The
Pharmaceutical Journal
Vol 273 No 7315 p327
4 September 2004
|
|
One-sided view but enough to cause an adjustment of opinion |
|
‘Medicines out of control? Antidepressants and the conspiracy of goodwill’, by Charles Medawar and Anita Hardon. Pp x+258. Price £19.25. Amsterdam: Aksant Academic Publishers; 2004. ISBN 90 5260 134 8. |
|
This is an unusually interesting book. It sets out to detail the “systematic fiddling of accounts of drug benefit and risk” in relation to the selective serotonin reuptake inhibitor group of antidepressants, and reviews what is described as “mountainous evidence of regulatory incompetence and inaction”. The authors provide useful overviews of the history of drugs used in mental illness and of the concepts and ever-changing definitions of mental illnesses themselves. There are also insightful, if one-sided, chapters on the pharmaceutical industry, UK regulatory systems and the validity of clinical trial methodology and interpretation. As a whole, the narrative compels readers to re-examine their views on drug treatment of depression. This book is, nevertheless, a polemic and as such gives only one side of the argument. The failing of this book is that its argument is rather weak, unfocused and poorly supported. For example, the authors frequently cite in support of their viewpoint a work of fiction (Le Carré’s egregious ‘The Constant Gardener’), the writings of journalists (not always known for their integrity) and even television programmes. In other places, the authors contradict themselves: they imply SSRIs are not effective but later claim there is sufficient evidence to support the therapeutic use of 5mg daily fluoxetine. The authors also make their conspiracy claim untenable by arguing, in essence, that everyone except the poor patient is involved in it. Despite these reservations, there is enough in this book to cause an
adjustment of opinion in most readers. Few will have their minds changed
but most will find themselves more open to the possibilities expressed
in this book. |
| David Taylor is chief pharmacist, South London and Maudsley NHS Trust, and honorary senior lecturer, Institute of Psychiatry |