When U.S. Rep. Adam Smith woke up, clenched by a sudden, inescapable and intense fear of an unknown source and the inability to get out of bed in 2005, he knew something was wrong.
The moment signaled the start of his first major bout of anxiety, which lasted five months and catalyzed a decadelong battle with mental and chronic health that now serves as the subject of his new memoir, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.”
In the book, Smith chronicles the saga from his first anxiety diagnosis to the myriad treatments he tried — including drugs like benzodiazepines, SSRIs and clonazepam — to his days in psychotherapy, and his challenges with lower body pain and hip surgeries.
The low point came in April of 2016 when Smith’s health conditions combined with “the fascinating mix of pharmaceuticals coursing through [his] body.” Despite his position of power, the Seattle, Washington-area congressman questioned if he was “finally broken.”
More than personal aggravation, though, the struggle sparked a change in how Smith viewed the U.S. healthcare system. Namely, Smith said it strengthened his belief that patients’ desire for a quick fix to health problems, along with misaligned market incentives in the industry, have led to the overprescribing of pharmaceuticals for mental health.
Now the highest-ranking Democrat on the House Armed Services Committee, Smith oversees billions in defense spending including budgets for departments like DARPA that support pharma innovation. And Smith said his personal revelations could impact his approach to regulating the healthcare industry moving forward.
“Society has focused a great deal on the outrageous cost of certain prescription medications, and rightly so,” Smith, wrote. “But the overutilization of many of these drugs, driven by a healthcare and drug industry focused more on making money than on positive results for patients is every little bit as evil and devastating to our society.”
We caught up with Smith to discuss how his struggles with mental and chronic health have impacted his outlook on drug policy, and his views on the pressing changes needed to fix the system.
This interview has been edited for brevity and style.
PHARMAVOICE: In the book, you mention your view that pharmaceuticals are overprescribed in the U.S. for mental health conditions like anxiety and depression. Could you elaborate on that view, and how your own mental health experience has influenced it?
REP. ADAM SMITH: I'm a very detail-oriented person and I believe that the specifics matter. I do start with the premise that we overprescribe medications for mental health conditions in this country because we spend a lot of money that could be better spent on other treatment options and because those medications frequently don't help. I have no doubt that there are certain instances where medications are enormously helpful and important for people with mental illnesses.
Part of the problem with healthcare in general is, if you have a severe healthcare problem, the odds are it's going to take a fair amount of work to get better, whether you're talking about understanding your anxiety and depression or if you're trying to get over some sort of physical injury. Whereas if there is a pill you can take, that strikes people as much easier. A part that no one ever wants to talk about is the degree that this is driven by patients — patients’ desire for a quicker and easier fix to a problem and an unwillingness to do the work.
And not to speak ill of the pharmaceutical industry, but there is another overarching problem in America right now, and that is the fact that profit and investors have become too much of the obsession of absolutely everything your average company does. And in the pharmaceutical industry, the more drugs you sell, the better you do. Furthermore, if you can find a drug that treats a widespread illness, well ding, ding, ding, you're in good shape because you're going to have a lot more people who are going to want to buy it. And it's aggressively advertised and promoted.
Do you see the pharma industry having a role in preventing this?
I think pharmaceutical executives want to be honest with themselves as opposed to simply being interested in profit. They need to think about how the profit motive can undermine the health of people. ‘Celexa didn't work for you? Let's do a three-month trial of Zoloft. Well, 20 milligrams didn't work for you? Let's try 40.’ Yes, you can make a healthcare argument for taking that approach. I don't agree with it. But it's also a rather convenient way to sell off a lot of drugs.
"A part that no one ever wants to talk about is the degree that this is driven by patients — patients’ desire for a quicker and easier fix to a problem and an unwillingness to do the work."
U.S. representative, Washington's 9th district
I always love to joke; I am a capitalist like Adam Smith. What choices do I have? It's the way the world works. But what has happened in America in the last 50 years is there’s supposed to be a balance —which by the way my namesake wrote a great deal about — between the profit motive and other societal goods, like how much money are your workers being paid, or are they able to meet their needs? And so the responsibility, in my mind, of the corporation should be to broader societal goals.
Policy-wise, how do you go about fixing that?
One of the things that a lot of pharmaceutical industry folks can fall back on is ‘I've got a fiduciary responsibility to my shareholders.’ If I'm in a position to make them another billion dollars by pushing some drugs, it's of marginal value. Then in their minds, their ethical choice is pushing the drug — that's their fiduciary duty. I think we need to change what their fiduciary duty is. I’m working on this legislation so that they also have a responsibility to other broader societal goals, but it’s tough. And if corporations won't do it, then I think government bodies will be forced, or should be forced, to regulate the crap out of them.
In the book, you said: ‘Health care policy is not easy.’ You mentioned that you're working on legislation to balance the incentives. Can you elaborate on that?
It’s really kind of a difficult scene to figure out right now. But a lot of the balance that I was talking about is corporate responsibility. Because a lot of what we run into is an argument from corporations, that they are legally obligated to maximize shareholder profit. And at first glance, it's fine — you're trying to run a business and people made an investment based on the idea that they’re going to get a return on that investment. But there are all kinds of crazy things you can do to maximize shareholder investment. In corporate law, there are a lot of incentives in there that push corporations to make those decisions. So we can change corporate law to say, ‘OK, you need to care about shareholder profit. You also need to care about the health, safety, wellness and well-being of your workers and the communities where you do business.’ So I would love to figure out a way to do that and I confess I've sort of run into a brick wall at the moment, but I'm still looking at options.