How to Achieve Bliss

If you take Thomas Gray's advice -- Where ignorance is bliss, / ‘Tis folly to be wise -- then the quickest route to happiness is to read the newspapers and watch TV.

How many of my 2 1/2 dedicated readers already know that according to a randomised, placebo controlled trial -- the Gold Standard -- published in the Archives of General Psychiatry about two weeks ago -- cognitive therapy, a form of counseling, is just as effective as antidepressants at treating moderate to severe depression, and that in fact, patients treated with cognitive therapy rather than drugs were less likely to relapse? Oh yeah -- cognitive therapy doesn't cause agitation, loss of libido, dry mouth, or suicide.

So here we have a multi-billion dollar annual industry, pumped up by all those television ads featuring ecstatic people running through meadows, advertisements in medical journals depicting your patients going from a lonely corner in a black and white world to a technicolor carnival of life -- persuasive enough that primary care physicians hand out happy pills by the billions. Not that the drug companies had to spend all that money on advertising, really: the corporate media were happy to do the advertising for them, laying forests to waste and treating the planets around nearby stars to the world transforming news of the miracle of Prozac. Did you hear a whisper, a hint, an intimation, that maybe, after all, IT WAS ALL A CROCK? Here's a newsflash you won't be hearing on ABC, Fox, or CNN. Antidepressants do not work. (By the way, cognitive-behavioral therapy is a brief, limited intervention. It does not resemble long term, or lifelong, psychoanalysis.)

A new book by Richard A. Deyo and Donald L. Patrick, "Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises," explains what's going on (although they don't discuss antidepressants specifically.) Judy Foreman, in her review in NEJM, says it better than I could. (Okay, almost as well.)

Deyo and Patrick make a well-documented -- if depressing -- argument that doctors, scientists and laypersons alike are far too easily seduced by industry hype for merely new (as opposed to truly better) drugs and medical devices. . . . [W]e are all too ready to believe that new, expensive or aggressive care must be better than older, cheaper, or milder treatments.

Uhuh. Heroic researchers conquering unhappiness and death make for exciting tales. But there's something else going on here. Cognitive behavioral therapy can't be patented, the profits can't be captured by a giant corporation and oh yeah, there's no advertising revenue to be had from it. But don't dare call the corporate media whores. It isn't nice.