Posted by joe schmoe on July 13, 2011, at 0:49:03
In reply to Re: Peter Kramer - mixed feelings, posted by mtdewcmu on July 13, 2011, at 0:07:54
> Actually, that sounded like a good idea to me. But you also raise a good point. Maybe doctors could be allowed to prescribe a drug off-label after the patent has expired, or after some set number of years. Keep in mind that if doctors were required to prescribe "on-label," the drug companies would have an incentive to get new drugs approved for the widest possible range of conditions.
No, only for conditions that would yield enough prescriptions to pay for the studies. Less common conditions would not be worth the investment by the company.
> Right now there is little incentive to get an antidepressant approved for, say, GAD, when it can just be prescribed off-label.
And for good reason - if a drug is safe, it's safe, and its interactions will be the same regardless of what it is prescribed for. A reason SSRIs are widely prescribed is because they are amazingly non-toxic.
> Some psych drugs undeniably work, and I don't think Marcia Angell is saying they don't. For instance, I don't think anyone doubts that lithium works for bipolar disorder. But if you're talking about SSRIs, how can you be sure that the drug cured you and you didn't just get better on your own?
The article was about antidepressants, and interestingly, mentioned at the beginning how they were discovered by accident (the original purpose of isoniazid and iproniazid was to treat tuberculosis). Despite the fact that no one was looking for a cure for depression (no placebo effect here!), the drugs worked for depression. The author of the article (and the books) blissfully ignore this fact for the rest of their discussions. Obviously, antidepressants work, and it has nothing to do with the placebo effect.
> There is an important difference here. Penicillin can be proven to work better than supportive care in double-blind studies. Prozac can't.I don't believe this for a minute. I believe the "no better than placebo" argument was debunked the minute it came out: the patient populations in these studies were not the patient populations psychiatrists actually see, but were adults who had never received treatment for depression before, in order to remove "complicating factors" like coming off another antidepressant. Talk about a skewed sample. Anybody with serious depression problems would not spend their lives waiting around for a pharm study, when there were already so many agents available (including, at the time of Prozac, imipramine).
It's easy in an antibiotic study to find people who just got infected. It's not so easy to find people who just "got" depression, especially if it is a genetic brain chemistry disease.
> One part of her article that raised questions in my mind that she didn't answer was the part about the exploding number of diagnoses in the DSM. Just because the diagnoses exist on paper doesn't mean that psychiatrists are going out of their way to find people to pin them on. Virtually anyone that walks into a psychiatrist's office can walk out with a prescription for antidepressants. Most of the dubious diagnoses in the DSM are not things that require heavy-duty drugs, they'll probably be treated with antidepressants. It doesn't follow automatically that just because there are more diagnostic categories that patients will be treated with more or heavier drugs.I think it's clear that when people find out there is a cure for something, they will seek out professional help instead of just enduring it. An example is restless legs syndrome (which the article also mocks). People who have this real disorder - and I suffer from it at times myself - suffered from it for decades with no diagnosis and no cure until fairly recently, when some light began to be shed upon it as a dopamine problem (and which a dopamine related drug could address). No doubt there is now a "skyrocketing" population of people seeking a cure, now that they have heard that doctors will actually give them one instead of giving a mystified shrug.
Who bothers to get a diagnosis for a condition when there is no cure? Of course people didn't bother in the past, especially when depression and other mental health issues were very heavily stigmatized. Frankly I am glad Big Pharma advertised these medicines enough to make the TV-watching non-patient general population realize that people with various issues were not "crazy" but simply had a common medical problem.
As I have stated elsewhere, for most of history, most people were farmers and did not have to deal with other people. Only in the 20th century did this pattern change, and I think it created a horribly stressful society for non-extroverts. It is no surprise to me that there has been an explosion of mental illness in the 20th century. What's amazing is how long stigmatization managed to keep it under wraps.
poster:joe schmoe
thread:990777
URL: http://www.dr-bob.org/babble/20110630/msgs/990889.html