Sunday, April 30, 2006

Disease Mongers   posted by agnostic @ 4/30/2006 06:26:00 PM

You may not be interested in Big Pharma, but Big Pharma is interested in you.

PLoS Medicine has an issue on the pharmaceutical industry's disease mongering. I liked this article on serotonin & depression, namely the disconnect between the muddy consensus within neuroscience (it may or may not be somehow involved) and the boastful direct-to-consumer advertisements (if you're depressed, you've probably got low levels of stuff we're happy to sell you). Given how little we understand about the brain compared to other organs; given how little we understand of the long-term effects of brain drugs; and given that we have recent evidence that -- prepare to be shocked -- Big Pharma honchos will try to keep harmful side-effects under wraps lest their profits suffer; I'd say it's a good bet to stay away from the stuff.

That raises the question: should we keep others from using such things as well? It's their body and their money, correct? Yes, but under the present circumstances, a good case could be made against their use -- namely, that they wouldn't have seen a doctor and asked for medicine had not the PR & advertising industries knowingly mislead them as to the status and/or cause of their condition. Again, this is crucial if they're being mislead as to the long-term consequences, which are potentially great when we're talking about drugs that affect an organ we understand poorly. Since it's easier to screw up a complex system than to improve it, we should adopt that as the null hypothesis for brain drugs, which only longitudinal studies could disconfirm.

Now, if the disease were life-threatening, like liver failure, you could argue that if the patient consents, dire measures could be taken -- after all, they face imminent death in any event, and basic work (where doctors will break some eggs) is needed in order to fine-tune the art of liver transplants before they become safe. In such cases, maybe. But anxiety and depression, let alone the conditions treated by "lifestyle drugs" such as Viagra, are not in the same league as liver failure. Moreover, you could make a similar argument to one for closing up most plastic surgery offices: that is, they represent a failure of the market to allocate resources where they're needed. The smartest, most highly motivated doctors should be where health is lowest (mainly the elderly and poor), not making Orange County housewives look like space aliens with shotput boobs.

On the other end of the spectrum in the PLoS issue, there's this review of Female Sexual Dysfunction from a feminist / social constructionist p-o-v. Typical of critiques against "reductionist" approaches, it gets some of it right but for the wrong reasons. She's right that FSD is mostly made-up by Big Pharma and that men & women are different, though not due to social forces but to different biology. If natural selection allowed the average female to have a sexual appetite equal to that of the average male -- say bye-bye to the advantage of female choice. Ditto for reliability of orgasm -- if it were as simple as the male version, any old bum could win her over provided his body was warm.

In any case, what do the readers think the best strategy is for keeping Big Pharma on a tight leash? Clearly, it's not rationally arguing the issue with them, as they already understand the shortcomings but don't care. So, some sort of force or threat of force is needed -- not physical, obviously. I should clarify: what can we do? Surely the FDA could enact harsh measures, but they've proven to be wimps.