Misdeeds — from hiding study results to paying off doctors — have made Big Pharma an inviting and, frankly, an appropriate target… Antidepressants have something like celebrity status; exposing them makes headlines.
It’s not that anti-depressants have celebrity status; it’s that more Americans take them than almost any other drug. Americans of all ages, including very little children. They make headlines because they are – I and many other observers believe – massively over-prescribed.
Peter Kramer’s missing the point here, in other words. As a result, his effort, in tomorrow’s New York Times, to defend anti-depressants against Marcia Angell, Irving Kirsch, and a range of other scientists who’ve argued that they achieve only a slightly better outcome than placebos, has a vague, irrelevant feel. He complains about the limitations of the studies Angell and Kirsch cite, but these limitations aren’t particularly significant, and the studies he cites have their own limitations.
Kramer insists, for instance, that anti-depressants seem to work for “social unease.” He does not ask whether social unease is something we should think of as needing treatment. Treatment with powerful brain-altering chemicals, chemicals that have significant side effects. He does not ask what we should do about a culture in which wall-to-wall happy pill television commercials make socially uneasy people demand anti-depressant medication.
Instead, Kramer points out that “data bearing on the question is messy.” Yes, it is. But increasingly the data points toward remarkably little effect, for many of the people taking them, from anti-depressants. To say this is not to be a headline-grabber. On the contrary, it is to express a concern about the well-being of one’s fellow Americans.
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Lacking an empirical basis for his claim that anti-depressants deserve to be given to masses of people, Kramer turns to scare tactics.
[I]t is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.
No one says anti-depressants are placebos. Would that they were. People getting bad side effects from anti-depressants would be far safer taking placebos. What people are increasingly saying — and shame on the press for reporting it! — is that when it comes to lifting depression, these pills are pretty much the same as placebos. For most people, they don’t seem to do squat.
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Felix Salmon also notices the remarkably vague, not-really-there feel of Kramer’s article.
July 9th, 2011 at 8:09PM
[…] of drugs have to be defended. Because, apparently, not enough people are hooked on the junk. Here is a brilliant post by University Diaries analyzing this intellectually dishonest […]
July 9th, 2011 at 10:11PM
I said my piece yesterday so I won’t repeat it here.
http://www.margaretsoltan.com/?p=31441
July 10th, 2011 at 2:20PM
“He does not ask whether social unease is something we should think of as needing treatment.”
It’s not up to you, or society at large for that matter, to determine whether “social unease” or any other mental health malady should be treated. Rather, it’s a decision made between patient and doctor. If the patient’s “social unease” is impairing or causing marked distress, then the condition is worthy of treatment. If the patient is apprised of the risks, benefits and alternatives to [insert evil medication], and expresses understanding and consent, then why should society cry out against that?
I offer depressed patients three general options:
1. Meds
2. Therapy
3. Meds + Thereapy
Guess what the majority opt for? Hint: It’s not therapy alone. Anyway, I know that psychiatry and its unholy relationship (at least academic psychiatry’s unholy relationship) with pharma has brought a lot of appropriate criticism. And of course, the debate over the definition of mental illness has gone on for hundreds of years, and I suspect will go on for hundreds more. In the meantime, those of us at the front lines are still pressed to find solutions to their patients’ travails, and antidepressants still remain an effective tool in helping our patients reclaim their lives.
July 10th, 2011 at 3:34PM
Kevin Nasky:
Actually, it is up to me – it’s a primary responsibility of mine as a citizen – to determine as best I can what social unease means, and whether I and my fellow Americans should be medicated for it. As a doctor dealing with a spectrum of complaints from suicidal despair to social unease, you know little more than I, or anyone else who bothers to inform herself, about the empirical bases, if any, underlying these complaints. Nor do you know much more than informed laymen do about chemicals or placebos that might lessen the complaints.
From Daniel Carlat’s book, Unhinged:
“Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” “Our diagnostic process is shallow.” “We know so little about the underlying neurobiology of … causes that our treatments are often a series of trials and errors.” “Psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all.” “I have no idea how Lexapro works to relieve depression, nor does any other psychiatrist.” “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep.” “When psychiatrists start using what I call neurobabble, beware, because we rarely know what we are talking about. … Using these words makes [the] illness seem more biological… But few laypeople realize how little we actually know about the underpinnings of these disorders.”
Since those of you on the front lines have done nothing to lessen depression rates in this country, and since there’s plenty of evidence you’re overprescribing antidepressants for many of your complainants, your There, there, little lady, I’ll take care of it. argument fails. If more Americans regarded the dispensing of antidepressants and anti-psychotics skeptically, we wouldn’t be in the mess we’re in.
I know that there are many cases in which antidepressants – or their placebo effect – help your patients reclaim their lives. There are many, many more cases, I believe, in which psychotropics take over people’s lives in a very bad way. That there are commercial interests making billions of dollars off of this situation is disgusting.
July 11th, 2011 at 10:09AM
Felix Salmon (!) on antidepressants:
http://blogs.reuters.com/felix-salmon/2011/07/11/the-antidepressant-debate/#comments
Salmon has a phenomenal talent for writing clearly about complicated subjects, you can see here that it’s a talent that comes from working at it.
July 11th, 2011 at 6:40PM
MattF: Thank you so much for the link to Salmon’ s piece. I’ll put the link in my post.
February 19th, 2012 at 9:37AM
[…] New York Review of Books was also, I guess, explosive… But so far that essay prompted only a flaccid little response from Peter Kramer in the New York Times. We’ve heard nothing from the companies that make billions […]