One of my first experiences of a media witch hunt came in the late 1980s: the British media had decided that Ativan (lorazepam) caused addiction. The “withdrawal symptoms” were remarkably similar to the anxiety and panic attacks which benzodiazepines are designed to treat but Roger Cook, a swahbuckling tabloid TV journalist, did not allow this to get in the way of a good story. His star victim was Ativan Ada. Our clients at Wyeth decided, despite our advice, that avoiding him would be the best strategy. Cook flew to the US and tracked down Wyeth’s CEO, Bernard Canavan, at the Philadelphia Country Club. On camera, Canavan told Cook to “get of my f***ing golf course” and hit him over the head with a golf club (Cook’s recollection of the event is here.) We recorded the broadcast and the next day I flew to the US to show the tape to Canavan, all the while trying to avoid my overwhelming feeling of Schadenfreude.

Wyeth refused to stand up to the tabloid bullies because so few psychiatrists would say in public what was obviously true: when people stop taking benzodiazepines, they often experience a recurrence of the same distressing symptoms for which the treatment was prescribed in the first place. Most would say it loudly and forcefully in private and many encouraged Wyeth to oppose proposed restrictions on use but hardly any would go on TV

In the 25 years since, a vast litigation and therapeutic industry has grown up around “benzodiazepine addiction”. Experts often ignore inconvenient data as we’ve noted in earlier stories. Other stories have been heavily skewed: look, for example, at reporting of a Finnish study on which drugs are associated with an increased risk of homicidal behaviour by patients taking them. The really interesting bit is that taking non-opiate painkillers (ibuprofen, for example) seems to make you much more likely to turn into a killer. Too many reports downplayed this puzzling finding (although it was highly significant) and focussed instead on the link to benzodiazepines — the finding is equally puzzling (and less statistically clear) but it feeds an established prejudice.

No popular media, that I have seen, reported a brave letter to the editor of World Psychiatry this month. Three researchers from major universities wrote about the need to appraise benzodiazepines “realistically”. As with any medicine, there are risks and adverse events but, they write, “clinicians know that benzodiazepines, like any other medications, are unlikely to entail permanent and definitive solutions to chronic anxiety states, insomnia and other conditions … The likely reasons for their ongoing popularity include their consistent and reliable effectiveness for the most prominent symptoms of anxiety, relatively good tolerability, quick onset of action, possibility of using them on an ‘as-needed’ basis and the realization that the newer antidepressants have not been as useful for anxiety and related disorders as they had initially seemed to be … Physicians should remain free to prescribe benzodiazepines like any other psychotropic medications. Suggesting simplistic measures for complex clinical issues is not an answer. Informed prescribing rooted in critical thinking is.”

 

ativan