thanks for this. I was struggling to characterize his position. "What drugs are available to us - and why?" is a good one. I found his politicization of the history of pharmacology -- the 60s attempt to lump drugs into this category or that, or even assign the same drug to both categories, depending on the analysis, was fascinating. I was especially fascinated since this distinction, one based on the so-called addictiveness of the drug, was exactly the stuff I was taught in the late 80s. If it was addictive, then bad. If not, then good. As Healey notes, lumping all those drugs into one category, as disruptive because addictive, was quickly undone a few years later. But recogniztion of antipsychotic dependence disappeared, precisely because it was inconvenient to the social construction of good v. bad drugs.
So, when he concluded by saying, are we going to lose the SSRIs because of this categorization, just as we've lost other classes of drugs, I thought it was a brilliant point to make. It certainly doesn't put him in the "SSRIs are bad" camp.
I mean, seriously, he spends his time writing about the potential problems with SSRIs, not because he wants to get rid of them, but because he wants to improve research, he wants to improve clinical trials, he wants to improve his patients lives with better SSRIs and with diagnoses and treatment that help them.
Fact is, a month ago, I'd seen the title, suggested by Amazon. I poo pooed it because Let Them Eat Prozac was reminiscent of some pot-boiler craptastic demonization of drugs and psychiatry that would be far too simplistic after reading Our Daily Meds and Shyness. I figured it was one of those books someone quickly writes in order to capitalize on a social phenom.
I only started reading it because a controversy broke out over Susie Bright's column, which doug posted here. A friend lambasted Susie and I defended susie and criticized my friend's position that Susie was condescending and that it is inapropriately and possibly oppressively normalizing to suggest that non-drug treatments be tried first.
Susie wrote me and I read another piece she wrote. The links led me to crazymeds.us which led me to Healey.
The other aspect of his writing I appreciated was -- speaking of Carrol's concerns about research -- were his very sophisticated examination of what we mean by "what works" when we think about clinical trials. Again, he says stuff here that could make you think his barking up one tree, and then he shifts just slightly and you realize you had him wrong, he's not barking up that cliched tree after all. His critique is far more complicated than something like "corporations=bad" or "capitalism=bad" or "science=bad".
Mostly, I think this is because he _is_ a clinician and researcher, embedded in the field, and one of the many researchers who, yes, DOES take money from drug companies to support his work, but also someone who stands as expert witness against those same drug companies.
His criticism of clinical trials, as well as his crits of trials that don't use placebos, was interesting. As was this piece on Evidence BIASED Medicine:
"We are in an era, which is popularly portrayed as an "Evidence Based Medicine" era. What can go wrong if we have clinical trial evidence to demonstrate what works and what doesn't work, if we but adhere to this evidence (Slide 20). What more can we do than that?
Arguably, the term "Evidence Biased Medicine" would be more appropriate. Clinical trials in psychiatry have never showed that anything worked. Penicillin eradicated a major psychiatric disease without any clinical trial to show that it worked. Chlorpromazine and the antidepressants were all discovered without clinical trials. You don't need a trial to show something works. Haloperidol and other agents worked for delirium and no one ever thought to do a clinical trial to support this. Anaesthetics work without trials to show the point. Analgesics work and clinical trials aren't needed to show this. Clinical trials nearly got in the way of us getting fluoxetine and sertraline.
What clinical trials demonstrate are treatment effects. In some cases, these effects are minimal. One may have to strain with the eye of faith to detect the treatment effect. The majority of trials for sertraline and for fluoxetine failed to detect any treatment effect. This is not evidence that sertraline or fluoxetine do not work. In clinical practice many of us are under no doubt that these drugs do work. It is, rather, evidence of the inadequacy of our assessment methods. To show that something works, we would need to go beyond treatment effects to show that these effects produce a resolution of the disorder in a sufficient number of people to outweigh the problems such as dependence syndromes that these drugs also cause. If our drugs really worked, we shouldn't have 3 times the number of patients detained now compared with before, 15 times the number of admissions and lengthier service bed stays for mood and other disorders that we have now. This isn't what happened in the case of a treatment that works, such as penicillin for GPI."