Madam, - Dr Brenda O'Hanrahan, in her recent letter on antidepressants and the pharmaceutical industry (April 21st), is incredibly selective in quoting from the UK National Institute of Clinical Excellence guideline on depression.
The same guideline, when discussing moderate to severe depression, states: "Antidepressants are as effective as psychological interventions, widely available and cost less". It also recommends that antidepressants should be considered for certain patients with mild depression, and acknowledges that failure to show statistically significant benefit over placebos in clinical trials does not necessarily mean that a treatment is ineffective.
Anyone enrolled in a clinical trial will be seen regularly by medical professionals and compelled to discuss their condition, which may in itself help to resolve mild depression; that confounding factor makes it extremely difficult to demonstrate a statistically significant difference between treatments in these trials.
Dr O'Hanrahan goes on to claim that "according to the 2005 Parliamentary health committee investigation in the UK, The Influence of the Pharmaceutical Industry, the industry 'buys influence over doctors, charities, patient groups, journalists and politicians, whose regulation is sometimes weak or ambiguous'." The committee's report said nothing of the sort. That quote is actually an opinion piece in the British Medical Journal, which was followed by a disclaimer stating that the author was expressing his own personal views.
The report itself stated: "Our over-arching conclusion is that the UK pharmaceutical industry is in many ways outstanding: it conducts much excellent research, produces products which make a vital contribution to the health of the nation and is of great economic importance; however, for want of critical scrutiny by, and lack of deference and accountability to, the public and public bodies, the industry lacks the discipline and quality control that it needs but cannot itself provide".
It should also be pointed out that the Association of the British Pharmaceutical Industry subsequently strengthened its code of practice in order to address the issues raised by that report.
Dr O'Hanrahan also quoted two more personal opinions. One was from a nutritionist, so it is not clear to me what qualifies him to assess the effectiveness of drug therapy. The other was from a former GP, who has spent most of his career writing tabloid newspaper articles and books on a variety of highly alarmist themes, so I would recommend taking his views with a pinch of salt too.
Incidentally, the recent research that Dr Terry Lynch referred to (April 8th) was actually a meta-analysis of data from previous trials, and as such open to question (as a case in point, pharmaceutical companies cannot rely on meta-analyses in their applications for product licences). To provide some further context, the research was led by a psychologist specialising in non-drug treatments, who receives funding from a complementary and alternative medicine organisation.
Furthermore, while the findings of the original trials have been formally reviewed by regulatory authorities across the globe, the recent meta-analysis has not. It would therefore be inadvisable to jump to any conclusions solely on the basis of this paper.
I don't know why Irish publications have apparently ignored this
story, but it seems unlikely that pharmaceutical companies would
have prevented them from covering it, given that several companies
issued statements on it to the mainstream media. - Yours, etc,
KILIAN KELLY
PhD, MRPharmS,
Malvern,
Victoria,
Australia.