“What if the way people understand the world is wrong? What if it isn’t politicians that shape the way people live their day-to-day lives, but secret business deals?” This is the question at the heart – and at the start – of Jacques Peretti’s new three-part documentary series.
Now my understanding of the world is that big businesses are constantly trying to shape new and bafflingly complex ways they can mine fresh, rich seams of our cash. They’re basically looking to frack us at every available opportunity. Thus Peretti’s opening gambit initially seemed about as contentious as the proposition that David Davis is an insufferable tossbag. Having said that, when I was little, I was convinced that I was being spied on via invisible cameras mounted in my bedroom, so maybe I’m just horrifically paranoid from the outset.
Peretti has a calm, persuasive air and tied strands together with a convincing clarity
Not to worry though, if I am, there’s almost certainly a pill that can help me – but at what cost? Looking at deals in the health industry for this first episode, Peretti started with the vast expansion of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. The increase in recognised conditions it contained helped to more accurately and effectively diagnose mental health conditions and was a watershed moment for GPs. However, it also meant more potential patients and, before you could say, “increased sweating, diarrhoea and a loss of sexual appetite” Pfizer – which had recently brought Sertraline to the market – stumped up the money to develop an assessment test to see which of us was depressed. The head of the DSM project, Robert Spitzer, has previously suggested that these events may have led to the needless medicalisation of 20-30% of the USA's population. 
It was a view echoed by Spitzer’s colleague, Allen Frances (pictured above). He also pointed out that, as a diagnostic tool, the DSM was, and remains, invaluable. It can help patients to feel they have a recognised illness; help them to see it as a medical condition rather than a state of being. Of course, a scalpel is also an invaluable tool that can benefit patients, but in the hands of a ruthless salesman, it could just as easily slit a well person’s throat in order to stuff a blisterpack of happy pills down it.
The question of over diagnosis in grown-ups is a complex one, and was presented as such, but the light Peretti shone on the rise of the number of children classed as ADHD was simply shocking. It was, he said, the research of Joseph Biederman, Thomas Spencer and Timothy Wilens that led to strong, anti-psychotic drugs – drugs made by companies who were paying these doctors – being dished out to children as young as two years old. Wilens was interviewed in a short segment here and showed no remorse for being such a shit of a shill. I’d happily diagnose him with a broken leg just before kicking him down a flight of stairs.
Just to be clear, part of the legacy he leaves is 10,000 two- to three-year-olds in the US on Ritalin and Adderall. Ten thousand.
Some people, of course, take this stuff willingly and with no real need, like Eric (pictured below with Peretti), who takes drugs to improve his efficiency or, on the evidence we saw here, type really fast. Needless to say, Eric is not a guy I would consider having a drink with – or indeed any drugs – although the light relief he provided was welcome.
The last two scandals that came under Peretti’s microscope affect us all, ill or well. The pricing of generic drugs – essentially a scam which can see the cost of drugs rise when there’s no competition – sees big pharma companies ripping off an NHS already straining at the seams. Thankfully, the legal loophole that allowed this has since been closed, but the attitude that exploited it remains.
One issue that remains far from resolved is one that was intended to help our health service by introducing AI into the diagnostic process. In 2015, Google owned-company Deep Mind did a deal with the Royal Free Trust that saw them gain access to 1.6 million confidential medical records without handing over a penny. In fairness, this was in order to build algorithms to pre-empt disease in patients, but it was still a huge data protection issue. Plus it's a bit like buying a hugely expensive car off someone and then finding that you have to supply the engine. For free.
Overall, it felt a coolly balanced and well-researched film by Peretti. He has a calm, persuasive air and tied strands together with a convincing clarity. I’m not entirely sure that the conclusions were as earth-shattering as he’d like us to think (people being sacrificed on the altar of big business? Who’d have seen that coming?) but the fine detail was no less diverting for that.
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