Wednesday, October 05, 2005

Big Pharma Bullies: PMDD is Crap!

About two years ago, I was sitting in the exam room of my OB/GYN when I happened to glance upon the wall and see a poster of a women that was half medusa and half sorority girl. The poster was advertizing "Sarafem," which to those of you who are not as obsessed with Big Pharma as I am, is fluoxetine. Fluoxetine is the generic name for Prozac. When Eli Lilly lost its patent for Prozac, it quickly remarketed it as "Sarafem" and argued that Sarafem treated Pre Menstrual Dysphoric Disorder (PMDD). This is one of the most obvious ways that Big Pharma has invented diseases that only they can cure with their compounds. PMDD is a controversial "mental illness," with very little consent that it belongs in the Diagnostics and Statistics Manual of Mental Disorders (DSM).

When I gazed upon the half medusa/half sorority girl poster I was outraged. Here, staring in my face was a poster telling me that if I took Sarafem, I would be less like that ratty, bitchy medusa and more like the serene, sweet natured blonde. I pointed the poster out to my nurse practitioner, who rolled her eyes and said she found this whole campaign to be bullshit. I asked her for it. I was about to give a talk on Prozac up at Columbia and wanted this poster as an illustration of my point.

Big Pharma goes after women alot. Watch the Direct-to-Consumer (DTC) advertisements for anti-depressants. They rarely, if ever, feature a man. They feature soccer moms who are neurotically trying to balance career and work (with, it seems, no other help than Prozac). The idea here is that the stressed out, exhausted mood that many women who balance career and children find themselves in is not a reflection of unfair social arrangements. Women are depressed because they have a "chemical imbalance." That phrase, btw, says nothing and yet it is commonplace, nowadays, to hear people explain their states of mind in those terms.

What does that mean "chemical imbalance"? Everything about us is chemical or biological. You eat fruit, chocolate, take Thera-Flu, run 5 miles, do yoga and, guess what, you are altering your neurochemistry. The imbalance part assumes that we know what the proper "balance" of neurohumors are, and since neuroscience is still figuring this out, I find it odd that Big Pharma has already discerned this.

The fact is that the serotonin hypothesis of depression is false. It was a convenient way to market SSRI drugs, like Prozac, to a great deal of people. You tell people that they have a serotonin deficiency like Diabetes' patients have an insulin deficiency, and whammo, Prozac to the rescue. It's bad science, and profit driven marketing. Why not argue that we have an alcohol deficiency? Afterall, after a couple drinks, I usually feel much less irritated. The logic that if you give someone a Serotonin reuptake inhibitor and they feel better, then you were lacking serotonin is silly.

What's more, Lilly knows that, so when it lost its patent it invented a new disease to treat: PMDD. The reason drug companies market diseases is because that is the only way they can get a patent to treat an ailment. You cannot manufacture drugs unless they treat diseases. That is why Viagra is for "erectile dysfunction" or "Propecia" is for the disease of male-patterned baldness. (I won't even get into the issue that Big Pharma spends its capital making "lifestyle ailment" drugs rather than really solving diseases.)

Now, I must make this disclaimer, lest those depressed folks out there think I am saying that depression is not real. I do think depression is real. The fact is, if you are suffering from major depression, SSRI drugs are not the drugs for you. They work, often quite effectively, for people who are sub-clincally depressed, for people really strung out with too many responsibilities and burdens. They work for women, who, by large, are the recepients of prescriptions for these pills (click here to see where I started writing about this before). SSRI drugs, however, are either used as "enhancement drugs" for low energy, stressed out and overly sensitive women or they are used to quit smoking and solve PMDD.

The Nation has a piece on this, worth a read: A Disease for Every Pill (thanks to Ralph for the tip).