Medicines out of control?

Antidepressants and the Conspiracy of Goodwill

Charles Medawar & Anita Hardon

reviewed by Mira de Vries

Guess who made the statement below?
    And yet so little of this is considered that one frequently hears the long continued use of some sedative lauded with naïve exultation, and without a word being said, or apparently without a thought being given, as to whether patients recovered better, or recovered at all, by taking it …
    A single dose, or an occasional dose from time to time, at the commencement or in the course of a mental disorder, as a palliative, may certainly be useful, but its habitual use is pernicious … When that which may be used fitly as a temporary help – whether it be stimulant or narcotic – is resorted to as an abiding stay, the result cannot fail to be disastrous.

It was pioneer psychiatrist Henry Maudsley, writing in 1895, that's right, 110 years ago. He was referring to chloral, one of a steady stream of drugs touted as the solution to emotional problems. It was preceded by alcohol, opium, morphine, cocaine, and heroine, and followed by the bromides, barbiturates, benzodiazepines (such as Valium), amphetamines, and various types of “antidepressants,” most recently, the SSRIs. Every one of these drugs was in its day prescribed by physicians (yes, even alcohol). Every one was considered effective and safe. Every one was widely used, including by children. Every one was claimed to be non-addictive. In fact, every one of these drugs except alcohol and the bromides were used to treat addiction to the previous drug of fashion once that drug’s harmfulness could no longer be denied.

A. R. Cushny wrote in his 1928 textbook: “Numerous drugs have been proposed for the cure of morphinomania [morphine addiction] but none of them seems to have the slightest effect.” This statement, when extended to addictions to all sorts of drugs and their proposed cures, is still as true today.

In 1957 R. A. Hunter wrote an equally enduring truth: “…not only do the patient’s symptoms for which barbiturates were in the first place prescribed, return in full force when a dose wears off, which might but for drug-taking have subsided without treatment – but they are reinforced by the symptoms of barbiturate abstinence ... From then, the drug is no longer taken for the original symptoms, but simply to ward off increasingly distressing abstinence symptoms. The cause of this exacerbation may not be recognized by doctor or patient – both may think his original illness has got worse. This may lead to yet further increase in barbiturate dosage with the result that not only do abstinence symptoms become severer, but the symptoms of barbiturate intoxication are added as well… Thus a mild psychiatric disturbance, in all likelihood amenable to one or two sympathetic interviews, becomes converted into a serious and perhaps protracted illness.” A half century later there are hundreds of psychiatric drugs on the market, but not one to which Hunter’s statement would not apply.

By quoting these statements, Medawar & Hardon have amply demonstrated that the inefficacy and harmfulness of the SSRIs was more than predictable. However, the main issue that they address in their book is not the folly of psychiatric drugging nor the phoniness of most drug claims, but the façade of drug regulation. This applies to all modern medicines, although it is most blatantly demonstrated by the SSRI story.

Their book’s catchy title hints that there is no control. Government watchdog agencies in reality cater to industry interests, not, as we like to imagine, the individual consumer’s. Actually, “patients” are the one party that these agencies have consistently ignored.

Medawar & Hardon have done an excellent job of presenting their case. But what about a solution? Immensely to their credit, they exercise restraint in not proposing unrealistic schemes. In fact, they propose none at all. They only fleetingly mention the need for “honest science and decent democratic values” without a suggestion how such might be achieved or judged.

This is what MeTZelf proposes: Let’s do away with (bogus) government regulation and prescription laws.

“What?” many an astonished reader will respond. "But we need protection. Think of thalidomide.” Indeed, think of thalidomide. This is what Medawar & Hardon say about it:
The thalidomide crisis will always be unique because of the innocence of the victims and the sudden, shocking evidence of harm. But thalidomide happened because there was no independent control for drug safety – whereas the SSRI crisis had grown under the aegis of an elaborate and expensive global system of drug control. (their emphasis)
The logic of this statement is flawed. If the SSRI crisis grew under drug control, how can the authors conclude that lack of drug control caused the thalidomide crisis? This might be explainable if the SSRI crisis were more contained than the thalidomide crisis, but they concede it is not. In numbers, the SSRIs have far outstripped thalidomide. The mischief these two drugs have caused is incomparable because of the uniqueness of thalidomide's harm, as the authors rightly state, yet the harm from SSRIs is also shocking, albeit less graphically sensational. Government drug control has obviously only set the scene for more crises, not in the least place by lulling the public into forsaking the vigilance that the thalidomide crisis might have taught us.

Furthermore, whereas in many European countries thalidomide was sold over the counter, SSRIs have always been available everywhere by prescription only. Far from fostering wise use, prescription laws, like watchdog agencies, discourage vigilance. In addition, they stimulate consumption. Manufacturers of all sorts of goods invest in persuading consumers to use their products, but no persuasion is as compelling as a doctor’s prescription.

The only fair appraisal can be that watchdog agencies as well as prescription laws, like most of the drugs they regulate, do more harm than good. Although the authors do not reach this conclusion, Medicines out of control? presents a powerful argument for the abolition of government interference in the drug market.

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