4/21/2000 – More Prozac Backlash

Here is a commentary that defends Dr. Joseph Glenmullen’s
book, Prozac Backlash, by Nicholas Regush, a medical features
writer for ABCNEWS. Mark

It appears today on the ABC News site:

More Prozac Backlash
Drug Firm Attacks Prozac Book, But Lacks Long-Term Data

By Nicholas Regush

Prozac Nightmare. This is what I would have called Dr. Joseph
Glenmullen’s book on the vastly over-prescribed, so-called
miracle happiness pill and its cousins such as Zoloft and Paxil.
He was actually much too kind in dubbing it Prozac Backlash.

Glenmullen, who has a private practice in Cambridge, Mass.,
claims far too many people, including 28 million Americans,
have taken the new antidepressants that boost serotonin in the
brain. He claims that their numerous side effects, including loss
of sex drive and self-destructive and violent feelings, are poorly
tracked and long-term safety data sorely lacking.

He is also concerned these drugs can cause some brain
damage and cites effects such as loss of motor control and
grotesque facial and whole body tics.

Glenmullen emphasizes, however, that individuals who have
moderate to severe illness might benefit from these drugs.
Those with mild depression or the “worried well” should avoid
the potentially harmful effects of these drugs and seek
alternatives such as talk therapy, he says.

Company Denounces Book
But Eli Lilly and Company, makers of Prozac, have denounced
Glenmullen’s book as loaded with “omissions,” “half-truths,” and

A call to Lilly provided me with an official company statement
about the book that pointed out Prozac “is one of the most
studied medicines in the world and often the first choice of
doctors.” Lilly, however, omitted the nagging fact that very little
known about their product’s long-term side effects.

Lilly’s statement goes on to say that Glenmullen discredits the
work of the Food and Drug Administration. But what does it
mean to discredit a government agency that does a pathetic job
of tracking drug side effects once a new drug gets on the
market? By the FDA’s own estimates, only some 1 percent to 10
percent of all drug side effects are reported to its surveillance

The “anecdotes” or case reports that Lilly denounces in
Glenmullen’s book can be a tip-off of what might be happening
to many more patients. It seems to me that it is better to have
case reports that point to potential problems than rely on the FDA
to process a tiny fraction of harmful events caused by the new
antidepressant drugs.
The company also writes that Glenmullen attacks the work of
research scientists, academic medical institutions and doctors.
In his indictment of the health care system, he apparently finds
collusion, conspiracy and ineptitude around every corner.

Valid Criticisms
Having read Glenmullen’s book, I can’t recall any conspiracy
theories. He does, however, do a very fine job of pointing out how
inept the drug approval and drug tracking systems are in this
country and that medical researchers financed by the drug
industry are on FDA advisory boards and sometimes even vote
on drugs that they helped to research.

Which brings me to Lilly’s suggestion that I contact several
doctors “who are available for comment on the book.” The first
one I reached was Dr. Jerrold Rosenbaum, director of outpatient
psychiatry at Massachusetts General Hospital, in Boston.
But wait, did he read Glenmullen’s book? Oh, only about 60 to 70
of the 386 pages, he said. (He “thumbed through” some other
parts of it). “There’s nothing new in this book,” he said. “There
are gross exaggerations.”

Rosenbaum also objected to Glenmullen’s suggestion that St.
John’s Wort might serve as an alternative for some patients who
are mildly depressed. True, this herbal approach to depression
needs more science behind it — but then so does Prozac. Did
Rosenbaum see anything of value in the small parts of the book
he read and thumbed through? Yes, Glenmullen offers some
ideas in the book “that are reasonable for fair debate.” For
example, maybe Glenmullen is correct in writing that the
managed care system gets too many people on
antidepressants because that’s often the cheaper approach.
Talk therapy, for example, can cost a bundle.

No Long-term Data
Dr. Anthony Rothschild, a psychiatrist affiliated with University of
Massachusetts Memorial Health Care, in Worcester, Mass.,
didn’t much care for the book either. He says he read most of it.

“The book ignores years of experience of the safety and efficacy”
of the serotonin boosters, he says. Really? I thought the book
included the strong argument that it would be really neat to have
long-term safety and efficacy data so that we can have some real
experience with these antidepressants.

Whose years of experience is Rothschild referencing here,
anyway? Considering that large numbers of users of these
drugs take them for more than a year, let’s not get too huffy and
puffy about people questioning their safety, particularly over the
longer term.

Yes, Glenmullen’s book may at times seem too insistent on the
value of case reports (often from his own patients), and, yes, his
interpretations of some of the scientific literature might differ
from those who strongly support the use of these

But in the end, he raises important questions that will become
increasingly difficult for Lilly and its doctor pals to duck.

Perhaps the federal government needs to do long-term studies
on the impacts of these drugs as the pharmaceutical companies
have little incentive at this point to do it because the drugs have
been on the market for several years.

Someone has to care about the long-term effects.


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