FacebookTwitterGoogle+RedditEmail

The Depressing Truth About Anti-Depressants

by STAN COX

A paper published January 17 in a prestigious medical journal demonstrated in the starkest of terms how pharmaceutical companies tend to publish research that’s favorable to their products and leave unfavorable results tucked away in their files. It’s a problem that everyone outside the industry already recognizes, but the results of this most recent study should really set off alarms.

Led by Dr. Erick Turner of the Oregon Health and Science University in Portland and published in the New England Journal of Medicine [1], the study took the results of 74 Food and Drug Administration (FDA)-registered trials of antidepressant medications (trials done by the companies that developed the drugs) and compared them with the results that the drug companies published in peer-reviewed medical journals. The study involved 12 antidepressants approved between 1987 and 2004.

In seeking approval of new drugs, companies are required by law to register their clinical trials with the FDA before conducting them, and then report results to the agency when they’re done. Of those 74 trials, the survey found 38 that showed antidepressants to be effective, and all but one of those was duly published. But stunningly, out of 36 trials that showed the drugs to be of questionable or no benefit, the results from only 3 trials were published accurately. Of the rest, 22 were not published at all. All of the other 11 that were published concluded that the drugs did have a positive benefit, in direct contradiction of FDA’s conclusion.

So, in the authors’ words, “studies that the FDA judged as positive were approximately 12 times as likely to be published in a way that agreed with the FDA as were studies with nonpositive results.” And it wasn’t just a matter of holding back results. Trial-by-trial, the beneficial effects of antidepressants as published in medical journals were 18 percent bigger than those recorded in the official FDA data. The authors don’t speculate on how this effectiveness-inflation occurred, but combined with selective publication of positive results, it made antidepressants look a lot better than they really are.

Antidepressants are the most frequently prescribed class of drugs in the US, with about 60,000 prescriptions written every working hour. Encouraged by all those favorable journal papers, doctors tripled their prescription-writing for antidepressants between 1988 and 1998 [2], and prescriptions had shot up another 31 percent by 2005. The greatest increase has come among doctors who are not psychiatrists. The products have become a convenient way to deal with people who find themselves in rough situations. Soldiers in Afghanistan and Iraq are reportedly being given “bags of antidepressants” and upwards of one-third of nursing-home residents are taking antidepressants at any given time.

FDA registration is designed to curtail the kind of deceptive publication practices that can boost unnecessary prescribing, and their data for more recently developed drugs are available on the agency’s website. (But getting data for the eight older drugs examined by Turner and colleagues required use of the Freedom of Information Act). Most academics, journalists, and others looking to inform the public on a drug’s overall usefulness rely on studies published in medical journals as being the “gold standard” for reliability. So biased publishing, coming on top of heavy advertising [pdf], overtesting [3], and close interaction between sales reps and doctors, is a highly effective way to improve the market for a drug.

Turner’s study looked only for exaggeration of antidepressants’ benefits, not at their often terrible side effects. But selective publication can also keep the public in the dark about serious harm that drugs can do. Most infamously, Merck & Co. was accused of leaving out some negative results and spinning others from trials of the pain-reliever Vioxx, when a study of the drug’s association with an increased risk of heart attack was submitted to the New England Journal of Medicine. By the time Vioxx was withdrawn in 2004, FDA estimated that it had caused in the range of 25,000 to 50,000 fatal heart attacks.

Each year, the drug industry churns out enough product to fill more than 15 prescriptions per American, and that adds up to more than $200 billion in annual sales. An international survey of the medical literature showing that around 5 percent of hospital admissions result from avoidable adverse drug reactions [4]; that means about 2 million of the pharmaceutical industry’s customers end up needlessly hospitalized each year. Countless other people are suffering side effects without even taking the drugs; they are simply living too close to pharmaceutical factories in India and other countries that export to the US.

It’s a depressing situation, one that can be resolved only by taking drug testing out of the hands of the corporations themselves.

STAN COX is a plant breeder and writer in Salina, Kansas. His book Sick Planet: Corporate Food and Medicine will be published by Pluto Press in April. They can be reached at: t.stan@cox.net.

