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Book and Media Reviews
February 7, 2007

The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

Author Affiliations

Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Fishbein Fellow, JAMA.

JAMA. 2007;297(5):533-537. doi:10.1001/jama.297.5.534

Among the countless forces that shape attitudes toward drugs, science is arguably the least influential. Although irrationality pervades people's use of all substances, from herbal preparations to antibiotics, a singular foolishness imbues the views of mind-altering ones.

Unfounded drug decisions can result in substantial costs to the public health. As just one example, the US Food and Drug Administration (FDA) recently decided that all antidepressants should carry a black box warning to the effect that they increase the risk of suicidal thinking and behavior in children and adolescents. The FDA decision was based on what can most charitably be described as inconclusive data. No children or adolescents in the trials at hand actually killed themselves; the slight increase in suicidal thinking and behavior noted in some of the antidepressant trials is of doubtful statistical and clinical significance; and, most pertinent, such behaviors do not foretell actual suicide.1 Thanks in part to this warning and the surrounding publicity, parents have become reluctant to have their children take antidepressants and clinicians reluctant to prescribe them. Numbers of antidepressant prescriptions fell precipitously following the warning, and although the effects are not yet clear, it is possible that morbidity and mortality among children and adolescents will increase.