It reminds me of a quote from a doctor: This relationship with drug companies starts slowly, and builds subtly. You start by holding hands, and the next thing you know, you're in a container on the ocean bound for a brothel in Thailand.

This reminds me of my former job as a Purchasing Manager for an aluminum die casting factory in Jackson MI. The company was insovlent and doing everything possible to stay out of receivership, and were under the close supervision of a committee of their biggest creditors. The company's main method of staying afloat: Pay as few bills as possible. Within a short time of my employment, I found that vendors would call me wondering why they weren't getting paid - the company controller would fail to pay any bills he could get away with not paying. I became a party to this, placing orders that I knew would not be paid for a long time, if ever. This bothered me, so I finally undermined the controller's efforts by buying everything C.O.D., instead the usual terms requiring that we pay the vendor in full within 30 days of receipt of goods. Once or twice I broke the golden rule, sneaking into the accounting office, stealing the stamp that we signed checks with, and paying the vendors myself.

I was like the doctor in your article - I was breaking no laws when making purchases, even if I knew they would not be paid for, and strictly speaking I was acting within the scope of my duties as Purchasing Manager. It was up to others to sign the checks. But the reality was that I was a party to cheating other small businesses out of payment fairly earned (or at least delaying payment unreasonably). After a short time I found that I didn't want to live that way, so I bought everything cash on the barrel until I left the company a few months later.

Sounds like the doctor had a similar change of heart.

THANK YOU FOR DISCUSSING EFFEXOR. I need to make an appointment with my doctor now. Given the importance in managing hypertension, I hope you will consider your quote this morning as having the potential to have saved a life, possibly my own.

THANK YOU FOR DISCUSSING EFFEXOR. I need to make an appointment with my doctor now. Given the importance in managing hypertension, I hope you will consider your quote this morning as having the potential to have saved a life, possibly my own.

Wow - thanks for telling me that. I was up last night blogging this like a madwoman and Gregg kept telling me I needed to get in bed, and it's amazing to know this might make a real difference in somebody's life.

As for this: "Sounds like the doctor had a similar change of heart"...

I don't support being in cahoots with a company to not pay vendors, but there's a difference between screwing somebody over financially and possibly killing or injuing them for life, and that's why I take this so seriously.

I'm in favor of evidence-based medicine (as opposed to taking advice from some gray-skinned lady in the health food store), but I think it's essential to apply strong skepticism in the medical arena.

Here's another from the NYT, by Alex Berenson:

http://tinyurl.com/2fuom8

Prescriptions for the cholesterol-lowering drugs Zetia and Vytorin are written for almost 800,000 Americans every week, at a cost this year of about $4 billion. Yet it still is not clear how well the drugs work.

Nearly two years after the medicines’ makers, Merck and Schering-Plough, completed a clinical trial of the drugs, they still have not released the findings. The delay has led to a growing chorus of complaints from cardiologists. And yesterday, the companies responded by promising to publish a portion of the results next March — but not the entire set of data.

Doctors say that decision is highly unusual and will do little to quell concerns about the trial, as well as broader questions about the effectiveness of the drugs.

Cardiologists have been awaiting the results of the trial, called Enhance, to learn how well Zetia and Vytorin work. If they are not as effective as other cholesterol medicines, patients taking them may be putting themselves at unnecessary risk of heart attacks.

I just don't take any drug that hasn't been out at least 10 years. My health is good, luckily, so not much temptation to.

I always try to emphasize to intro psych students how antidepressants work- they block receptors in your brain so they can't absorb certain chemicals that help dampen depression. That leaves the chemicals out, so they can keep working. Morphine and heroin are addictive because they do the same thing- they block opiate receptors in the brain, and after awhile, the brain figures this out and stops producing it's own opiates. Then when you stop the drug, you don't have anything. That's why I'll bet some people have trouble getting off of SSRI's like Paxil and Prozac. I get that a certain small percentage of people suffer from chemical depression, but most just need to change something dysfunctional in their life. That's what normal depression normally motivates.

Hey, the other day I saw an Alleive commercial where the guy was saying something like, "This knee just kills me every time I run, but with Alleive, I just take one and run all I want!"

Wow.

Yeah - imagine considering that the pain is telling you something, like that you're going to be a cripple at 50 if you don't stop marathoning.

These doctors are at fault, but patients/people need to take the time to be a little self-aware. It's a bad idea (and drives up costs) to go to the doctor to get little things fixed when they can be treated with basic things like rest, fluids, stretching, ice, etc. at home. Part of the problem is people demanding that they get fixed right away - and many doctors are willing to oblige with stuff people don't need or that won't really help (like antibiotics for viral respiratory infections). And part of the problem with taking drugs for depression (BTW Allison, SSRI drugs inhibit reuptake; they don't block receptors. This is a non-trivial difference) is that they may mask the need to take action and fix whatever is causing the depression.

