Well, I decided to throw up last weekend instead of doing my Paper Machete gig.That's all right. Because the lovely Chris Piatt invited me to come back today and read my piece. Same topic, same bat time, same bat place. I had a wonderful time and, best of all, didn't vomit on anyone. Overall, I'd say the day was a success. Without further ado, I present the text of my piece. If you hate it, just imagine that it was better written when read aloud. (And if I end up podcasted, I'll post a link to that as well. For proof.)
A couple of weeks ago, I happened on a blog post on Scientific American's website by an anonymous author who called himself Sci Curious. In this blog, the writer shares his thoughts on the findings of a meta-analysis published this fall by the British Medical Journal about reboxetine, an antidepressant drug marketed by Pfizer. It's known by a number of brand names, including Edronax, Norebox, Prolift, Solvex, Davedax and Vestra. If you've never heard of it, that's because it's sold only in Europe. But in Europe, it's relatively common. And scientists have been pretty excited about it. It's not like the other drugs. Drugs like Lexapro, Prozac, Paxil and Zoloft are called SSRIs, selective serotonin reuptake inhibitors. They work by making this so-called "happiness hormone" more readily available to the brain. But reboxetine is an SNRI, meaning it targets norepinephrine. So it's thought that patients who don't respond so well to more traditional SSRIs might have better luck with a drug that targets a different neurotransmitter. And this one is the first of its kind. Great news! Or so they thought. So we were made to think for quite a while. But the results of this meta-analysis weren't exactly encouraging. That's okay, right? Certain drugs aren't for everyone.
I speak from experience. I've been in therapy since I moved to Chicago, and I'm convinced my first doctor was on retainer with a pharmaceutical company. But I was actually lucky. Okay, let's face it: We're all pretty lucky that I found a drug right off the bat that worked like a dream. But then my doctor became convinced that I was actually far crazier than she thought. So she put me on Abilify, an antipsychotic that turned me into a sad robot. All I wanted to do was sleep. And cry. I was not at fan. I decided I'd rather be psychotic. Then, a few months ago, for reasons you can put together yourself later with a simple Google search, I took Wellbutrin for a test drive. Unlike the zombie effect of Abilify, this was like being hooked up to an espresso IV. I couldn't sleep. I was irritable and snappy. I ran my mouth off a mile a minute. And the effect Wellbutrin was supposed to have on me? The whole reason I switched? No dice. I know people who have had great results with those drugs that backfired on me. So I get it. I'm anecdotal proof that no drug is for everyone. But here's the thing: Reboxetine was for NO ONE. Because not only did it produce more side effects than the placebo — side effects like insomnia, dry mouth, constipation, sweating, headache, blurred vision, vertigo, loss of appetite, heart palpitations, difficulty urinating, impotence or delayed or painful ejaculation, chills, cold hands and feet, vomiting, rash, and aggressive behavior — because that stuff's all normal, and kind of a trade-off you have to be willing to endure while your body adjusts to the chemicals — what's not normal is that reboxetine actually had no positive effects. None whatsoever. And no one knew that until this meta-analysis was published. Turns out Pfizer kind of…neglected to publish some of their results. They didn't publish the results of 74 percent of the patients they tested. Because almost three-quarters of their results were inconclusive, negative or otherwise less than profitable to disclose. So they published the good results and just forgot to mention the stickier stuff. After all, what self-respecting multinational pharmaceutical company would want to have negative information floating around about drugs that could make them money? Exactly. And apparently drug companies are actually under no legal obligation to publish all their findings.
This lying by omission, the idea that positive findings can be and are handled differently than less savory results, actually has a name. It's called publication bias, and it runs rampant in this industry. And as a journalist — or maybe just as a decent human being — I take umbrage at the concept. Doctors have to take the Hippocratic oath when they begin practicing medicine, promising they'll conduct themselves ethically as they care for patients. You know, that whole "first, do no harm" thing? If pharmaceutical companies aren't going to be held to some legal standard for withholding information that could seriously impact their end users' health, then that oath should at least extend into the farther reaches of the medical world. But big business will be big business, even when people's lives are at stake.
There's another, less nefarious concept at issue here, too, though. And this is the part that has scientists really stymied about where to go from here. This drug that does ABSOLUTELY NOTHING for humans worked like a dream…in animals. They used two specific tests to determine how effective reboxetine was in laboratory mice: the Porsolt test, also known as the forced swimming test, and the tail suspension test. Actually, let's go back to the ethical question for a minute. How messed up do these tests sound? Think about animal testing for things like makeup. Yeah, that's wrong, but it's also pretty easy for me to picture a mouse or a bunny wearing teal eye shadow or bright red lipstick, and I can deal a little better. There's no way to dress these tests up and make them seem a little cuter. The forced swimming test actually involves dropping a mouse into a clear glass cylinder filled with water with no way of escaping. Twenty-four hours later, there's a second, shorter test, and scientists measure how long the animal just sits there in the water. It's meant to measure its level of hopelessness. The tail suspension test? Exactly how it sounds. String that mouse up by its tail for a few minutes and see how much time it spends struggling versus just hanging there. In both tests, a drug's effectiveness is measured by how much it increases the animals' physical activity. In the reboxetine tests, those mice were swimming and swinging to beat the band. So it's safe to assume that those mice won't end up bellied up to a bar drowning their sorrows somewhere. They won't be holed up in the corner of their cages, writing emo poetry and listening to sad bastard music while their exercise wheels collect dust… But their well-adjusted little whiskers don’t in this case translate into shinier, happier people in the end.
The fact that the reboxetine has been SO effective in the animals tested — and so ineffective in the human patients it was actually designed to treat — raises the question of whether the forced swimming and tail suspension tests extrapolate at all to the human brain or are just coincidence. Or maybe reboxetine is just an anomaly here. A wild card where the normal rules don't apply.
But the human factors at play are no wild card. Bottom line: The world's a dark place and it's getting darker. We're all getting more and more depressed. And the need for effective drugs is only going to continue to increase, given that many people's immediate reaction to a bad feeling these days is popping a pill. Of course, I can't really blame them. Why invest time and energy in actually figuring out what's eating you when you can just get some pills and cover the angst with a pharmaceutical Band-Aid? Right now, it's a lot easier just to add on a Prozac scrip while your GP's writing one for blood pressure meds or a Z-Pak for the bug that's going around. Insurance companies start asking some pretty pesky, invasive questions when they start to see you're actually trying to take care of yourself. That's the way things are going to be for a while, until this health care mess gets straightened out. For now, it would behoove researchers to work a little harder at figuring out whether their current testing methods are as valid as they can be. And it wouldn't hurt for pharmaceutical companies to worry less about their bottom line and more about ensuring their drugs will actually help people feel better.
Doesn't seem so crazy, does it?