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Antidepressants and our ‘Brave New World’

How beauteous mankind is! O brave new world,

That has such people in’t!

(The Tempest Act 5 Scene 1)

Shakespeare’s irony did not escape the novelist Aldous Huxley. His 1932 novel, Brave New World, takes place around the year 2500. The people are oppressed by ruthless authorities, distracted by inane televisual ‘entertainment’, controlled by genetic and social engineering and numbed into conformity by a tranquilising drug called ‘soma’.

Brave New World (1932) preceded the more famous but similar  novel, 1984, written by George Orwell in 1949. The contemporary world seems to be approaching these novelists’ apocalyptic vision with alarming speed. As a doctor, I am most concerned by the exponential increase in the prescription of antidepressants and tranquilisers – especially during the present recession. The Guardian reports that the prescription of antidepressants has increased by 20% in just three years.

This is particularly outrageous because two years ago a major study warned that antidepressants were no better than placebo in mild and moderate depression (surely the majority of cases) as I mentioned in a post at the time. My point was that it was the height of hypocrisy to criticise NHS homeopathy (drug budget £10 million) when the budget for these less-than-evidence-based antidepressants was £232 million!

At the time, the medical profession vowed to ‘do something’ about it. What has been ‘done’ is that the prescription of antidepressants in the UK has – in the words of the Guardian – soared. The situation across the Atlantic in the USA which offers the best medicine money can buy – is even worse. The use of anti-depressants in the ‘home of the brave’ has in the words of USA Today ‘skyrocketed’ by 400% (sic!) since 1988.

The situation with highly addictive tranquilising drugs is another horror story that I’ll leave to somebody else to write about. Both sets of drugs have potentially dangerous side effects and patients really should be monitored carefully on them – if their doctors can find the time of course. But it seems nobody cares that much about these horrific statistics. After all should we really be knocking such a profitable industry during a recession? Much better to start a new organisation protesting against all that money wasted on treating naive patients who want NHS homeopathy. And don’t read Huxley’s Brave New World either – read his last novel, Island. It’s about a type of Utopia and much more optimistic than Brave New World.

Stay optimistic and banish your fears

Orwell was out by at least forty years.

(from Instructions for Androids)

By | 2012-01-24T14:00:29+00:00 January 24th, 2012|Current Affairs, Health, Homeopathy|13 Comments

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  1. h Felton January 24, 2012 at 3:36 pm

    excellent article!

  2. Luke Scientiae January 26, 2012 at 12:00 pm

    What a disgrace to be promoting homeopathy, for which the reliable, peer-review evidence is non-existence. Not just that, but the idea of homeopathy violates basic science. The ways in which homeopathy is said by its promoters to “work” (the memory effect, etc.) amount to scientific illiteracy. It is, as the British Medical Association called it, “nonsense on stilts”.

    I note also that the question of evidence (i.e. how many peer-reviewed studies show that homeopathy is effective vs. how many show that it’s not) is not discussed here, nor on the FAQ page for homoepathy on this site, even though Kaplan happily criticises other remedies on the basis of published studies.

    In fact the FAQ page is very telling: Under the “Why are there so many negative articles about homeopathy” question, there is no answer; only the admission that homeopathy has been attacked for a long time. Yes, it has been, and for good reason: there is no good data that supports its efficacy.

    It’s shameful to be telling people this is a genuine treatment. Doctors really should know better than this; they should be well aware of how to assess the preponderance of evidence and its quality. Clearly not in this case.

    I challenge Kaplan to list the scientific studies that show homeopathy to work AND show their context in the wider literature (how many show it works, how many show it doesn’t, what is the quality of the data, and so on). My guess is that Kaplan will not rise to this. This website already fails at listing evidence and instead opts in places to criticise the “reductionist” paradigm of science instead. (If you can’t prove what you believe, attack the accomplishments of others.) The science Kaplan attacks is the same that has doubled average life expectancy in 100 years, eradicated smallpox and many other great things. Homeopathy has nothing of the sort to show for it beyond the placebo effect.

