The Medicalisation of Everyday Life

September 1st, 2008 by Ben Goldacre in adverts, alternative medicine, bad science, big pharma, celebs, equazen, fish oil, medicalisation, nutritionists | 43 Comments »

As the pace of medical innovation slows to a crawl, how do drug companies stay in profit? By ‘discovering’ new illnesses to fit existing products. But, says Ben Goldacre, in the second extract from his new book, for many problems the cure will never be found in a pill.

image

Ben Goldacre
The Guardian
Monday September 1 2008

When you’ve been working with bullshit for as long as I have, you start to spot recurring themes: quacks and the pharmaceutical industry use the exact same tricks to sell their pills, everybody loves a “science bit” – even if it’s wrong – and when people introduce pseudoscience into any explanation, it’s usually because there’s something else they’re trying desperately not to talk about. But my favourite is this: alternative therapists, the media, and the drug industry all conspire to sell us reductionist, bio-medical explanations for problems that might more sensibly and constructively be thought of as social, political, or personal. And this medicalisation of everyday life isn’t done to us; in fact, we eat it up.

In 2007 the British Medical Journal published a large, well-conducted, randomised controlled trial, performed at lots of different locations, run by publicly funded scientists, that delivered a strikingly positive result: it showed that one treatment could significantly improve children’s antisocial behaviour. The treatment was entirely safe, and the study was even accompanied by a very compelling cost-effectiveness analysis.

Did this story get reported as front-page news in the Daily Mail, natural home of miracle cures (and sinister hidden scares)? Was it followed up on the health pages, with an accompanying photo feature, describing one child’s miraculous recovery, and an interview with an attractive happy mother with whom we could all identify?

No. This story was unanimously ignored by the entire British news media, despite their preoccupation with antisocial behaviour, school performance and miracle cures, for one very simple reason: the research was not about a pill. It was about a cheap, practical parenting programme.

imageMeanwhile, for over five years now, newspapers and television stations have tried to persuade us, with “science”, that fish-oil pills have been proven to improve children’s school performance, IQ, behaviour, attention, and more. As I have documented with almost farcical repetitiveness in this paper, these

so-called “fish-oil trials” were so badly designed that they amounted to little more than a sham. In the case of the biggest, “the Durham trial”, the county council has refused even to release the results, which I have every reason to believe were unflattering.

I’m not desperately interested in whether fish-oil capsules improve children’s IQ, and I say this for a number of reasons. Firstly, I’m not a consumer journalist, or a lifestyle guru, and I am not in the business of handing out “readers’ health advice”. Also, if you think about it rationally, any beneficial effects of fish oil on school performance will probably not be all that dramatic. We do not have an epidemic of thick vegetarians, and humans have shown themselves to be as versatile as their diets are diverse, from Alaska to the Sinai desert.

But I wouldn’t start with molecules, or pills, as a solution to these kinds of problems. The capsules Durham are promoting cost 80p per child per day, while it spends only 65p per child per day on school meals, so you might start there. Or you might restrict junk-food advertising to children, as the government has recently done. You might look at education and awareness about food and diet, as Jamie Oliver recently did very well, without recourse to dodgy pseudoscience or miracle pills.

But you might also step away from obsessing over food just for once and look at parenting skills, teacher recruitment and retention, orsocial exclusion, or classroom size, or social inequality and the widening income gap. Or parenting programmes, as we said right at the beginning. In fact, Durham’s GCSE results, where the “trial” was performed, improved far more in the year before the fish-oil pills were introduced, after a huge input of extra funding and, more importantly, extra effort from local teachers and the community. But the media don’t report stories like that: because “pill solves complex social problem”, even if it’s not true, is a much better angle.

The fish-oil story is by no means unique: repeatedly, in a bid to sell pills, people sell a wider explanatory framework, and as George Orwell first noted, the true genius in advertising is to sell you the solution and the problem. Pharmaceutical companies with serotonergic antidepressant drugs to sell have worked hard, in their direct-to-consumer advertisements and their lobbying, to push the “serotonin hypothesis” for depression – the idea that low serotonin causes low mood – even though the scientific evidence for this theory is growing thinner every year. Meanwhile the nutrition supplements industry promotes dietary deficiencies as their treatable cause for low mood.

