Follow the Money Trail!

Depression has always been a major issue.  It's pharmacologic therapy has been even more problematic given that early medications were rife with side effects and risk of overdose high.  Thus, treatment was mainly left to the psychiatrists until the advent of the selective serotonin reuptake inhibitor (SSRI) class, which was noted for its much lower side effect profile and overdose potential, and which has allowed for its widespread prescription by non-psychiatrists, namely primary care physicians, such as family physicians and internists.  

Now, after two decades of use, we have a less sanguine view of SSRIs with their withdrawal syndrome, serotonin syndrome, and even an increase risk of suicidality in children & teenagers necessitating a black box warning.  Lately, there has been some concern & controversy about a possible link between antidepressant use and an increase risk of breast & ovarian cancer.

But what I find intriguing is the conflict, which at face value is not new in the medical world.  However, it's interesting to note that in a study published last week in PLoS ONE, one's ties to Big Pharma appeared to influence the conclusion of one's research.  Of the 61 studies that were reviewed, one third reported an association between antidepressants and cancer.  The remaining two thirds reported no association or possibly even an antiproliferative effect.

However, the authors with industry affiliations were much less likely to report a link between antidepressant use and cancer compared to those authors without industry ties.  Maybe there's no real link but doesn't it appear suspicious that someone is hiding something?

We may accept cloak & dagger secrets when it comes to business & government but not with regards to our science & medicine.  However, despite our many attempts to develop & enforce conflict of interest policies, there are still too many reports of breach & loss of faith in our medical profession to maintain the public's trust.  We must absolve to free ourselves of any hint of bias and place our patients' interests above our own.  Yes, medicine is a business.  But it is a business in which the customer must always come out a winner and believe in the word of the owner/physician.