Notes

1. E.H. Turner et al., ‘Selective publication of antidepressant trials and its influence on apparent efficacy’, New England Journal of Medicine, 358: 252 (2008)

2. S.M. Foote and L. Etheredge, ‘Increasing use of new prescription drugs: a case study’, Health Affairs, Jul-Aug, 2000

3. D. Studdert et al., ‘Defensive medicine among high-risk specialist physicians in a volatile malpractice environment’, Journal of the American Medical Association 293: 2609 (2005) and D. Merenstein et al., ‘Use and costs of nonrecommended tests during routine preventive health exams’, American Journal of Preventive Medicine 30: 521 (2006).

4. H.J.M. Beijer and C.J. de Blaey, ‘Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies’, Pharmacy World and Science 24: 46 (2002)

 

 

 

 

More articles by:

Stan Cox (@CoxStan) is an editor at Green Social Thought, where this article first ran. He is author of Any Way You Slice It: The Past, Present, and Future of Rationing and, with Paul Cox, of How the World Breaks: Life in Catastrophe’s Path, From the Caribbean to Siberia

Weekend Edition
February 16, 2018
Friday - Sunday
Jeffrey St. Clair
American Carnage
Paul Street
Michael Wolff, Class Rule, and the Madness of King Don
Andrew Levine
Had Hillary Won: What Now?
David Rosen
Donald Trump’s Pathetic Sex Life
Susan Roberts
Are Modern Cities Sustainable?
Joyce Nelson
Canada vs. Venezuela: Have the Koch Brothers Captured Canada’s Left?
Geoff Dutton
America Loves Islamic Terrorists (Abroad): ISIS as Proxy US Mercenaries
Mike Whitney
The Obnoxious Pence Shows Why Korea Must End US Occupation
Joseph Natoli
In the Post-Truth Classroom
John Eskow
One More Slaughter, One More Piece of Evidence: Racism is a Terminal Mental Disease
John W. Whitehead
War Spending Will Bankrupt America
Dave Lindorff
Trump’s Latest Insulting Proposal: Converting SNAP into a Canned Goods Distribution Program
Robert Fantina
Guns, Violence and the United States
Robert Hunziker
Global Warming Zaps Oxygen
John Laforge
$1.74 Trillion for H-bomb Profiteers and “Fake” Cleanups
CJ Hopkins
The War on Dissent: the Specter of Divisiveness
Peter A. Coclanis
Chipotle Bell
Anders Sandström – Joona-Hermanni Mäkinen
Ways Forward for the Left
Wilfred Burchett
Vietnam Will Win: Winning Hearts and Minds
Tommy Raskin
Syrian Quicksand
Martha Rosenberg
Big Pharma Still Tries to Push Dangerous Drug Class
Jill Richardson
The Attorney General Thinks Aspirin Helps Severe Pain – He’s Wrong
Mike Miller
Herb March: a Legend Deserved
Ann Garrison
If the Democrats Were Decent
Renee Parsons
The Times, They are a-Changing
Howard Gregory
The Democrats Must Campaign to End Trickle-Down Economics
Sean Keller
Agriculture and Autonomy in the Middle East
Ron Jacobs
Re-Visiting Gonzo
Eileen Appelbaum
Rapid Job Growth, More Education Fail to Translate into Higher Wages for Health Care Workers
Ralph Nader
Shernoff, Bidart, and Echeverria—Wide-Ranging Lawyers for the People
Chris Zinda
The Meaning of Virginia Park
Robert Koehler
War and Poverty: A Compromise with Hell
Mike Bader – Mike Garrity
Senator Tester Must Stop Playing Politics With Public Lands
Kenneth Culton
No Time for Olympic Inspired Nationalism
Graham Peebles
Ethiopia: Final Days of the Regime
Irene Tung – Teófilo Reyes
Tips are for Servers Not CEOs
Randy Shields
Yahoomans in Paradise – This is L.A. to Me
Thomas Knapp
No Huawei! US Spy Chiefs Reverse Course on Phone Spying
Mel Gurtov
Was There Really a Breakthrough in US-North Korea Relations?
David Swanson
Witness Out of Palestine
Binoy Kampmark
George Brandis, the Rule of Law and Populism
Dean Baker
The Washington Post’s Long-Running Attack on Unions
Andrew Stewart
Providence Public School Teachers Fight Back at City Hall
Stephen Cooper
Majestic Meditations with Jesse Royal: the Interview
David Yearsley
Olympic Music
FacebookTwitterGoogle+RedditEmail