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Bootleggers and baptists in the drug industry

Peter Whoriskey reports in the Washington Post that the pharmaceutical industry has influenced the decision to classify grief due to the loss of a loved one as a form of depression. In the primitive past, grief was thought to build character. Now it’s a disease. That in turn, of course, allows anti-depressants to be prescribed and covered by health insurance.

It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.

The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.

When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.

But that may be changing.

In what some prominent critics have called a bonanza for the drug companies, the American Psychiatric Association this month voted to drop the old warning against diagnosing depression in the bereaved, opening the way for more of them to be diagnosed with major depression — and thus, treated with antidepressants.

The change in the handbook, which could have significant financial implications for the $10 billion U.S. antidepressant market, was developed in large part by people affiliated with the pharmaceutical industry, an examination of financial disclosures shows.

It’s worth reading the whole article. Of course, the bereaved have to want to take the drug. So in many ways this is a classic bootlegger and baptist coalition–a mix of pure self-interest (sell lots of high-margin drugs!) and high-minded motivation (help the depressed!).

Some commenters at the Post have noted that this is the problem of having a for-profit pharmaceutical sector. Perhaps. But the real root of the problem is the ability to get other people to pay for your drugs. If pharmaceuticals weren’t covered by government subsidy, the problem might not go away but it would be a lot smaller. I don’t care if depressed people want to assuage their grief with chemicals. That should be their choice. Just not on my nickel. So all of these fights and all of the influence of the drug companies come from the immense profits available from selling something that the consumers can have without paying the full price.

For related conversations on these issues, see this podcast with Marcia Angell or this one with Gary Greenberg.