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Ethics

: Neuroethics and Law

Why's everybody always picking on me?

By Peter Reiner

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Marcia Angell, formerly Editor-in-Chief of the New England Journal of Medicine, has a detailed piece in the New York Review of Books entitled Drug Companies & Doctors: A Story of Corruption. In the article, she reviews three books:

Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial by Alison Bass

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen

Shyness: How Normal Behavior Became a Sickness by Christopher Lane

What is notable is that two of the books focus on the intersection between Big Pharma and psychiatry (I have previously written about Christopher Lane's book Shyness here), and Marcia Angell does an admirable job of reviewing the recent travails of the field. She does point out that we should not be too hasty to condemn one field at the expense of others:

"The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices."

It seems easy to agree with Angell's conclusions, especially when she notes that,

"To promote new or exaggerated conditions, companies give them serious-sounding names along with abbreviations. Thus, heartburn is now "gastro-esophageal reflux disease" or GERD; impotence is "erectile dysfunction" or ED; premenstrual tension is "premenstrual dysphoric disorder" or PMMD; and shyness is "social anxiety disorder" (no abbreviation yet).

The most important question that the Angell piece raises is whether the field of neurosciences (writ large) is at least partly cupable for this incursion into psychiatric disease by promulgating the notion that all diseases of the brain are due to disordered chemistry. Don't get me wrong: I am a dyed-in-the-wool neurobiologist who is fully convinced that, on some level, all diseases of the brain are due to disordered chemistry. But it is one thing to say that a disease is caused by altered chemistry and something else entirely to know what that altered chemistry is. I can think of no disease of the brain for which we have developed a mature and robust understanding of the underlying pathophysiology (suggestions welcome). Absent that, all that the pharmaceutical industry can offer are chemical band-aids. The problem is that the general public wants - no, expects cure-alls. And the marketing arms of the pharmaceutical industry are all too eager to depict their latest offerings as such.

Full post as published by Neuroethics and Law on December 29, 2008 (boomark / email).