by Alison Bass. Chapel Hill, N.C., Algonquin Books of Chapel Hill, 2008, 260 pp., $24.95.
Over the years, the pharmaceutical industry has offered almost all practicing psychiatrists gifts (both large and small), meals, and educational opportunities in their offices and at professional meetings. More recently, psychiatrists have been greeted in the morning with front-page newspaper exposés of huge sums being directed by these same drug companies to the physician leaders of our field. In Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial, journalist Alison Bass has written the powerful story of a leading medication, its manufacturer, and a favored psychiatrist, whose driving force was profit not treatment. Although no longer shocking in the context of so many pharmaceutical scandals, this book is still necessary medicine for the public and for physicians who wish to know the operational details of one dirty little piece of the enormous pharmaceutical-medical complex. It unfolds as the sad tale of an established and lucrative antidepressant that came to be promoted for use by adolescents based on the questionable, if not biased, support of scientific experts who were themselves the beneficiaries of the drug company’s largesse.
Side Effects opens with the case vignette of a teenager who asks her primary care physician about a particular antidepressant after watching its direct-to-consumer advertisement on television (1). Later, her symptoms of anxiety and depression paradoxically intensify after being prescribed this medication, and she eventually mutilates herself in self-destructive despair. The author weaves together the stories of the protagonists—a clinical and research psychiatrist, a public interest lawyer, and a teaching hospital administrator (2)—who together drive a successful lawsuit for consumer fraud brought by the Office of the New York Attorney General against the antidepressant’s manufacturer.
Of particular interest to Journal readers is the account of the psychiatrist, who published an initial case series identifying the phenomenon of selective serotonin reuptake inhibitor-induced suicidality. His portrait as an idealistic and dedicated physician is contrasted with that of a well-financed medical school department of psychiatry chairman, whose alignment with the pharmaceutical industry appears to erode his scientific credibility and jeopardize patient care. Although drug companies should not be confused with the Mafia, criticizing their products is not a smart career move for aspiring academic psychiatrists lacking the resources to defend themselves and their beliefs. In keeping with the genre, it is easy to discern who are the heroes, villains, and victims, and it is surprising and gratifying when truth and justice prevail at last, although not entirely.
This well-told cautionary lacks the excitement of a novel but instead informs the reader with an actual case study with the real names of psychiatrists we know. We can see exactly how corporate greed, drug-company-sponsored clinical research, and mental health care become a toxic mix that inevitably damages our patients’ well being, our colleagues’ reputations, and our profession’s good name. Now what we need is a book showing us how to fix this mess before it is too late to save the patients and physicians who must depend on the integrity of the pharmaceutical industry.
1.Donohue JM, Cevasco M, Rosenthal MB: A decade of direct-to-consumer advertising of prescription drugs. N Engl J Med 2007; 357:673–6812.Campbell EG, Weissman JS, Ehringhaus S, Rao SR, Moy B, Feibelmann S, Goold SD: Institutional academic-industry relationships. JAMA 2007; 298:1779–1786
The author reports no competing interests.
Book review accepted for publication January 2009 (doi: 10.1176/appi.ajp.2008.08121834).
Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.