Bipolars A Drag On Economy? Bullshit!

Last week, there was a slew of media coverage of a study asserting that bipolars lose 65.5 days of work a year (a combination of missed days and allegedly "lost" productivity), twice that of people with depression. The cause, according to the study by Harvard's Ronald Kessler, has nothing to do with mania and everything to do with bipolar depression, which is apparently more disabling than regular old depression. I'm not sure that I buy the study's assertions, at least in their broad implications, nor the resulting media coverage. (The study also lead to a nice thread in one of the bipolar group's on MySpace.)

But, then, I am having trouble with the study itself. It was part of a broader national health survey and, as such, was working with an interview instrument called CIDI. The survey is not administered by docs nor does it diagnose a mental illness or ask if the alleged bipolars were officially diagnosed (that would create survey bias problems also). Instead the survey was something of a proxy for diagnoses, meaning that the people identified as being bipolar could only be classed as being bipolarish.

Although I have not obtained a complete copy of the study yet (I was kinda busy with other things last week), another article in the same issue of AJP mentions something about the study that troubles me: It states that the bipolars losing all all those work days were, in fact, a subset of the people being identified as bipolarish in the study. This subset was comprised of people who worked 20 hours a week. To whit:

"From scores on the WHO Comprehensive International Diagnostic Interview (CIDI), investigators identified individuals who met diagnostic criteria for major depressive disorder or bipolar disorder. Among these individuals, they identified a subgroup of individuals that were employed at least 20 hours per week. Among these employed individuals, they found annual prevalences of 6.4% and 1.1% for major depressive disorder and bipolar disorder, respectively. These individuals were asked to report their absences from work as well as assess their performance at work on a scale in which 100 represents fully effective work performance and zero represents no productive work. The ratings of absenteeism and "presenteeism" (i.e., low performance while at work) were combined to estimate annual days of lost productivity and the costs associated with those losses."

It is from this subset, from what I can tease from accounts of the study itself, that the news went out that bipolars are basically a drag on the economy.

And our friends at NIMH may have helped the hype along with a press release that states, in part: "Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression."

That's horseshit, especially since the conclusion is drawn from a study that distorts the full range of experience of bipolars. It enables a discouraging tendency in the media to draw conclusions without looking behind the numbers. Why would they when they got the word from NIMH itself? It also reflects a tendency among researchers to focus their journal articles on the most-wounded subgroups of the mentally ill, which permits to media to play along and paint a false, incomplete picture of us. If you were an employer, would you hire someone with bipolar disorder after reading this news? Would you find a way to screen them out? Would you find a way to fire them?

Why don't Ron Kessler, one of the grand poobahs in the bipolar research world, and his colleagues focus some attention on highly-productive bipolars? Are we not worthy of study because it would upset the applecart of assumption about mental illness? Did that national survey turn up evidence of people who were bipolarish who worked 60 hours a week? In fact, who the hell were the people in the survey to begin with?

I work 60 hours a week, between the day job and this work. Why don't people like me get included in papers like these? I know quite a few bipolars in my professional life who are over-achievers—I am talking about highly successful lawyers, cops, software engineers and so on. Why isn't the media interested in them? I am not arguing for political correctness here, but I do expect NIMH and researchers to not misrepresent the the fact base on the broad range of bipolar disorder and those who live with. They are working with our tax dollars, after all.

Or is there no money or news in studying and writing about people with mental illnesses who do quite well in life and who aren't committing acts of violence? What's the agenda here? Once I confirm my suspicions with the entire paper, I will bring this to NIMH's attention and, if warranted, will ask they they distribute a correction or clarification to their press release.

To be deeply skeptical, let me point to a hypothetical possibility. Kessler's study asserts that bipolar depression results in loads of lost work days among a select subset of a bipolarish population. That is being spun that bipolar disorder itself results in many lost work days, mostly due to bipolar depression. AstraZeneca is the maker of an atypical antipsychotic called Seroquel. One of the alleged benefits of that drug, according to numerous studies (funded by AZ of course) is that it well-treats bipolar depression. It is already approved by the FDA for treating schizophrenia and acute-phase manic episodes. AstraZeneca has an application before the FDA seeking approval to market Seroquel for use in treating bipolar depression. I have little doubt that the FDA will approve the application. Once it does, what do you want to bet that AZ's marketing focuses on this lost work days hypothesis and points to Seroquel as a fix for that? What do you want to bet that the media plays along?

I bet I am right. Stay tuned.