Editorial Note: Two comments from Johanna and Neil in response to The Dark is for Mushrooms and Preventing Precaution.
Johanna
I didn’t see the BBC Panorama show (not available in the US) and don’t know if the outrage expressed by the Mumsnet blogger is sincere. It hardly sounds like Dr. Pilling was against using SSRI’s for any woman physically capable of getting pregnant. In any case he didn’t propose to ban anything; he simply thought we deserved to (gasp!) know the facts.
But I think Neil Gorman is on the right track: if you just talk about the (physical) harms to the fetus and say nothing of the (mainly mental and emotional) harms to the woman, you miss the point.
And you hand the microphone to the drug companies to accuse you of discounting women’s concerns, treating us as mere containers whose welfare should take a back seat to even the slightest threat of fetal harm.
The flip side of course is the HUGE exaggeration of the benefits of these drugs (and the unsupported assertion that depression itself will physically harm the baby). That’s the key to understanding the whole “pre-pregnancy” issue. As a woman, I should absolutely be the one to decide what risks to my future fertility or the health of possible future children are acceptable. But it depends entirely on what the benefits are – and if I’m being force-fed a wildly inflated notion of my own ‘mental illness and the drugs’ benefit, I am deprived of free choice. Especially once you get me hooked.
The latest edition of Our Bodies, Ourselves, the pioneering feminist health guide put out by the Boston Women’s Health Collective, took a much different tack on SSRI’s and pregnancy. They did not take the birth-defect issue seriously enough in my view. But on the subject of what are the roots of “prenatal depression” and what can women do about it, I thought they were spot-on and their thoughtful rebellion against Pharma orthodoxy deserves to be publicized and celebrated.
Just a snip:
“Too often women experiencing reasonable responses to difficult life situations are treated by health care professionals with mood-altering medications that can have unwanted side effects. These medications—whose popularity is fuelled by simplistic and unrealistically optimistic advertising—are often prescribed before women are offered more holistic approaches that have been demonstrated to be equally or more effective.”
It’s not unlike the example of the woman in her late twenties raising 2 or 3 kids alone who wonders why she’s just not interested in sex these days – and the “expert” who wants to test her testosterone levels! Apparently nothing could be all that wrong with our lives and the choices we’re given. No, if we’re unhappy with our lot, we must have a disease … This approach, while pretending to empower women, is actually the most controlling and disempowering I can imagine.
I knew “mommy blogs” had become a lucrative industry with worrisome commercial ties that threatened their just-folks sincerity. But I never saw the like of NetMums. They are a marketing monster in the UK it seems – there was just a Product of the Year competition juried and sponsored by them along with The Sun, Woman’s Own Magazine and other big-time outlets.
Funny thing too … GSK won. Not for their Rx drugs of course – for Sensodyne toothpaste. Seems they’ve had “relationships” with Netmums around other consumer brands like Ribena kiddie drinks, etc. Siobhan Freegard, their Czarina, makes Oprah look like just a regular gal speaking her mind … I don’t think there’s a single blog in the US with commercial clout of this sort.
That being said, I can’t know whether any of the posts by individual women in their chat forum were in any sense “sponsored” material. And my hat is off to Edam, Ragusa and others who had the guts to point out that Big Pharma is not exactly an agent of women’s liberation!
Neil
A few interesting little things I noticed but didn’t include in my original post. The reason I found this particular discussion on Mumsnet was down to a Google search for the keywords ‘Panorama ssri’s pregnancy’.
No matter the combination of related keywords, RCPsych tend to dominate the first page with their response, either from their own website, or one of the many others that carries their statement or at least parts of their statement. Their SEO guys rock!
You don’t have to go off the first page of results to the see a pattern emerge. I see it as a two pronged approach:
1. A general ‘scientific/expert’ defence that is carried out by Lundbeck and RCPsych. To me this appears to be coordinated, with both citing evidence from ‘recent well designed trials’ (as opposed to all those old badly designed ones that Professor Piling is reviewing), and both also go on to reassure women that the risks are very low, uncertain even, before finishing with the very real risks to mum, baby and family if depression goes untreated. I have found this argument replicated dozens of times since the Panorama program from both Lundbeck and RCPsych.
2. The womens rights approach. Mumsnet isn’t the only place this argument has taken place. Still on page one of my search is the Daily Mail. Slightly different readership demographics and so a slightly different approach to the issue, with the rights of women with mental health problems to have children taking centre stage here.
Best rated comment – 102 likes
Actually zenia, some of us are unable to control our serotonin production in the body and need the medication to function…granted being depressed isnt a great thing to bring a baby into but are you seriously telling me because i was born with a disability i do not deserve to be a mother?? having a disabilty such as depression is something that is hard enough without being told your not good enough to be a parent i have been taking my medication through out my pregnancy but have been very closely monitored via the hospital and i have done everything i can to protect my daughter to ensure nothing will hurt her so grow up you silly silly women or child which ever you are. being a mother is any ones right not something you have to earn through perfect genes the next time you feel your perfect enough to comment on such matters firstly
2nd best rated – 100 likes
Yay something else for depressed mums to feel guilty about. I am of course being sarcastic.