    • Dr. Kaplan January 27, 2012 at 3:10 pm

      Dear Luke,
      I apologise for the lateness in approving your comments and those of the other commentators. I am not an ‘agit prop’ blogger who sits in front of monitor all day – but a practising physician.
      Thanks for commenting – even though I much prefer to talk to people who have the courage to use their true name on the internet. I’ve heard your position enunciated many times and just as angrily. May I respectfully point out to you that this post was about antidepressives not about homeopathy which was merely cited to show the hypocrisy of those who want homeopathy removed from the NHS for financial reasons (sic) but have nothing to say about antidepressant prescriptions soaring despite the poor evidence for their use. Your comments would be reasonable in relation to the many posts I’ve made about homeopathy and the NHS but it’s got nothing to do with this post. It is not I who isn’t addressing the issues raised, it’s you. Why don’t you address my point about antidepressants? After all the Kirsch et al metanalysis which I cite is VERY scientific, Luke Scientiae. You might also look at what I and other have written about Science, Scientism and Para-science. Then maybe change your name to Luke Scientismiae or Luke Parascientiae. Better still, have the guts to use your real name when you make a comment. We are talking about medicine here after all.

  3. Luke Scientiae January 26, 2012 at 12:05 pm

    Those interested in understanding what is wrong with homeopathy and why evidence for it is lacking should read Ben Goldacre’s book Bad Science. It explains to non-scientific audiences how data is assessed for medical treatments (and why) and why homeopathy doesn’t meet the standard.

    A good article to begin with is here:

  4. Stephanie Forshaw January 26, 2012 at 12:24 pm

    You are so right Brian. Antidepressants are pretty scary – but I have found them ok for acute sitautions once or twice.
    Imagine the phone rings – its the Police to say your loved one has just been killed. Aconite 10M or diazepam? I just dont know.

    • Dr. Kaplan January 27, 2012 at 2:56 pm

      Hi Stephanie,
      Diazepam is a tranquliser not an anti-depressant. It has many uses in medicine. Antidepressants are much more contraversial and would be of little use in the situation
      you describe whereas Aconite 10M may well be of use – in my opinion.

  5. geeta arora January 27, 2012 at 5:51 am

    the fiction written years ago does come to reality some day ..indian mythology talks about all the adversity humans will have to see one day and this is what is happening with so many diseases and terrorism around..
    for antidepressants many studies have shown they are addictive and yes come with adverse side effects ..it is time that awareness is brought about for such side effects and for what homeopathy can offer these people ..

  6. Alix Whittal January 27, 2012 at 8:28 pm

    Dear Luke,

    Regarding your request :
    “list the scientific studies that show homeopathy to work AND show their context in the wider literature (how many show it works, how many show it doesn’t, what is the quality of the data, and so on)”.
    You will find a report commissioned by the Swiss health authorities to inform decision-making on the further inclusion of homoeopathy in the list of services covered by statutory health insurance here:
    The report comes to the following conclusion:
    “In conclusion we have established that there is sufficient supporting evidence for the pre-clinical (experimental) as well as clinical effects of homeopathy, and that in absolute terms, as well as when compared to conventional therapies, it offers a safe and cost-effective treatment”.
    The Swiss health system surely cannot be accused of being “scientifically illiterate”. Therefor I suggest you read the report as you will find plenty of evidence and valid references to accredited research articles in favour of homeopathy’s efficacy.

    • Dr. Kaplan January 28, 2012 at 6:43 pm

      Thanks Alix,

      However homeopathy’s detractors will not appreciate you ‘confusing them with facts’ such as these. Homeopathy is an affront to their deterministic and mechanistic view of the world and they will do everything
      they can to force that viewpoint on the people whether the people want it or not. See my post on homeopathy, politics and liberty.

  7. Luke Scientiae January 28, 2012 at 11:11 pm

    Reply to Dr Kaplan:

    My blog (lukesci.com) is presently down for maintenence, but its About page explains why I use a pseudonym. The basic reason is that a number of cranks and pseudoscientists have attacked criticism by litigation (an attempt to silence scientists they don’t like), rather than providing evidence. I don’t plan to be on their list. (For an example, see here: http://www.guardian.co.uk/science/2010/apr/15/simon-singh-libel-case-dropped1)

    The veracity of truth claims made by homeopathy advocates does not rest on their authority as doctors, nor my anonymity or otherwise. It rests on the EVIDENCE.

    It’s no good substituting, as you did, Dr Kaplan, the question of evidence with allegations that mainstream science is somehow determined to keep out alternative explanations; you first have to show that reliable data warranting those explanations actually exist.

