Methyl blue would stain one type of cell, while methyl red stained a different type. In an effort to explain this specificity, Ehrlich hypothesized that cells had molecules that protruded into the surrounding environment, and that a chemical dye fit into these structures, which he called receptors, in the same way that a key fits into a lock. Every type of cell had a different lock, and that was why methyl blue stained one type of cell and methyl red another—they were keys specific to those different locks.

Ehrlich began doing this research in the 1870s, while he was a doctoral student at the University of Leipzig, and this was the same period that Robert Koch and Louis Pasteur were proving that microbes caused infectious diseases. Their findings led to a thrilling thought: If the invading organism could be killed, the disease could be cured. The problem, most scientists at the time concluded, was that any drug that was toxic to the microbe would surely poison the host. “Inner disinfection is impossible,” declared scientists at an 1882 Congress of Internal Medicine in Germany. But Ehrlich’s studies with aniline dyes led him to a different conclusion. A dye could stain a single tissue in the body and leave all others uncolored. What if he could find a toxic chemical that would interact with the invading microbe but not with the patient’s tissues? If so, it would kill the germ without causing any harm to the patient.

Ehrlich wrote:

In 1899, Ehrlich was appointed director of the Royal Institute of Experimental Therapy in Frankfurt, and there he began his search for a magic bullet. He focused on finding a drug that would selectively kill trypanosomes, which were one-celled parasites that caused sleeping sickness and a number of other illnesses, and he soon settled on an arsenic compound, atoxyl, as the best magicbullet candidate. This would be the chemical he would have to manipulate so it fit into the parasite’s “lock” while not opening the lock on any human cells. He systematically created hundreds of atoxyl derivatives, testing them again and again against trypanosomes, but time and time again he met with failure. Finally, in 1909, after Ehrlich had tested more than nine hundred compounds, one of his assistants decided to see if compound number 606 would
kill another recently discovered microbe,
Spirocheta pallida
, which caused syphilis. Within days, Ehrlich had his triumph. The drug, which came to be known as salvarsan, eradicated the syphilis microbe from infected rabbits without harming the rabbits at all. “This was the magic bullet!” wrote Paul de Kruif in a 1926 bestseller. “And what a safe bullet!” The drug, he added, produced “healing that could only be called biblical.”
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Ehrlich’s success inspired other scientists to search for magic bullets against other disease-causing microbes, and although it took twenty-five years, in 1935 Bayer chemical company provided medicine with its second miracle drug. Bayer discovered that sulfanilamide, which was a derivative of an old coal-tar compound, was fairly effective in eradicating staphylococcal and streptococcal infections. The magic bullet revolution was now truly under way, and next came penicillin. Although Alexander Fleming had discovered this bacteria-killing mold in 1928, he and others had found it difficult to culture, and even when they’d succeeded in growing it, they hadn’t been able to extract and purify sufficient quantities of the active ingredient (penicillin) to turn it into a useful drug. But in 1941, with World War II raging, both England and the United States saw a desperate need to surmount this hurdle, for wound infections had always been the big killer during war. The United States asked scientists from Merck, Squibb, and Pfizer to jointly work on this project, and by D-Day in 1944, British and American sources were able to produce enough penicillin for all of the wounded in the Normandy invasion.

“The age of healing miracles had come at last,” wrote Louis Sutherland, in his book
Magic Bullets
, and indeed, with the war over, medicine continued its great leap forward.
⁴
Pharmaceutical companies discovered other broad-acting antibiotics—streptomycin, Chloromycetin, and Aureomycin, to name a few—and suddenly physicians had pills that could cure pneumonia, scarlet fever, diphtheria, tuberculosis, and a long list of other infectious diseases. These illnesses had been the scourge of mankind for centuries, and political leaders and physicians alike spoke of the great day at hand. In 1948, U.S. secretary of state George Marshall confidently predicted
that infectious diseases might soon be wiped from the face of the earth. A few years later, President Dwight D. Eisenhower called for the “unconditional surrender” of all microbes.
⁵

As the 1950s began, medicine could look back and count numerous other successes as well. Pharmaceutical firms had developed improved anesthetics, sedatives, antihistamines, and anticonvulsants, evidence of how scientists were getting better at synthesizing chemicals that acted on the central nervous system in helpful ways. In 1922, Eli Lilly had figured out how to extract the hormone insulin from the pancreas glands of slaughterhouse animals, and this provided doctors with an effective treatment for diabetes. Although replacement insulin didn’t rise to the level of a magic-bullet cure for the illness, it came close, for it provided a biological fix for what was missing in the body. In 1950, British scientist Sir Henry Dale, in a letter to the
British Medical Journal
, summed up this extraordinary moment in medicine’s long history: “We who have been able to watch the beginning of this great movement may be glad and proud to have lived through such a time, and confident that an even wider and more majestic advance will be seen by those living through the fifty years now opening.”
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