Back on to mumsnet and some other things I noticed. The Gobsmacked post wasn’t the only one on mumsnet talking about Panorama, just the only one to appear in my google search. I didn’t spend much time looking but found a few others. One was in the antenatal section, as you would expect but had a mere 8 replies.
Another was in the chat area. [It was at http://www.mumsnet.com/Talk/_chat/a1793060-Panorama-pregnancy-and-pills-anyone-watching]. Here you can read an interesting set of posts by opensesame74. You can follow her through this discussion and then to the feminist one.
And yet another was an official post of a guest blogger added by Kate at Mumsnet HQ.
This discussion…OP and responses, reads very like the one in the feminist section, covers all the same points, but the language is much softer and it carries the impression of being an officially sanctioned part of Mumsnet, with a nice graphic, pale blue background and a long, well written guest post. Of course it is cross linked to the unofficial harsh version by NiceTabard.
Once again the star of this discussion is edam, who gives me some hope.
It’s not hard to find evidence of a link between pharma marketing departments and websites like mumsnet. I obviously can’t prove anything without GCHQ or Prism type powers, but I can show how plausible it is. If you want a peek at how pharma think about websites such as mumsnet, you can go to the pharma marketing society website…yes, mumsnet gets a mention!
Some interesting stuff here, there is even a list of software to help you identify, listen, engage and respond to influential people on these social networking platforms.
If you had the time to read all that, and have digested the different code compliant strategies pharma marketing use to engage with these social networking sites, then take that thought back with you to mumsnet and do an internal search for popular antidepressants to see how often they are discussed… you get some interesting results.
- Citalopram – About 2,570 results (0.16 seconds)
- Celexa – About 122 results (0.11 seconds)
- Effexor – About 90 results (0.14 seconds)
- Venlafaxine – About 377 results (0.29 seconds)
- Seroxat – About 490 results (0.19 seconds)
- Paroxetine – About 206 results (0.14 seconds)
And there you have a plausible link with Lundbeck… Like I said, it proves nothing but it is interesting.
neil says
Not wanting to be accused of cherring picking, I decided to do a a few more searches for antidepressants on mumsnet. As the brand name that pretty much defines the entire class of drugs, I expected prozac to top this list by some margin.
Mumsnet – Search for advice, by parents for parents
Here you can search through Mumsnet’s wealth of advice for parents, by parents.
1. Citalopram – About 2,570 results (0.16 seconds)
2. Prozac – About 2,200 results (0.18 seconds)
3. Sertraline – About 1,340 results (0.27 seconds)
4. Fluoxetine – About 985 results (0.16 seconds)
5. Seroxat – About 490 results (0.19 seconds)
6. Venlafaxine – About 377 results (0.29 seconds)
7. Paroxetine – About 206 results (0.14 seconds)
8. Escitalopram – About 185 results (0.17 seconds)
9. Cipralex – About 149 results (0.13 seconds)
10. Zoloft – About 125 results (0.20 seconds)
11. Celexa – About 122 results (0.11 seconds)
12. Effexor – About 90 results (0.14 seconds)
13. Duloxetine – About 49 results (0.13 seconds)
14. Fluvoxamine – About 17 results (0.12 seconds)
15. Cymbalta – About 17 results (0.10 seconds)
I don’t have access to prescription numbers in the uk, but according to a paper in the British Journal of Psychiatry,…”the three most commonly prescribed SSRI antidepressants (fluoxetine, paroxetine and sertraline; n=10 308) in the UK were included”.
http://bjp.rcpsych.org/content/177/2/163.full
gbl says
There was a similar marketing scam going at the old google groups circa 2000-2005 — sci.med.cardiology, and sci med, for statins. We worked those groups with the same marketing knowledge that the pharma wonks did. They met their match in us. We were all women who had either been injured by statins, or had family members who were. We were all writers, reseachers, and damn angry.
We know we had pharma reps working against us, but we were as motivated as the reps were, albeit, not by money. We made inroads with the commenters, who while not inclined to believe a group of women/strangers on the internet, had experienced to some degree the side effects we wrote about. Fully half of our work there was to out the reps and we, knowing our way around the internet better than they did, found where they work, who they were in real, and embarrassed them with it at will. We used whatever we could.
Toward the end of our work there, we became connected with Drl Beatrice Golumb, who eventually was funded $5 million from NIH to study statin side effectx. I know were were instrumental in that even being considered.
Incidentally, George Monbiot wrote about Monsanto pioneering this type of social media marketing, here: http://www.monbiot.com/2002/05/14/the-fake-persuaders/
I’ve never seen anything since, where women worked together extemporaneously, to back down industry. Hats off to you wherever you are gals, from you know who.