But this fish-oil story is also a classic example of a phenomenon more widely described as “medicalisation”, the expansion of the biomedical remit into domains where it may not be helpful or necessary. In the past, commentators have portrayed this as something that doctors inflict on a passive and unsuspecting world, an expansion of the medical empire; in reality, it seems that these reductionist biomedical stories can appeal to us all, because complex problems often have depressingly complex causes, and the solutions can be taxing and unsatisfactory.

In its most aggressive form, this process has been characterised as “disease-mongering”. It can be seen throughout the world of quack cures – and being alive to it is like having the scales removed from your eyes – but to understand its relevance to the pharmaceutical industry, we need a quick primer in medical history.

Before 1935 doctors were basically useless. We had insulin, morphine for pain relief – a drug with superficial charm, at least – and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn’t yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between the 1930s and the 1970s, science poured out an almost constant stream of miracle cures.

Everything we associate with modern medicine happened in that time: antibiotics, dialysis, transplants, intensive-care units, heart surgery, every drug you’ve ever heard of, and more. For people who were ill, the difference was spectacular. If you got TB in the 1920s you died, pale and emaciated, in the style of a romantic poet. If you got TB in the 1970s, then in all likelihood you would live to a ripe old age. You might have to take rifampicin and isoniazid for months on end – they’re not nice drugs, and the side-effects make your eyeballs and urine turn pink – but if all goes well you will live to see inventions unimaginable in your childhood.

imageTimes have changed. The pharmaceutical industry is in trouble: the golden age of medicine has creaked to a halt, the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of new drugs. Fifty “novel molecular entities” a year were registered in the 1990s, but now it’s down to 20, and many of those are just copies of other companies’ products, changed only enough to justify a new patent. So the story of “disease mongering” goes like this: because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.

Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a new use for Viagra in women), the widening diagnostic boundaries of “restless leg syndrome”, and of course “night eating syndrome” (another attempt to sell SSRI medication, bordering on self-parody) to name just a few: all problems, in a very real sense, but perhaps not necessarily the stuff of pills, and perhaps not all best viewed in reductionist biomedical terms. In fact, you might consider that reframing intelligence, loss of libido, shyness and tiredness as medical pill problems is a crass, exploitative, and frankly disempowering act.

Selling us crude biomedical mechanisms may well enhance the placebo benefits from pills, but these stories are also seductive precisely because of what they edit out. In the media coverage around the rebranding of Viagra as a treatment for women in the early noughties, and the invention of female sexual dysfunction, for example, it wasn’t just the tablets that were being sold: it was the explanation.

Glossy magazines told stories about couples with relationship problems who went to their GP, and the GP didn’t understand their problem (the first paragraph of any medical story in the media). Then they went to the specialist, and he didn’t help either. But then they went to a private clinic. Here they did blood tests – hormone profiles, esoteric imaging studies of clitoral bloodflow – and then they understood. The solution was in a pill, but that was only half the story, and the diagnosis was almost more important: she had a mechanical problem Rarely was there a mention of any other factors, that she was feeling tired from overwork, that he was exhausted from being a new father, or finding it hard to come to terms with the fact that his wife was now the milky mother of his children, and no longer the nubile sex vixen he first snogged on the floor of the student union building to the sound of Don’t You Want Me? by the Human League in 1983.

This is because we don’t want to talk about these issues, any more than we want to talk about social inequality, the disintegration of local communities, the breakdown of the family, the impact of employment uncertainty, changing expectations and notions of personhood, or any of the other complex, difficult factors that play into the apparent rise of antisocial behaviour in schools.

This wishful deafness to the clamour of reality reaches its purest form in our newfound obsession with food, as if it was the most important lifestyle risk factor for ill health, as if every technical detail should be devoured and acted on, for the promise of eternal zest. From the Daily Mail’s ongoing project to divide all the inanimate objects in the world into ones that either cause or cure cancer, to daytime television’s obsession with the healing power of this week’s magic berry, there is no end to this material. Should you believe it? No. I have demonstrated time and again how these claims are flawed in their own specific cases. But something more interesting is being ignored in the background.

