WELCOME TO THE SOCIAL AUDIT HOME PAGE
This website was last updated on 5 December 1998. At its heart is a 250K paper you can download, The Antidepressant Web. This paper and the site built around it develop two interwoven themes: How are medicines used to treat depression? and, What can be learned from this about the conduct of the main providers of 'healthcare' - doctors, pharmaceutical companies, and government regulators? There are two main ways in. Please click on one:
1.1 Introduction. This website is operated by Social Audit Ltd, the publishing arm of a UK Registered Charity, Public Interest Research Centre Ltd. Founded in 1972, PIRC is a strictly independent enterprise, thanks largely to grants from the Joseph Rowntree Charitable Trust, also through sale of publications. Our principal legal object is "to procure" that organisations of all kinds "properly and adequate serve the interests and needs of the public generally (or any section of the public for whose benefit service or assistance they exist or are supposed to exist)."
Our size is in inverse proportion to the breadth of our terms, therefore our work is very focused. Mostly it concerns the web of organisations at the centre of power in pharmaceutical medicine, which pretty much decide how medicines are used and to what effect. Over the past 20 years, we have increasingly used this paradigm for exploring where "the public interest" lies.
It is a useful model because at the core of pharmaceutical medicine is a good cross-section of the different kinds of organisation that determine what "the public interest" is. The pillars of this establishment represent business, the professions, government and the media; the way in which such organisations interpret and discharge their responsibilities powerfully shapes the quality and direction of public life.
Our approach reflects our belief that the public interest is founded on, whatever else, the right to ask questions - and that asking how medicines work provides a good measure of where the public interest really lies. Is medicine dedicated to securing health, and committed to working within a framework of scientific and democratic values? This is what it takes for medicine to work:
"... science and technology can contribute to the improvement of health standards only if the people themselves become full partners of the health-care providers in safeguarding and promoting health ... people have not only the right to participate individually and collectively in the planning and implementation of health care programmes, but also a duty to do so" (WHO, 1983)
1.2 Website overview. The centrepiece of the website is a case history in pharmaceutical medicine, a 25,000 word (250K) paper that raises even some unthinkable questions. This paper is by Charles Medawar, a sequel to his book Power and Dependence - Social Audit on the safety of medicines. The paper was first published in the International Journal of Risk and Safety in Medicine and describes an "intensely worrying" state of affairs. (Dukes MNG (Ed), 1997).
The paper was originally conceived at chapters two and three of a still very unwritten book: chapter two mainly addresses the question, "Do antidepressants work?"; chapter three discusses "Dependence as an iatrogenic disease". The later chapters on this website are still growing; at the time of writing they exist as repositories for the kind of feedback that will prompt further thoughts, new information and fresh perspectives. The main point of publishing on the Internet in this way is to promote discussion and review of the issues - and to post revised and expanded versions of text in the light of new data and comments received.
The most effective way of navigating the site is to get a paper copy of these two chapters. You can either download them (in about five minutes) or you can order the print copy published in Int J Risk & Safety in Medicine. With a hard copy of the main text, you should find it much easier to jump around to sections of the text which concern you most.
The paper is constructed as an argument that grows from one numbered SECTION to the next, and they are best read in sequence. Each SECTION deals with a specific topic as well as carrying the main thread, and most are about three A4 pages long. At the end of each SECTION, you can either click to read on, or check the DISCUSSION - or go to/from the CONTENTS page and text REFERENCES.
This is Version 1 of the Internet edition of The Antidepressant Web, first posted in February 1998. At that date, all discussion boxes were empty - except for a few supplementary points raised by the author. From that date, we hope some boxes will begin to begin.
We welcome discussion and hope you will feel like contributing to it. But please please bear in mind that this is no guide to individual treatment, nor a technical paper. It does follow the basic science, but mainly in order to analyse the policies and practices that drive medicine to and from health. Dogged lay readers may get most out of it: others, more involved in medicine may find it harder to put aside some conventional wisdoms and beliefs.
1.3 Abstract The focus in the main text is on the drug treatment of "depression", notably with products like Prozac®, and on how such drugs are promoted, used and controlled.
On the surface, the text examines hard evidence relating to a rhetorical and hypothetical question, "Do antidepressants work?". The reason for asking this ostensibly silly question is to provide the broadest possible framework for looking at the meaning and values of medicine. Implicitly, the question also asks: what is better than nothing, and how much better are antidepressant drugs than the placebos they are compared with in clinical trials ?
Between the lines of the paper lie basic questions about the ethics, activities, performance and impact of the three main centres of power in medicine - government, professionals and the pharmaceutical industry. The underlying issue is whether people who are miserably unfulfilled, sad, anguished or depressed are in hands as safe as they might imagine or need.
There are no conclusions in this paper, but something of a hypothesis emerges from it: that "depression" is fast developing as an iatrogenic disease and that, however much they are part of the solution, antidepressant drugs seem much more implicated in the problem of depression than is supposed. Moreover, the publics opinion that antidepressants are drugs of dependence seems much closer to the reality than mainstream professional views.
Similar scenarios go back a long way; they have repeatedly shown public concern to be justified and seen the medical establishment caught unawares. Past experience in this field links risk of dependence to unaccountable power. Is the same not true today?
Click HERE to enter The Antidepressant Web
Or click HERE to download main text