This is a wonderful book. It has many strands, but the main themes are whether SSRIs cause suicidal thoughts and whether SSRIs increase the risk of suicide. This was the topic of a recent BMJ cover and the cumulative graph of meta-analyses shows that SSRIs do increase the risk of suicidal thoughts and suicide. Healy was one of the authors of this definitive article.
Healy believes that SSRIs are more dangerous than drug companies are willing to admit. This book describes his journey towards proving this belief and the lengths Pharma went to stop him. Along the way he describes the birth of antidepressants (he has written a definitive history of the creation of psychopharmacology), how drug companies initially did not value antidepressants and how they came to love them. He describes his role in working for drug companies and then acting as an expert witness against them in several trials. At one time he finds himself working for lawyers funded by the Church of Scientology. At times the book whizzes along at the speed of a thriller.
His description of large psychiatric meetings is positively Hogarthian: famous speakers delivering papers written for them by drug companies, which they have not even read prior to speaking; drug companies funding most people who are there; halls of stalls giving away every type of gift/bribe to complicit professionals. He describes how many articles by ‘eminent’ psychiatrists are ghost written by drug companies. He also describes how large amounts of money can be made by complying with Pharma. GPs are not exempt from his justifiable wrath.
This is upsetting enough. But the way in which the pharmaceutical industry has led the medical profession by the nose is much worse. I started in general practice 17 years ago. I remember my evangelical crusade against benzodiazepines. I thought I was an individual fighting the rising tide of Valium. How wrong I was. Valium and its compatriots were off patent and held little attraction for drug comapnies. A new generation of expensive pyschoactive drugs was on the way. Funded and supported by the drug industry, anxiety became a thing of the past and depression became the new illness/epidemic that had to be treated. Think of all the depression campaigns of the 80s and 90s. Most were partially or wholly funded by Pharma. A current example is the way osteoporosis and osteopaenia are now being pushed as ‘epidemics’. I began to understand how a lot of ‘independent’ thinking was being manipulated by Pharma and the drive for profits.
The most frightening chapter follows the experiences of healthy volunteers who took SSRIs. Up until this point the drug companies blamed any suicidal ideation or suicides on the illness; depression, not the drug. This study, run by Healy, showed that healthy volunteers on SSRIs may have severe suicidal ideation. The volunteers had enough sense to stop the drug. Patients, who are told by their GP to stay on the drug for a month, may not feel they can stop the drug and go on to kill themselves or others. Eventually Healy was allowed access to the drug companies' hidden files on their own healthy volunteer studies. These studies showed that the drug companies had had the same results and not only was suicidal ideation reported, one healthy subject actually committed suicide. These reports were initially suppressed for many years by the drug companies.
This is a sobering book for all GPs, especially those who believe that they think for themselves and are not influenced by Pharma. It shows how powerful the companies are at influencing how and what we think about illness, let alone what we prescribe.
- © British Journal of General Practice, 2005.