Finding Help Between Drugs and Marketing

Re “Truth: a Bitter Pill for Drug Makers,” Opinion, Jan. 25: Greg Critser has it exactly right that the use of selective serotonin reuptake inhibitors (antidepressants) reflects a tenacious mix of medical and cultural factors. These medicines are overused for some patients, underused in others. It’s so easy to accept the idea of a chemical imbalance. It sounds reasonable, whether or not it’s scientifically true. If the doctor buys it, so will the patient. And when the drug appears to work, it looks like the “imbalance” has been corrected. It’s circular reasoning, but it’s very powerful.

Critser’s proposed solutions -- having the Food and Drug Administration debate cultural issues, closer monitoring of patients -- only address the medical pieces of the puzzle and can’t succeed by themselves. He says the SSRIs’ better safety record, compared with older meds, is a myth, but it’s no myth. Although SSRIs shouldn’t be monitored casually, there is no question that they are safer than the older drugs, whose risk of death by overdose is well known.

Depression is a life-threatening illness. The problems with SSRIs shouldn’t blind us to their benefits, even if we don’t fully understand how they work. Meanwhile, Critser does well in reminding the public to be wary of the limits of scientific knowledge and the power of drug companies’ marketing skills.

Richard Moldawsky MD

Anaheim

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Does anyone else find it somewhat ironic that large U.S.-based corporations feel totally justified in exporting their jobs overseas yet insist on legislation to prevent us, the citizens of this country, from purchasing for ourselves from overseas? They claim this is being done “for our protection,” of course.

Be it for pharmaceuticals or whatever, these huge corporations want it both ways: They want to be able to freely manufacture anywhere in the world they can get labor at the cheapest rates, but heaven forbid that I, as an individual, should use the Internet to shop anywhere in the world I can get the cheapest prices. Fair? I think not.

William Bennett

Los Angeles