The World Health Organisation’s Commission on the Social Determinants of Health reported this week, and it contained some chilling figures. Life expectancy in the poorest area of Glasgow – Calton – is 28 years less than in Lenzie, a middle-class area just eight miles away. That is a lot less life, and it isn’t just because the people in Lenzie are careful to eat goji berries for extra antioxidants, and a handful of brazil nuts every day, thus ensuring they’re not deficient in selenium, as per nutritionists’ advice.

People die at different rates because of a complex nexus of interlocking social and political issues including work life, employment status, social stability, family support, housing, smoking, drugs, and possibly diet, although the evidence on that, frankly, is pretty thin, and you certainly wouldn’t start there.

But we do, because it’s such a delicious fantasy, because it’s commodifiable and pushed by expert PR agencies, and in some respects this is one of the most destructive features of the whole nutritionist project, graphically exemplified by figures such as Dr Gillian McKeith PhD. Food has become a distraction from the real causes of ill health, and also, in some respects, a manifesto of rightwing individualism. You are what you eat, and people die young because they deserve it. You hear it from people as they walk past the local council estate and point at a mother feeding her child crisps: “Well, when you look at what they feed them,” they say, “it’s got to be diet, hasn’t it?” They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 80. You deserve it. Not like them.

Genuine public-health interventions to address the social and lifestyle causes of disease are far less lucrative, and far less of a spectacle, than anything a lifestyle magazine editor or television commissioner would dare to touch. What prime-time TV show looks at food deserts created by giant supermarket chains, the very companies with which the stellar media nutritionists so often have their lucrative commercial contracts? What glossy magazine focuses on how social inequality drives health inequality? Where’s the human interest in prohibiting the promotion of bad foods, facilitating access to healthier foods by means of taxation, or maintaining a clear labelling system?

There is no glamour in “enabling environments” that naturally promote exercise, or urban planning measures that prioritise cyclists, pedestrians and public transport over the car. There are no votes, it seems, in reducing the ever-increasing inequality between senior executive and shop-floor pay. When do you ever hear about elegant ideas like “walking school buses”? Somewhere near you, a softly spoken public-health official has probably tried to interest your local paper in a story on them; presumably the latest urgent food-fad news left no space.

We love this stuff. It isn’t done to us, we invite it, and we buy it, because we want to live in a simple universe of rules with justice, easy answers and predictable consequences. We want pills to solve complex social problems like school performance. We want berries to stop us from dying and to delineate the difference between us and the lumpen peasants around us. We want nice simple stories that make sense of the world.nd if you make us think about anything else more complicated, we will open our mouths, let out a bubble or two, and float off – bored and entirely unphased – to huddle at the other end of our shiny little fishbowl eating goji berries.

image This is an edited extract from Bad Science by Ben Goldacre, published by Fourth Estate today at £12.99. To order a copy for £10.99 with free p&p, call 0870 836 0875 or visit guardianbookshop.co.uk

You can also buy it from Amazon for £6.49, and I recommend doing so, because the price might go up later, and then you’d feel a right charlie. At least you can give it to your local headteacher/quack/MP if you don’t like it.


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If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

43 Responses



  1. macker said,

    September 1, 2008 at 8:00 am

    What was the simple practical parenting programme that the papers didn’t cover?

  2. muscleman said,

    September 1, 2008 at 8:04 am

    Well said Ben, this needs saying and saying lots and in the no holds barred terms you use. Hear! hear!

    NB one small point: it is fazed, not phased so hence it whould have been unfazed. For the second edition ;-)

  3. pseudomonas said,

    September 1, 2008 at 9:27 am

    macker: www.bmj.com/cgi/content/abstract/334/7595/678

  4. ayupmeduck said,

    September 1, 2008 at 9:45 am

    Wow. This is nearly politics Ben. Actually, there’s more real politics here than you will hear from your average MP.

    If you can now figure out how the UK can get out of the monetary policy Cul-de-sac, you’ll get my vote for the next PM ;-)

  5. electric_wizard said,

    September 1, 2008 at 10:20 am

    ” Also “As I have documented with almost farcical repetitiveness in this paper” seems odd if the book isn;t just a clippings job. ”

    Rumbled.

