The marketing of selective serotonin reuptake inhibitors in the psychopharmacological industry presents a serious moral problem for the corporate model of medicine. In this paper I examine ethical issues relating to the efficacy and safety of these drugs. Pharmaceutical companies have a moral obligation to disclose all information in their possession bearing on the true risks and benefits of their drugs. Only then can patients make fully informed decisions about their treatment.
- FDA, Food and Drug Administration
- SSRI, selective serotonin reuptake inhibitors
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↵i For a view wholly favourable to the development of SSRIs and their therapeutic benefits see P D Kramer’s Listening to Prozac, especially chapter 3.7 David Healy offers an expanded history of this development and a counterargument to over inflated claims of the benefits of SSRIs in his Let Them Eat Prozac.8
↵ii This is described by Flores in the article in the Textbook of Psychopharmacology.12 This widely used classic of psychopharmacology provides the standard evidence in favour of the serotonin hypothesis but fails to discuss any evidence against the theory. This problem is repeated in Nemeroff’s paper in Scientific American.13
↵iii Direct to consumer advertising of pharmaceuticals is prohibited in every country except the United States and New Zealand.22
↵iv The psychological disorder “social phobia” was replaced by the marketable “social anxiety disorder”, which falls within the generic category of “depressive illness” now treatable with SSRIs. Since simple cases of shyness are on a continuum with social phobia, SSRIs have been prescribed for the former without any real assessment of the risks or the legitimacy of the very idea of such nosology. SmithKline Beecham’s business plan26 is a rare glimpse of how sales reps are encouraged to prepare themselves “to take full advantage of the opportunity Social Anxiety Disorder provides to differentiate Paxil, grow our market share and achieve our super bonus goal of passing Zoloft and attaining $1.5 billion in sales. Let’s get psyched!”
↵v See my case study in the Hastings Center Report for direct evidence of ghost writing30 and the discussion of this in a speech by Paul Flynn MP.31
↵vi A whole issue of The Journal of Clinical Psychiatry in 1997 was devoted to Antidepressant Discontinuation Syndrome. These papers were presented by opinion leaders at the closed symposium “SSRI Discontinuation Events” held 17 December 1996, in Phoenix, Arizona, sponsored by Eli Lilly.
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