Some readers have wondered what my problem is with Big Pharma, which in my last post I accused of corrupting medicine and journalism. My problem with Big Pharma is that its products are often--and especially in the case of psychiatric drugs--much less effective than claimed. This was a major theme of my book The Undiscovered Mind. See also my short 1999 oped for the Times, "Placebo Nation." That's also why I've been so scathing about Listening to Prozac, which a responder to my last post recommends, but which I consider one of the Worst Science Books. Peter Kramer's book explores, yes, with great philosophical subtlety the implications of a drug that dispels despair and makes us "happy." Is this happy new me really me? And so on, blah blah blah. But the premise of the book is false! If you read the peer-reviewed clinical trials rather than the puffery of Kramer you would know that Prozac and other SSRIs are no more effective than earlier antidepressants, such as tricyclics, and antidepressants as a whole are no more effective than psychoanalysis and other talking cures. When I made this claim in The Undiscovered Mind in 1999, it was treated as highly controversial, but now it's been overwhelmingly confirmed. Moreover, Listening to Prozac's surge to bestsellerhood in the early 1990s coincided with a surge in Prozac sales. Newsweek also boosted Prozac sales with a March 26, 1990 cover story titled "A Breakthrough Drug for Depression." And so we come full circle.

Comments

[Andrei Kirilyuk]

You are certainly right, John, about Big Pharma interested exaggerations and related corruption. But it appears that the problem is simply deeper than this particular situation around antidepressants. Together with many other cases, it just reveals the fact that the whole modern medicine remains a purely empirical science, without any deeper understanding of unreduced life processes and their interaction with our artificial interventions. They just try it (e.g. a new substance) and if it works, at least with a limited success, they apply it on an industrial scale. And the problem is that there is nothing else, nothing better than this. I think that this was the underlying reason for some questioning on your idea in the previous post comments. There is indeed a growing number of “suffering” people (often also due to deceptive “successes” of that mechanistic medicine and without its ability even to clearly distinguish a “normal” life problem from a pathological deviation), and then there is the only possible proposition of that doubtful “chemistry”. But in the absence of other real choice, all that remains is to try (where people often would rather prefer to believe even not totally reliable publicity). In this sense there is no fundamental difference between that “rigorous” and “scientific” medicine and any Oriental “healing” approach; it's the same trial and error, the same desperate hope of patients, the same unpredictability of individual results, and much more predictable resulting profits... [I can only imagine your reaction to the situation in Ukraine, probably among many other such “developing” countries, where in the absolute majority of cases a patient can buy any desired, including narcotic, drug directly in a drugstore, by a “momentary prescription”, without passing by a doctor (expensive, loss of time, etc.). And they have there the full spectrum of Western chemistry, but also much more doubtful versions from “poor” countries, with a very heavy, unrestricted publicity on TV... Do you imagine the resulting bordello? That's why selling drugs here is a very hot business, the number of round-the-clock drugstores exceeding the number of any other selling points.] Another level of quality of medical interventions is not impossible, but only at another level of knowledge, which is not here yet...

[mike cook]

I got out of primary and secondary education in the U.S. after it became clear that cultural change was forcing the removal of all effective social discipline and almost all effective approaches to moral development.

Consequently, we are raising physically large children who have little or no self control, almost no work habits, no shame, and no reliability when it comes to telling the truth. They do sometimes exhibit a certain complaisance and quietude, which is not at all indicative of a state of peace of mind, but only the outward manifestation of their being drugged to the eyebrows with expensive Big Pharma products which allow the hard-working parents and the greedy Education Establishment to pretend that these children are being educated.

[Dan Sandberg]

What you´re saying about prozac not being more effective than earlier antidepressants is something every doctor with some knowledge about psychiatrics know. In fact, tricyclics are considered more effective than prozac against severe depression. So, why use prozac? Prozac has two important advantages: relatively low occurence of adverse effects, and low toxicity (difficult to use for suicide!).

On anti-depressants versus psychotherapy: according to a review of the research on this topic done by a public-funded institute in Sweden, anti-depressants are more effective than psychotherapy for treating severe depressions, and the effect of medical treatment occurs earlier. Besides; psychotherapy is extremely expensive and also time-consuming.

[Peter Kramer]

For the record, Listening to Prozac said that tricyclics are probably more effective than SSRIs for treating major depression and that psychotherapy remained the most important treatment for minor depression.

[Maury Markowitz]

"If you read the peer-reviewed clinical trials rather than the puffery of Kramer you would know that Prozac and other SSRIs are no more effective than earlier antidepressants, such as tricyclics"

You don't have to read peer-reviews to learn this. I clearly remember the public message when these drugs were introduced that they were of similar effectiveness, but had fewer side effects.

That's a very real benefit. One that you ignore in this diatribe. One that, if mentioned, changes the nature of the debate considerably.

Complaining about the drug industry using misleading tactics is one thing, but using the same tactics (intentionally or not) while doing so is downright insulting.

Indeed, your complaint about big pharma's effects on journalism appear accurate; one needs only to look at this post.