  6. John Smith said,

    September 1, 2008 at 10:34 am

    I don’t think this is about wanting the world to make sense. You may be reading a little of your own personality into that analysis. :)

    This is about people feeling like they’re out of control, and people’s reaction to unalterable fate. It’s about superstition, really.

    People who work in professions where they believe they have no control over the outcome tend to be the most superstitious. Examples include coal miners, who perform all kinds of rituals before going underground, because the mine might explode. They see this as outside of their ability to do anything about it. Sports people are also very superstitious and again, this is because they believe they have no control over the outcome of the game.

    If we believe we believe we have no control over an outcome, we tend to be superstitious. If we have no firm foundation of belief, we go a little crazy. All you have to do to control people is confuse them a little bit, and, as they flap about searching for truth, guide them where you want them to go.

    What all the health scares have actually done is confused people into believing they have no control over their lives or their own well-being. And THAT’s why they believe popping pills can cure everything, including “syndromes” that don’t actually exist. In past societies, they might have performed a rain dance, or made a poultice out of eggs, chicken feathers and tar. Now we take a gelatine-coated pill. But there’s no real difference.

    In some ways, medical doctors are guilty of propagating this. Doctors make no effort to explain WHY a pill works. Most doctors don’t even explain what they’re prescribing. Instead, from the patient’s point of view, they’re given a magical ticket, that they present to a shaman (a chemist), who then gives them magical food they must swallow that clears up their strep throat or make them stop feeling so depressed. They may as well touch wood every hour, or take a pill full of fish oil…

    Doctors should work harder to explain what they’re doing, even if the patient is resistant (and I realise that most are) That should be part of a diagnosis session—an essential element of bedside manner. “You must understand what I am telling you.”

    Once that’s done, people will be more resistant to quack cures, and made-up illnesses, because they will feel they are in control.

    This is the big difference between now and 50 years ago. 50 years ago we felt we knew what was what. If you had a cold, you drank lemon and whiskey, and stayed in bed. You walked daily and ate an apple a day because “it’s good for the constitution”. We had a definite idea of what was good for us, even if sometimes it was off the mark. Nowadays we have no concrete idea of what’s good for us. One report says wine will slowly kills us. Another says that a glass a day will stop us dying of a heart attack. One report says fast food will kill us. Another says that a Big Mac a week is actually good for us. MMR jab? Good for our kids. Bad for our kids. Confusion reigns. Doctors sit idly by, smug in their ivory towers, with their head in order, and baffled as to why everybody elses’ head isn’t in order.

    Ben, I think your analysis is very astute but you’re not looking at the bigger picture. You’re only looking at immediate cause and effect, and drawing divinations from that. The bigger picture is about the nature of humanity, and how we respond to knowledge (and the lack of it). This is perhaps one of the biggest issues of our time as we have more and more knowledge, thanks partially to the Internet, but also thanks to the fact we’re living in a sci-fi universe when pretty much everything is possible.

  7. John Smith said,

    September 1, 2008 at 10:43 am

    Quote: “[the father is] finding it hard to come to terms with the fact that his wife was now the milky mother of his children”

    OK, you HAVE GOT to get t-shirts made with “I’m a milky mother” on. Get them made in XXXL size. Pregnant women will snap them up. It sounds like I’m being flippant but, actually, I’m serious. You might be onto something.

    Get ones made for husbands—ones like the old “I’m with stupid” t-shirts. An arrow pointing left or right, with the words, “I’m with this milky mother.”

    Also, I suggest a range of greetings cards for fathers to send to their wives on the birth of a new child: “Thank you for being the milky mother of my children”.

    :)

  8. A Geek Tragedy said,

    September 1, 2008 at 12:00 pm

    Have you forgotten that you are meant to be a shill for big pharma. The homeopaths on CIF remind you often enough. ;)

  9. Getonyerbike said,

    September 1, 2008 at 1:06 pm

    “The reigning myth of today is that the evils of society can all be understood as evils of impersonality, alienation, and coldness. The sum of these is an ideology of intimacy that transmutates political categories into psychological categories. “Richard Sennett: The Fall of Public Man.

    Alternative myths abound, relevant to this debate though: the depoliticisation of health (ooh, and the environment) by transmutation (great word) into the technological [is a reigning myth]

    In other words, the onus is on scientist to fix political problems, so that when they (frequently) fail, they get the blame.

