Along the Tracks

Tuesday, August 12, 2003

My turn for a break!

August seems to be Blog Vacation Month (although Glenn Reynolds took his in July), and now I’m joining the parade outta “Dodge,” headin’ for the Jersey shore, and letting the ocean wash away my troubles for a few days. I’ll be back in Montpelier next Tuesday, and I’m sure I’ll post here if anything monumental happens. But I’m hoping for a quiet week.

In the meantime, surf through some of the sites and papers at left. When you get there, surf through some of their links too. You’ll find the “blogosphere” is a pretty big world, well worth the exploration. And you might just find a new favorite!

More on Paxil

The New York Times features an op-ed by Richard A. Friedman, a psychiatrist at Cornell University, on the question marks surrounding Paxil and other selective serotonin uptake inhibitors. His point is one we hear quite often when medications have problematic side effects: It’s the drug industry’s fault. In particular, Friedman says the tendency of drug manufacturers not to publish all their studies keeps patients (and doctors) uninformed.

Now, I do believe all the studies should be published, but not for quite the same reasons as the good doctor. Friedman admits that the unpublished study results are available to the FDA, so negative results do make their way into the drug vetting process. And often, studies are complicated and the results mixed enough to make their value to the consuming public zilch. Finally, in the specific case of Paxil and other SSRIs, the questions about increased risk of suicidal urges run back to the late ‘80s, and were decided against by a panel of experts in 1991.

Here’s where the open publishing doctrine could be valuable. As individual physicians note the problems occuring with drugs, they could go back and check those studies looking for earlier indications. They could report the problems to the drug company and to the FDA. But in many cases - and the question of suicidal thoughts among the depressed certainly counts here - it is difficult for the treating doctor to parse what is a drug side-effect and what is a disease symptom. Open publishing could help.

Ultimately, doctors do seem to know the risks of SSRIs. Even Friedman notes the drugs cause a period of increased activity in some patients during the early phase of treatment. What I find shocking is that so many doctors seem perfectly willing to ignore this potential side effect - a side effect which could cost the patient his or her life. This may also be the case sometimes in treating other diseases, but when it happens in those circumstances, we call it malpractice. Apparently, in the mental health field, it’s just an “oops.”

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