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CONTENTS

Preface

1. Medicines out of Control?

  • The case history
  • Crisis unfolding
  • Of science and common sense
  • Role of the Pharmas
  • Medicalisation and ‘disease awareness’
  • Government regulation of medicines
  • Scientific standards
  • Iatrogenesis
  • Towards resolution

2. Sedative hell

  • Alcohol
  • From opium to morphine
  • Freud, denial and cocaine
  • Non-narcotic solutions
  • Ordeal by bromides
  • Enter the barbiturates
  • Addiction false and true

3. Tranquillisers

  • Librium and Valium
  • Benzos versus barbiturates
  • Measuring tranquilliser effectiveness
  • Methodology of denial
  • The trouble with Ativan
  • Xanax and Halcion
  • Slouching towards understanding

4. Drugs to defeat depression

  • Origins of antidepressants
  • First steps in treating depression
  • Growing the antidepressant market
  • Do antidepressants work?
  • Testing the efficacy of the SSRIs
  • The risk of dependence
  • Changing the meaning of dependence
  • Pennies begin to drop

5. From secrecy to common sense

  • The Medicines Control Agency
  • Official secrecy
  • Growth of the Internet
  • PANORAMA on paroxetine
  • Attempts at withdrawal
  • The meaning of ‘discontinuation’
  • FDA preoccupation with ‘abuse’
  • In praise of transparency

6. Explaining the Pharmas

  • Drug innovation
  • US gravitational pull
  • Blockbuster imperatives
  • Influence at work
  • Reputations
  • Pharmas and world health
  • Pharmas and the WHO

7. Medicalisation and ‘disease awareness’

  • Direct-To-Consumer drug advertising
  • Direct to Europe promotion
  • The British Way
  • G10 and the pharmaceutical review
  • The European Parliament steps in
  • Public-Private postscript

8. Regulatory dependence

  • Origins of drug control
  • Figureheads in US drug regulation
  • UK-style drug control
  • Commercial sponsorship of government regulation
  • A footnote on European medicines control
  • Dossiers and dosage
  • Limitations of regulatory scrutiny
  • Adverse drug reaction reporting
  • Self-regulation?

9. Scientifically tested and approved

  • Medicines Control Agency reviews
  • Reliability of evidence from drug trials
  • Clinical research practice
  • Scientific integrity
  • Placebo factors and beyond
  • Organisms in organisations

10. Iatrogenesis

  • Illich on iatrogenesis
  • Clinical iatrogenesis
  • Misplaced emphasis on numbers of ADRs
  • Analysis of paroxetine Yellow Cards
  • Yellow Cards on suicidal behaviour
  • Medicalisation

11 The story so far

  • Parliamentary limitations
  • SSRIs and children
  • Seroxat label transformation
  • Unsuitable for publication
  • Yellow Card prohibition?
  • Towards 2004
  • DISCUSSION
  • Doing more with less
  • First principles of reform
  • Health for one and all?

References

Glossary and notes

Drug names and identification
Currency equivalents: £, $ and €
Institutional identities and acronyms