    The claim that mainstream science is somehow inherently biased towards mechanistic explanations is fallacious. History shows that science accepts changes of paradigm wherever the preponderance of evidence mandates it, from the Copernican revolution to the development of quantum physics (btw, quantum physics is NOT mechanistic but quantum theory is the theory that most precisely matches experimental evidence). There are many other examples.

    Dr Kaplan goes on in his comment to attribute to me a “deterministic and mechanistic view of the world”, which he cannot have any information about since he knows exactly nothing about what I think about determinism, for instance. It’s a change of subject and it’s a personal attack. Very far from answering the call for evidence validating what you do and claim to be true.

    I’ve been extremely disappointed to find that not only did you refuse to engage me on the evidence, Dr Kaplan, and that you resorted instead to insults and unfounded imputations, but were openly critical of Alix, who did – in your defence, I emphasise! – attempt to provide evidence. I was right in my prediction:

    “I challenge Kaplan to list the scientific studies that show homeopathy to work AND show their context in the wider literature (how many show it works, how many show it doesn’t, what is the quality of the data, and so on). My guess is that Kaplan will not rise to this.”

    Kaplan also refers to hypocrisy and ignores my comment about his: He fails to provide links to peer-reviewed literature (and, as we see above, is derogatory towards others’ attempts), whilst criticising anti-depressants in his post on the basis of peer-reviewed literature. You can’t have it both ways.


    Reply to Alix:

    Thank you for standing up for your beliefs and providing the link.

    However, the journal you cite is dedicated to CAM (Complimentary and Alternative Medicine). That’s hardly a neutral source, since it is dedicated to supporting the very thing that is in question, and which – were it discredited – would end the existence of the journal.

    You might be interested in wider studies and meta-studies, such as this one published in J Med Aust, 2010:


    It concludes:

    “Collectively, the six reviews that I appraised failed to provide compelling evidence for the effectiveness of homeopathic remedies. These reviews, being Cochrane reviews, are likely to be more reliable than other sources of evidence.6 Furthermore, as most were authored by homeopaths, it seems unlikely that they were biased against homeopathy. In fact, one might argue that they were biased in favour of homeopathy.

    “…In conclusion, the most reliable evidence — that produced by Cochrane reviews — fails to demonstrate that homeopathic medicines have effects beyond placebo.”

    I would also ask why it is that representatives of, e.g., the British Homeopathic Association, squirm away from recommending homeopathy for malaria prevention/treatment (e.g. here: http://www.youtube.com/watch?v=s1UJ_qGZ24k) or why there have been so many disastrous consequences when people have attempted to treat their diseases homeopathically: http://www.youtube.com/watch?v=QdLOBRUwq10.

    All this comes down to a desire to believe that homeopathy works, or cherry-picking the data to enable the confirmation bias. And it shows in what happens when an accurate appreciation of the evidence isn’t of concern.

    I don’t attack those who have been misled by cherry-picked data, but I do attack those who refuse to provide the evidence they should be eager to show if it truly supports their claims. Dr Kaplan, as we see from his attacks on me, is a perfect example.

    • Dr. Kaplan January 29, 2012 at 4:55 pm

      Okay Luke, you have brought up several points and I’ll answer them this time – not without reluctance because this post was about antidepressants, the lack of evidence behind most of their prescriptins and the hypocrisy of attacking homeopathy on the basis of ‘we can’t afford it’ ( NHS drug budge £10) when these non-evidenced SSRI antidepressants have a budget of at least £232 before the reports on their ‘soaring’ and ‘skyrocketing’ prescription rate. You fail to comment on this, central theme of the post and simply segway off into attacking homeopathy. In future I will only publish comments pertaining directly to the main theme of my posts.

      INSULTS: You use the words ‘disgrace’ and’shameful’ towards my writing and repeat the ‘nonsense on stilts’ (is this EBM?) insult spewed at some pathetic meeting of junior BMJ (I think) – and I now think they rather regret saying that. Not that you shouldn’t be inspired by it of course. I think the word ‘witchcraft’ was used there too.

      I admit using the words ‘mechanistic’ and ‘deterministic’ towards the sort of philosophy I frequently find lies behind comments such as yours in your note but (these are not necessarily insulting words and will aways be seen as objectively less offensive than calling someone a ‘disgrace’, ‘shameful’ and their art ‘nonsense on stilts’ My guess is that you are a lot worse at receiving any form of insult than you are at dishing insults out.

