More doubts about Prozac

[unixronin]

Recently, Prozac and related SSRI antidepressants were dealt a blow when it was made public that Eli Lilly, Glaxo-SmithKline and the other manufacturers of the drugs had failed to disclose data from unfavorable clinical studies that showed patients using SSRIs had an increase as much as four to one in suicide risk.  Now, a new study from Hull University, using the data submitted to the FDA to gain approval for the drugs, has found that for most patients, SSRIs are no more effective than a placebo.

Eli Lilly, of course, defends the drugs' effectiveness; and another researcher, the head of psychopharmacology at Bristol University, says that "if they provide some sort of placebo benefit, this shouldn't be discounted."

Now, the thing that immediately occurs to me is this: If you have the choice between a placebo that is medically inert, and has no side effects that aren't psychosomatic, or a drug that performs no better than the placebo, but has a vicious side-effect profile and may quadruple your likelihood of suicide ... aren't you better off with the placebo?

Clarification:

I should point out that I have not read the studies cited; I have only read summaries.  My intention here was not to discuss the studies per se, but rather to question the idea that it's still a good idea to use a drug with known severe side-effects for it's placebo-like effect if it's (allegedly) no better than a placebo.

Comments

[jmkelly.livejournal.com]

Odd that we find it unethical to deceive patients with placebos, but not to supply them with active drugs that may have serious side effects. I guess that's a good thing; it's hard to reconcile respect for the patient with deception.

[unixronin.livejournal.com]

In the case of the placebo effect, I think it's a tough call. Remember, the Hippocratic oath says, "First, do no harm". Given how well documented the placebo effect is, I have always thought it bizarre that it's considered unethical — if your intent is to cure the patient, and you know that the condition is such that no harm will be done if you try using an inert placebo first and thus avoiding the risk of adverse reactions or side-effects, I would have thought the Hippocratic Oath would REQUIRE that you try the placebo first.

Of course, this is complicated by the fact that if it becomes common knowledge that you may be issued a placebo first, there's the risk that the placebo won't work because the patient knows it's a placebo, and there's even the risk of reverse placebo effect reducing the effectiveness of a real drug that the patient believes to be a placebo.