I think the biggest real problem with drugs for depression is that they are too often a substitute for cognitive therapy. The drugs can be very instrumental in making therapy work, but they are not even close to being an adequate substitute.

What are the most reputable publications or Web sites for comparing drugs and educating yourself about effectiveness and side-effects? Does anyone on here have any suggestions?

Hey Justin-

Via Prozac.com under the heading 'How It Works'-

When serotonin is released from the "sending" nerve cell, some of it is reabsorbed by an uptake pump. By blocking the serotonin uptake pump, Prozac increases the amount of active serotonin that can be delivered to the "receiving" nerve cell. This may help message transmission return to normal.

Here's a post on this by a pharmacologist, who blogs at Terra Sigillata, under the name Abel Pharmboy. I also recommend the great PLoS article he links at the end of the post, about MDs as pharma reps.

I was absolutely serious too. I take two meds, one for hypertension and effexor. I like my doctor, but I think he sees drugs as the answer to everything.... But it's been clear the past few weeks that the hypertension meds haven't been working as well as they have in the past. Ringing in the ears, an occasional dizzy spell.

I've known I needed to make the appointment, but now, not only will I make it, but I can talk about getting off the effexor that I've largely regarded as bullshit.

Synchronicities, last year a friend's wife had a mysterious spider bite that just got worse and worse. He told us about it, and I showed him an article I had just read about MRSA....

So thank you.

Thanks again...and yes, you really have to approach medical advice with skepticism.

...And part of the problem with taking drugs for depression...is that they may mask the need to take action and fix whatever is causing the depression...

Glad he qualified that with a "may." It's easy to assume that depression is always situational and not chronic.

You may need a WSJ subscrip to check this out, but here's a link to a Health Blog item by David Armstrong about a prof who it seems was being asked to stamp her name on a study she didn't do:

http://blogs.wsj.com/health/2007/11/21/odd-ghostwriting-offer-raises-researchers-blood-pressure/

An excerpt:

Sealey, professor emerita of physiology and biophysics in medicine at the Weill Cornell Medical College, is a well-known expert in hypertension. But she was being asked to author a report on research she hadn’t conducted. In fact, she had never heard of the drug until receiving the email pitch.

To Sealey, it appears the company was shopping for a name to slap on the cover of internal drug company research. “I was totally perplexed,” she says. “I surmised they wanted a name and maybe a woman because they were going to compare the drug in men versus women.”

The email indicates the abstract would have to be submitted by Nov. 19 — just a week later. But the email assured Sealey that she wouldn’t have to do much work. “We can draft the abstract, offer our editorial support in developing the content of the abstract and help with the submission process on your behalf,” wrote Liz Burtally, who identifies herself in the email as a medical writer “for the nebivolol team working with Forest Laboratories.”

Burtally sent another email on Nov. 13, and called Sealey the next day. Sealey asked a lot of questions. Would she be the only author? Yes, she says she was told. When Sealey asked if she would have access to the raw data, the phone went dead. Burtally never called or emailed again.

The Health Blog called Burtally, who says she didn’t hang up on Sealey, but confirmed the call was cut off. She said Forest Labs had recommended Sealey for the authorship. Asked if it was common to ask someone to author an article on research they hadn’t conducted, she said “no, not really.”

When told it appeared the company was offering to ghost write the abstract for Sealey, Burtally said she wasn’t sure what to call the proposed arrangement. She did say Forest wasn’t going to go forward with the planned abstract.

When told it appeared the company was offering to ghost write the abstract for Sealey, Burtally said she wasn’t sure what to call the proposed arrangement. She did say Forest wasn’t going to go forward with the planned abstract.

Oh, I don't know. How about fraud?

I had a doctor (as a result of insurance changes) for a short time that reached for the prescription pad first thing. This made me very nervous. I went back to my old doctor, who actually explains shit.

I'm also a bit leery of the whole "here, take this pill and be happy" kick that so many brain doctors are on. I mean, if you've got a woman who's being psychologically abused by her asshole husband, is the right answer really "here, take all these pills"? I'd think that the answer is "kick the fucker out". My gut tells me that the incidence of true, biological depression is much smaller than the drug companies would like anyone to believe.

Hey Justin-

Via Prozac.com under the heading 'How It Works'-

When serotonin is released from the "sending" nerve cell, some of it is reabsorbed by an uptake pump. By blocking the serotonin uptake pump, Prozac increases the amount of active serotonin that can be delivered to the "receiving" nerve cell. This may help message transmission return to normal.

Feel free to accuse me of pedantry, but.

