Ahh yes, ignorance…
Lets delve into this subject. It happens to be something I feel very passionately about.
First, why is it unethical? You have to understand that a drug salesperson does not have the best interests of the patient in mind. They care about themselves like any other person on the planet. However, their selfishness comes with drugs that are many times good, sometimes ineffective (Prozac) and infrequently dangerous (phen-fen, Vioxx). Of course, they believe that their actions are both ethical and useful. And why wouldn’t they? Generally sane people like to think they’re good people. Generally this means looking at the good and ignoring the bad, or passing it off as insignificant.
They have no means to argue, other than what they have been hand fed. Many of them have business degrees, and they don’t know what makes a study reliable or even valid. The FDA has proven to be largely ineffective at protecting American. Why?
In the recent past there was a need to increase the size of the FDA. Drugs were not being processed quickly enough. The money to fund the increase in size did not come from citizens; it came from the drug companies. And who do you think works at the FDA? Do you think they have ties with the drug companies? What about the government? Do drug companies impose on government like other companies? CDW owns a radioactive landfill in Ransomville, and they’re probably going to get legislation passed so that they can dump more there. It’s ignorant to think the same type of thing doesn’t happen in any other industry.
Prozac was passed along with some fanfare during the late 80s. Aha! Finally an antidepressant that didn’t have the repercussions of the MAOI’s. You could eat cheese with Prozac! There was no threat of tardive dyskensia! yay!
Ah. But is Prozac even a very effective antidepressant? The FDA’s findings are a resounding YES! But scoop…
The FDA’s study wasn’t valid. By valid I mean–it didn’t study how effective PROZAC was at treating depression. When Eli Lilly was preparing to introduce Prozac to the market, their findings were that it was not any more effective than the placebo.
This is hilarious, and when I read this 3 years ago I sat there in disbelief. They reused the subjects that were the other control in the study as the Prozac treatment group. This control group was receiving impramine, which was proven to be effective at treating depression. THIS ISN’T A VALID STUDY=THEY COULD NOT POSSIBLY PROVE THAT PROZAC WAS AFFECTING THE DEPRESSED STATE OF MIND. You can read a nice book by Dr. Braun. Its on page 22. It is actually a very good book, and it isn’t biased (unlike something by, say, Breggin, which goes off the other deep end and says that all psychiatric methods are basically crap–ouch, Dr. Breggin, you’re just as scary as the people you hate…). He does make a very good point–if depression were solely a “chemical imbalance” then how does the placebo work? Ah. Marketing. It’s very dangerous. Dr. William Glasser says the same thing.
If you want more proof that fluoxetine alone is not very effective, read some studies by Wagner.
Sigh. How does this make pharmaceutical sales unethical? Ignorance to what you’re selling is no excuse. They knew Vioxx was dangerous when they released it. They know that around half the time Prozac is ineffective when not combined with therapy. I believe it jumps to around 70% effective when combined with therapy, but I’m not sure, and I’m not digging through my shelf of journal articles. Ignorance to knowledge is never an excuse, and I’m very happy that Walter brought it up. 
Pharmaceutical salespeople were targeting medical students. Some schools still allow it. No I do not know why. Actually, I do know why. Money. Money is the culprit to this whole problem. They target medical students because they want to make them feel indebted to the company. Reciprocity drives more exchanges in the real world than anybody wants to think, and I dare somebody to go a day without encountering it themselves. The problem is that it can create doctors that are less likely to speak out when something is wrong.
If this isn’t achieved, the alternative is feeling entitled to the treatment. This is bad for the pharmaceutical industry because they are basically taking advantage of them, but it’s also bad for the patient because this is unethical in its own right. This is a summary of an article I read in the Australian Journal of Medicine, I believe.
I’ve spent the past 5 years researching the pharmaceutical industry. I have come across many good things and many bad things. I wish they held themselves to a higher standard than other industries, but they do not. It’s my personal mission to make people aware that they are not in the business of losing money, and many times doctors are not able to see their own missteps because they are receiving special treatment. It’s an industry run amuck, and the FDA is not doing its job anymore.
I’m also scared that as much as I’ve tried to find good information on the long-term effects of SSRI’s, I haven’t been able to. The best information I have found is, “No one has anything but the vaguest idea of the chemical effects of these drug on the living human brain”-Glenmullen.