      ANONYMITY: I don’t accept your explanation. Untrue damaging ad hominem attacks on people are still illegal in the UK. Personally I favour the USA style 1st Amendment influenced law. ie Freedom of Speech. However unless you attack individuals unfairly, you should not fear libel at all – as British justice showed in the Simon Singh case. Where the campaign to ‘Keep Libel Laws out of Science’ was wrong is they would have like to have continued attacking (in many vile ways) individuals whose views with which they disagreed – without fearing libel for their unprovable ad hominem slights. Get rid of the libel laws altogether and I for one would not object. But to campaign to get libel laws ‘out of science’ is utterly disingenuous because it seeks to allow people who call themselves ‘scientists’ to break the libel laws and make untrue ad hominem attacks people whose views on science annoy them. What nonsense.

      SCIENCE & SCIENTIFIC STUDIES: I do NOT attack science. I am a doctor, have practised surgery and treated a syphilitic primary chancre, meniningitis, pneumonia etc with Penicillin. But I do attack SCIENTISM and PARASCIENCE. I also draw attention to the fact that huge swathes of conventional medicine are far from evidence based as this graph in the BMJ’S CLINICAL EVIDENCE clearly shows. Let the ‘authorities’ create a level playing field and say what ‘level of evidence’ is needed for use on the NHS. Reasonable suggestion, Luke? Or am I asking too much? Or is the fact an overambitious young doctor at a junior BMJ meeting called homeopathy ‘nonsense on stilts’ good enough ‘evidence’ for you. As far as I am concerned outcome studies all over the world, in particular Bristol are very convincing that homeopathy has powerful therapeutic effects – however it works.. Any decent human being or honest doctor would want to investigate what is happening at these institutions – rather than insult, trash call for the NHS banning on homepathy. And any decent doctor would also look at that BMJ pie chart and be honest about it. I’ve written about this here and here. So feel free to comment on those posts Luke. Comments on this one will now be restricted to those that address the subject of the post.

      ANTIDEPRESSANTS: This is the subject of this post I have written extensively about homeopathy, studies and the nasty, hypocritical and disinginuous attack on NHS homeopathy (citing financial (sic!) reasons for the reason to abolish NHS funding of it) when so much of conventional medicine lacks an evidence base yet is MUCH more burdensome to the taxpayer than homeopathy. Antidepressants are just one rather good example of this. If you want comments published in this blog, then please write about the the subject of any given post. Comments on other issues on my site can be made in relation to those posts and I’ll certainly publish them – even though you continue to hide behind a mask.

  8. David Eyles February 11, 2012 at 2:32 am

    Dear Brian,

    Firstly apologies for entering the fray rather late, but I have only just picked up this debate via twitter.

    For the record, I am a livestock farmer who uses homoeopathy on a regular basis with good and sometimes surprising results.

    The point of your post is well made (i.e contrasting the hypocrisy of the NHS spending on antidepressants vs homoeopathy and the subsequent flak that the latter gets whilst not an eyelid is batted over the former). For my part, I get even more angry when I consider the naked waste made by the NHS in huge requirements for IT and administration which serves no real clinical benefit. This phenomenon is never pointed out by the Skeptics [sic].

    However (and at the risk of incurring your ire in going off topic) I feel I have to respond to Luke’s reference to one of Edzard’s little ruminations, to which Luke links above.

    Firstly, it is published in the Medical Journal of Australia. I am unable to say if this is a first rate medical journal or not, but it seems odd that Ernst felt compelled to send what would otherwise be an item of interest (albeit a short one) so far afield. His observations could just as easily have been made in a UK or US journal and have been given a wider audience if they had been.

    Ernst’s inclusion protocol from within the Cochrane database are fair enough and the numbers of reviews accord with my own searches.

    His assessment of individual reviews are arguable in two or three cases, but principally it is his use of “non-significance” in a review to mean “No effect” by the time he gets to his conclusions that I take issue with, because he does it habitually with many of his so-called systematic reviews. In this case his conclusion states: “….the most reliable evidence…..fails to demonstrate that homeopathic medicines have effects beyond placebo.” Given that he does this with a set of Cochrane reviews; and given that the Cochrane guidelines repeatedly state “No evidence of effect is not the same as evidence of no effect” I find it astonishing that this paper got past peer review.

    • Dr. Kaplan February 11, 2012 at 3:30 pm

      Thank you very much for your considered and erudite comments. I am delighted to hear from a farmer who values homeopathic treatment of his animals.

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