  10. used to be jdc said,

    September 1, 2008 at 1:40 pm

    “Also “As I have documented with almost farcical repetitiveness in this paper” seems odd if the book isn’t just a clippings job.”

    Rumbled.

    Heh – not if the Guardian article is an edited extract from the book and the actual book does not include that line. I’ll have to remember to check that later.

  11. sideshowjim said,

    September 1, 2008 at 4:12 pm

    I’m sorry, “Dr” Gillian Mckeith “PHD”? A typo, surely…

  12. mrhunnybun said,

    September 1, 2008 at 6:09 pm

    How come Amazon is still showing your book as a pre-order Ben? Is it not released today?

    I was hoping to get it for tomorrow from them, At this rate I may have to visit a SHOP. Horror!

  13. Picklish said,

    September 1, 2008 at 11:35 pm

    @ John Smith
    Many people can be superstitious because they confused by the plethora of advice that is out there, but again there is the danger of simplfying the problem, of simplfying people. Saying that is surely giving a simple answer to a complex question?

    But i agree that education must be the key to helping people, on all levels of the social strata. Doctors and teachers of course play a role in this, but with so many people relying on the media for their knowledge of the world, a large step towards helping people to understand facts and rational thinking is journalists with accreditation in the subjects they write about.

    Which is exactly why we need mass media journalists like Ben,because as a society we still haven’t moved to using the internet objectively as our main source of information. It’s getting better though. The kids of today won’t even bother reading the Guardian or the Mail in the future. Well, we can only hope…

  14. peterd102 said,

    September 2, 2008 at 1:18 am

    ” You might look at education and awareness about food and diet, as Jamie Oliver recently did very well, without recourse to dodgy pseudoscience or miracle pills.”

    Jamie oliver does promote pseudoscience – he advocates rocket with sausages – ****.

    Leave the kid to make their own minds on what to eat, give them the info but dont force them.

  15. peterd102 said,

    September 2, 2008 at 1:45 am

    EDIT actually No.3 The god delusion was at 4 lol – only place youd ever see the two next to each other

  16. notzed said,

    September 2, 2008 at 8:03 am

    From the first section of this article – could it be that you notice these types of stories more because you’re looking out for them? Anyway, just a thought.

    What I’m really curious about is whether the patent system is stifling progress in medical advances. There is currently a raging debate about the problem of software patents – currently only a handful of countries possess them, and none of the major players had to contend with them when they were not major players. Software patents threaten to increase the cost of software development and/or lock out competing software from monopolised markets. Either way, it will have a major negative effect on innovation and technological progress. The argument from the big-wigs is that they need some compensation for their r&d spending – but in reality they just want to monopolise their simple ideas and lock out competitors and competing business models.

    Medial patents tend to be seen as necessary investment protection because of the cost associated with development and approval of drugs. But does the patent system instead encourage the development of ‘paper-wealth’ and ‘innovation’ driven by the minor modification of a drug so they can get a new patent? Does this encourage drug companies to spend more on marketing than r&d?

    Maybe we have come to the end of the road for major medical advances for the time being – but is that a bad thing? Can we all live forever? Then again, we have vaccines for some types of cancer now – for example. Still, if we have come as far as we can, maybe it’s time for some of the wind to be taken out of the drug companies sails. By artificially inflating the worth of these companies – for example through patents – they are also leeching money from other endeavours which may further the human situation on this planet.

  17. gantlord said,

    September 2, 2008 at 11:41 am

    Unphased indeed! I considered not buying your book for a moment. Just a moment though. No 11. in all books!

  18. kim said,

    September 2, 2008 at 1:13 pm

    Actually, if you look in the dictionary, you’ll see that “phased” is an acceptable (if unusual) alternative to “fazed”.

  19. gantlord said,

    September 2, 2008 at 1:27 pm

    Really? I looked in my favoured dictionary and it wasn’t there. I thought I’d best look before flaming! Anyway, I’ll take your word for it though and stand corrected. Which dictionary you using?

  20. chltx said,

    September 2, 2008 at 3:35 pm

    Hmmm… I think diet *is* important for health and longevity. More important than exercise, but probably less important than getting enough sleep.