Right, as I said, SSRIs block reuptake but don't block don't block receptor sites. This is a significant difference. In simple terms, an SSRI drug makes more of your body's serotonin available by blocking the natural process by which neurons take the serotonin your body produces back in (aka, reuptake). Opiates like heroin or morphine are agonists, which work by binding to and activating the receptor sites normally activated by your body's natural opiates. Other drugs, e.g., PCP, are antagonists; they bind to a given receptor site and block the normal action of that site (in the case of PCP, that's NMDA receptors). So, it's not accurate to say that SSRIs block receptor sites; in general, the term block also isn't very informative as to the action of drugs in the brain. And, comparing SSRIs to opiates in terms of their psychopharmacology is off-base.

brian -

Even when a cognitive approach is called for, drugs can be a big help. Take the hypothetical you describe. Ok great, easy to say she should kick the fucker out. But how about dealing with why she's with him in the first place. Get to the cause of her innate sense of self-loathing that pushes her to go for the dipshit that's going to beat her. Get to the place where she realizes that she not only can, but should leave him.

Meds can make the difference between dealing with the bullshit that put her there and a life of misery. The problem is when the drugs are the only therapy. In that case, she's just as likely to stay with the asshat and feel better about doing so.

I am not disputing the existence of memetic dysfunction, capable of being alleviated by cognitive therapy; although I have come to realize that insight is highly overrated. (Epimenides would have liked that.) That said, what is the evidence that all or most non-situational depression is memetically rather than chemically based?

THANK YOU FOR DISCUSSING EFFEXOR.

I'd like to second that, Amy. My wife is currently taking Effexor and is also being treated for hypertension. I had no idea it caused hypertension so we'll be having a chat about it tonight. Thanks.

The hairs are standing up on the back of my neck. My daughter's on Effexor. Fortunately, her blood pressure is low and her doctors are weaning her off it already because she's doing so well and the therapy seems to be helping much more than the drug. She has had problems with insomnia and that's also one reason they're looking to get her off it. I printed out this article for her and will encourage her to rely more on therapy and to discus this with her doctor. The scary thing is since they started lowering her dosages she has had some crying jags over such trivial nonsense that I'm left stunned watching it. This helps me understand why. So, yes, thank you, Amy, for posting this.

That said, what is the evidence that all or most non-situational depression is memetically rather than chemically based?

What do you mean by this? Are you talking in terms of Dawkinsian memes? As in, cultural comparisons, keeping up with the Joneses (a la Robert H. Frank's comparisons of relative wealth, etc.)?

University of Michigan's Randy Nesse has done some very interesting thinking on depression being adapative: "low mood" in response to continual frustration...ie, slowing you down so you'd stop doing the thing that was getting you nowhere.

phunctor -

Who exactly is making that claim? The claim that I am making, is that even in situational depression medication can be a critical component of the necessary cognitive therapy. This is because when one is delving into the root cause/s of their depression, it is likely to make it much worse in the delving. To forestall the potentially serious spiral effect, medication can and often should be used.

If you actually read my posts, you will see that I advocate using cognitive therapies as well, indeed believe they are a critical component. I believe this is true of chronic depression, as well as situational.

For studies and articles analyzing them, do a google search of scienceblogs.com (depression, neuroscience, neurology, medication, cognitive) There are a number of neurologists, psychiatrists and cognative therapists blogging there. Articles at Retrospectacle, Neurophilosophy, Cognitive Daily and Corpus Collosum, would be great reads.

To be absolutely clear on my position. I think that in nearly all cases a cognitive approach is essential. In many, if not most cases, medication is also an important factor in therapy. Studies have shown that even with situational depression, chemical imbalances are a common occurrence. Likewise, chronic depression does not necessarily mean that the chemical imbalances are always there. It simply means that the person has a strong propensity for said imbalances, i.e. they are easily triggered.

Let me make it clear that I'm not anti-drug; in fact, I'm about to take 10 milligrams of Ritalin right now. I'm just for prudent, evidence-based use of drugs...as opposed to evidence-omitted or evidence-fudged use of drugs.

The FDA is also part of the problem:

I've got something bad to tell you about those pills you took today. The people who are supposed to make sure they're as safe as possible may be failing.

CAROLINE NEVELS: If the FDA would've been doing their job, my daughter would still be here today.

BRANCACCIO: We've got the whistleblower at the Food and Drug Administration with a civics lesson from hell. When government regulators cozy up to the industries they regulate, the results can be deadly.

DR. DAVID GRAHAM: That's 50 people a day for 5 years, who had heart attacks and it basically happened while the FDA said "this drug is perfectly safe."

BRANCACCIO: And what did the agency do? Instead of going after the drug… it went after him.

Full transcript:
http://www.pbs.org/now/transcript/transcriptNOW101_full.html