Wednesday, February 22, 2012

Why was the 60 Minutes report on antidepressants "explosive"?

I’ve read some more responses to the 60 Minutes report on antidepressants. Several have mentioned surprise at the presentation of the story as shocking and novel, both in terms of Leslie Stahl’s amazed reactions to some of the statements made and in terms of her repeated suggestion that this was all revelatory. (It seems to have become a cycle: challenging articles or books appear, journalists and others are shocked by the radical news, those who’ve been following the issue express surprise and dismay at the treatment of these arguments as new, and then things return to normal, with the companies raking in their billions off of these drugs, until the next round.)

In her article “'60 Minutes' antidepressants report may be 'explosive,' but it's not 'new',” Susan Perry writes:
Explosive? Well, yes,…

But new? Hardly. Studies linking the placebo effect to antidepressants have been around for more than a decade….

It’s not as though the antidepressant/placebo story hasn’t received press coverage in the past….

All this history made me wonder why Stahl seemed so astonished during her interview with Kirsch. She seemed to be unaware of the decade-long controversy surrounding antidepressants.
Howard Brody, who makes the crucial point that the story didn’t say nearly enough about the adverse effects of the drugs, remarks:
As seems typical, the news program featured as "gosh golly gee whiz" news stuff that we've been over in this blog many times before:…
To some extent, I think this is just Stahl’s shtick: she often reacts to interviewees’ remarks with that wide-eyed, almost giddy I-can’t-believe-I’m-hearing-this expression. But I think there’s something else going on as well. Surely she had to have read several of the materials (I’m honestly not sure whether or not she read Kirsch’s book) in preparing the report, so on the one hand it does seem strange for her to respond with such surprise to these arguments, although it might lend the report more excitement. On the other, I wouldn’t be at all surprised to learn that she was unaware – or not fully aware - of these challenges until very recently. And given how entrenched the neurotransmitter-fixing model is in our consciousness, she could at some level have been genuinely stunned to hear someone saying the actual words, and responding as most people would.

It seems to me, as someone comparatively new to this discussion, that when you’ve been investigating or writing about it for some time you can to some extent lose sight of just how many people believe these notions. In the US, we’ve had decades of corporate propaganda pushing the idea that “psychological problems like depression are caused by neurotransmitter imbalances and psychotropic drugs work effectively to correct them.” We’ve had decades of doctors (some who sincerely believe themselves and some who don’t) and other educated people spreading this message both privately and publicly. Those in leadership positions who’ve acknowledged problems haven't tended to do so in the most public forums, or to go out of their way to correct the misinformation being spread by others. The very fact that the drugs have long been approved and that their manufacturers have been allowed by the FDA to use advertisements making this suggestion leads many people, quite naturally, to assume that the claim is well established scientifically.

Since I’ve been talking about this with people I know – admittedly not a representative sample, but I don’t think unrepresentative in any important way in this particular case – I’ve found that every single person with whom I’ve brought up the subject, without exception, accepts the neurotransmitter-fixing story. They take for granted that it’s true, as I did until fairly recently. It would be quite different if those challenging the claim entered a neutral context. In a neutral (scientific) context, those making the original claims would be required to demonstrate their truth, which in this case they couldn’t. But because the claims have now become so widely accepted, we have a reversal of the burden of evidence, in which the assertions of those challenging them meet with shock and suspicion and they are from the start put on the defensive, expected to defend their skepticism (which they have) while those making the original substantive claims are given a relative pass. So there is real resistance at the cultural level to engaging with these challenges or taking them seriously, and it affects, I would suppose, even those who don't have a strong personal stake in the validity of the original claims.

Even when we don’t actively resist the challenges, they often don’t register with us or tend to fall out of our consciousness or memory because they don’t fit with the cultural schemas so embedded in our minds. In the absence of sustained discussion and demands that the original claimants provide supporting evidence and fully address challenges and problems, and in a context saturated with the message of the original claimants, there’s nowhere to “put” these criticisms on and after the occasions in which we’re briefly exposed to them. So, many people watching the report likely had the same shocked response as Stahl, despite the challenges having been made and reported in the media earlier.

If we look at scientific claims that are widely accepted, we can recognize that if they were being made for the first time today, they could be supported on the basis of the existing evidence. This isn’t the case with this psychiatric model. It hasn’t established itself scientifically; in fact, it’s proven a failure. But it has been established culturally, through the work of powerful organizations relying on cultural inertia. That does seem to be changing, finally, and I hope we won’t be seeing the same “explosive” reports five years from now.

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