    I achieved some major (and dramatic) improvements in my health by simply banning sugar and grains from my diet, and eating more very rare beef, fish, and raw veggies. However, it’s a bit tough to make any money off of that particular program… ‘specially since I just gave away most of my dietary ‘secrets’ for free.

  21. mwitthoft said,

    September 3, 2008 at 4:37 am

    There are problems with overmarketing of drugs, but restless leg syndrome is not a good example. Rather the opposite, in fact: RLS is a horrid disease, easily treated with the right pill, not amenable to any other known treatment, and — until the recent advertising frenzy — underdiagnosed and often incorrectly treated or not treated at all.
    You try to salvage the wobbly case for RLS as disease-mongering by redirecting to ‘the widening diagnostic boundaries’ (whatever THAT is supposed to mean). A better approach would have been to admit RLS as a counterexample to your thesis, and then draw what lessons you could from that.

  22. martine s said,

    September 3, 2008 at 6:02 pm

    “There are problems with overmarketing of drugs, but restless leg syndrome is not a good example. Rather the opposite, in fact: RLS is a horrid disease, easily treated with the right pill, not amenable to any other known treatment, and — until the recent advertising frenzy — underdiagnosed and often incorrectly treated or not treated at all.”

    Yes, it’s not the first time Ben has targeted RLS unfairly. What’s happening is just the opposite: a set of symptoms whose cause is unknown (central nervous system) and afflicted people looking for a cure.
    “Easily treated”? : I wish it were.

  23. frontierpsychiatrist said,

    September 3, 2008 at 9:21 pm

    ( asshellbewell, Lumpen means 1. marginalized, 2. not educated or enlightened. )

    It’s not just in the realm of medications that we see society being medicalized. The number of mental health employees and classifications for psychiatric disorders have mushroomed over the past decades. Alongside this we see a professionalization of friends (counsellors) and some neat excuses to avoid personal responsibility (sex addiction)

  24. mwitthoft said,

    September 3, 2008 at 9:23 pm

    –“Easily treated”? : I wish it were–

    Neither Relpax nor Mirapex works for you? Ouch.

  25. martine s said,

    September 4, 2008 at 9:13 pm

    “Neither Requip nor Mirapex works for you? Ouch.”

    Unfortunately so. So if big pharma has anything remotely likely to work, bring it on I say.

  26. kim said,

    September 4, 2008 at 9:40 pm

    gantlord – apologies, I can’t find that definition of “phase” in the dictionary yet I’m sure it was there last time I looked! Er, must have imagined it. Sorry.

    BTW, agree with people about restless legs. A relative of mine suffered from it for about 30 years before it was finally correctly identified and treated. The drug treatments have worked very well for him. I can’t comment on whether it is over-diagnosed, but the symptoms are so very distinctive and unusual, I imagine it would be hard to diagnose a case that didn’t exist.

  27. peterd102 said,

    September 5, 2008 at 12:39 pm

    Enough of the Grammar Nazis please – “Lumpen is usually applied to porridge”, “no its a type of pen”, there could be many meanings LEAVE THE GRAMMAR ALONE.

    run “sigh”

    Medicalization may be a good thing, if we applied evidence based reasoning the world might be a better place. We dont always take medical advice, we weigh it up against the benifits of the lifestyle we have. I know that certain foods may be bad for me, i still eat them as i enjoy them and thats more important, I dont exercise for the same reason.

    I just listened to your podcast btw ben – you say you would allow Boots to lie to their customers about the beneifts of homeopathy to exploit the placebo effect. The trouble is i would prefer that doctors are the only people who can perscribe a placebo and only with previous aggrement by the patient to placebo treatment.
    Id be rather annoyed if an gardener came in and said he would make my plants grow faster and then do bugger all and proclaim ‘Your plants are taller, they have grown faster, see…’

  28. Robert Carnegie said,

    September 6, 2008 at 3:39 am

    I think that a milky mother’s T-shirt will be identifiable without the printed slogan.

    I’m still quite sceptical about scepticism about the role of serotonin in mental health, or at least the role of fiddling around with serotonin. But an idea that’s just occurred to me is to suppose that depression arguably consists of poor self mood management, and SSRI treatment takes the brakes off your mood control completely and compels you to improve your own mental discipline or go mad. Coming out the other side, you can use your improved skills to cure yourself – or you could do the same thing with talking instead of a drug.

    But I’ve gone through drug treatment for depression twice, which kind of torpedoes the theory. But the second episode was with my Mum suffering fatal cancer (as it turned out) and elderly Dad needing care, so maybe it was the advanced course in not letting it get you down, that I needed, that time.

    Still, this idea is probably unoriginal, and also just as reductive as taking pills to sort yourself out in the first place.

  29. Diotima said,

    September 10, 2008 at 2:42 pm

    PV Ah! this is bella Italia where everything is just wonderful! Where life expectancy for males is 78 years (UK 77) and females 83 (UK 82). Good heavens what a remarkable effect pasta and regular swimming have. And of course everyone, just everyone cycles everywhere (which explains the appalling traffic jams in Rome and Milan). I think that you are still seeing your ‘adopted country’ through rose-coloured glasses.

  30. Qui said,

    September 11, 2008 at 10:37 pm

    “Some punters” just aren’t capable of understanding the real information or even distinguishing what is real from what is hype. I have no science background and find myself trying to work out who is telling the truth. I need facts but the World is not interested in such mundane matters. Scientists seem to find humour, or wealth, in keeping alternative theories alive – perhaps this is the GSKs and ICIs who pay the salaries rather than the scientists themselves?? Even our beloved Govt touts the trendiest statistics and creates wonderful new regulations or laws for our benefit (blind-siding us perhaps?) Science-speak leaves me cold, so I resort to anecdotal evidence – not the best but certainly something I can understand. I have the ability to question what I read. There are lots of people who don’t. What help do they have? Please don’t mock or reprimand the ‘punters’, after all we are only human (and goji berries don’t taste that bad, little squidgy perhaps, nice pink colour, make the muesli look interesting :-) ).

  31. projektleiterin said,

    September 18, 2008 at 7:55 pm

    Ben is getting upset about social injustice and its consequences – I like that, it sounds genuine. :)

  32. incitatus said,

    January 6, 2009 at 9:08 pm

    Far be it from one to be anal or picky on such an august and deserving website, especially so long after the fact…..but TB isn’t a good disease to pick for the benfits of treatment. I’m not referring to the fact that many of the drugs used for treatment are becoming less effective but to the difficulty in analysing the data. Most studies on TB mortality use deaths per thousand rather than treatment outcomes.
    (Detecting the effect of medical care on mortality

    Ralph Catalano, and John Franka, Journal of clinical epidemiology doi:10.1016/S0895-4356(01)00348-1 )

    As that article goes on to say you can see the effect of medicine but the improvement in death rates comes with the sanatoria rather than streptomycin. And not everyone did the byronesque coughing either. Outcomes were strongly nutrition and housing and other conditions related. Miners died, mine owners didnt. Indeed dependent on the strain TB can be eminently survivable without treatment if you are well fed, warm and housed. In fact the whole area should be metanalysed a bit more thoroughly…what, for example, is responsible for the twelve year cycle in TB? what made the pulmonary to non pulmonary statistics vary so wildly between 1917 and 1953?

    May I suggest Staph Aureus sepsis as a less problematic example?

  33. beadsandweeds said,

    January 17, 2009 at 2:49 pm

    I’m still looking for a pill to cure my hypochondria. Every pill I try seems to make it worse.

  34. mirelle said,

    February 9, 2009 at 4:20 am

    To control the pain we must first go to the doctor because we can give him what is appropriate and what we need, such as oxycodone that I take is a medicine used to counter the pain of my back pain for years, but This was the prescribing doctor, I take it in moderation because I read in findrxonline.com is a pill that causes anxiety, and if you can not control it can affect your nervous system, we must always know what the physician and thus avoid setbacks …

  35. Kalevi said,

    February 27, 2009 at 1:24 pm

    This is a good article on a important topic which is methodically neglected by most Western science and media. I live in a Scandinavian welfare state in which reductionist biomedical solutions to social and psychological problems of every kind and proportion are embraced with hypnotic alacrity both within and without the medical establishment. In Finland 400,000 men, women and children are on anti-depressants, and this in a population of only 5.2 million. What is more, the established professional opinion is that the actual prevalence of depression “far exceeds the statistical prevalence.”

    Scientific-technological orthodoxy has grown to such dizzying proportions in Finland that it is not uncommon to hear all manner of Orwellian health care reforms, such as the nomination of a scientific committee to supervise the brain chemistry of the president, from even the most eminent scientists in the country. My personal favourite in the way of mind-boggling quackery passing as respectable medicine is the suggestion that the problem of alcoholism could be solved once and for all by obliging the manufacturers of alcoholic beverages to supplement their products with anti-depressants.

    Only a handful of disillusioned professionals in this country have openly raised doubts as to the scientific rigour of current diagnostic practices, and these are very quickly drowned out by such a flurry of protest and defensive ridicule as is only matched by the fervour of the religiously converted. The childish confidence of the general population in the protective magic of medical professionalism is in fact such that it reminds me of the saying “pious in medicine.” I encountered that phrase in a passage on the unwavering trust of King Louis XIV of France in the lunatic medical practices of his court physicians. In other words, some things never change.

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  37. jameskildare said,

    December 19, 2009 at 4:18 pm

    The Drug Dependence is a special form of addiction that is derived from the reiterated drug consumption, of any substance that serves to prevent, to cure or to alleviate the disease, or to repair its consequences. The psicofarmacos (they treat the mental upheavals) are most susceptible to cause fármacodependencia. According to the function for that they were created, the drugs can be divided in different categories, First they correspond to greater tranquilizers (Neuroleptics) this indicates findrxonline than are used substances to fight psicóticas conducts like the maniac’s schizophrenia, processes or the depression. Also they are used for the treatment of the Drug Dependence. Another drug class is the smaller tranquilizers (Anxiolytic), applied to treat some neurotic conducts. A third type is made up of the somniferous (hypnotic sedatives) between which most known are the barbiturates that began to be used like substitutes when the opiate derivatives were prohibited that were used like sedatives, this indicates findrxonline. One is substances very addictive, which create great physical dependency and serious syndromes of abstinence. Its use, more and more restricted, is directed to fight the functional upheavals and the insomnia.

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  39. tomannic said,

    December 30, 2009 at 10:31 am

    Just read ‘Bad Science’. Utterly fascinating – could not put it down but found Ben’s dismissal of female sexual dysfunction somewhat glib, especially his robust defence of the importance of listing anorgasmia as an important side effect of a tested drug in the previous chapter.

    Need to see evidence before accepting assertion that female sexual problems are normal. Why shouldn’t women have viagra?

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  42. letsBcivil said,

    February 19, 2014 at 7:19 pm

    “We love this stuff. It isn’t done to us, we invite it, and we buy it, because we want to live in a simple universe of rules with justice, easy answers and predictable consequences.”

    So very true. Dr. OZ on U.S. daytime TV comes to mind. He hawks every berry, spice, supplement, etc. fad in the universe and invites in every shister with a diet book to sell. And people eat it up. They rush out to buy all these costly items and inflict it on their families.

    It was laugh worthy when he did a special show aimed at people in great distress that their cupboards were overflowing with his long and ever growing list of recommendations. People were stressing out trying to fit it all into their day and the “correct time” to consume it. All he did was placate the masses so they’d line up for whatever he was hawking the next day.

    Another one that was laugh worthy. He invited some doctors on the show to talk about supplements. He evidently assumed doctors would be so health conscious that they’d all be consuming this stuff in handfuls, he asked each one for a list of their daily supplements. Caught off guard by the first one who said he didn’t actually take ANY daily supplements he forged on to the next two who also didn’t take any. That didn’t fit his agenda at all so he plowed on further to list the supplements HE (great “doctor” that he is) consumes daily and thinks everyone should be taking. There was an uncomfortable silence from the non-supplement popping doctors.

  43. Sanchia said,

    May 5, 2014 at 7:46 am

    Amazing article. This just goes to show the laziness of todays society. We constatntly look for an easy way out: pills to help aid social problems is just ridiculous. Self control and a proper up bringing is a ‘medication that will help ‘cure’ these social problems.