Todayâ€™s claim that some anti depressant drugs are little or no better than pretend pills for all but the most severe kinds of depression poses some interesting questions about medicine on the NHS.
The drugs bill is huge and growing. All too many patients expect a visit to the doctor to produce a prescription as a solution. Many doctors have learned that offering tablets is the best way to handle their patients, and to ensure a swift and satisfactory consultation. I can understand the pressures and why they might come to that conclusion. The last time I went to a doctor some years ago I found it quite difficult to get out without a prescription, when I had merely gone on the insistence of a family member for a check up. People are less willing to hear that changing their diet, their lifestyle and their routine might do them more good than swallowing another tablet.
Depression is all in the mind. Some depressed people come to see their MPs. They may have a genuine case for an MP, but sometimes they are externalising their unhappiness. I take the problem they tell me they have seriously, but sometimes have to explain that I do not think anything can be done about it as I do not wish to raise false expectations. It is a pattern I well remember, from years of family experience. The depressed person often thinks there is an objective external cause of the unhappiness. If they can change their job, their home, the conduct of their wife or husband, their friends or their neighbours, they believe their unhappiness will vanish. All too often they discover that having made the change they are still unhappy, so the search for another cause begins and the pressure for another change builds up to try to appease the depression gods.
Taking a pill that is nothing but well disguised sugar might well work. If the patient believes in it, it could bring some relief from the inner darkness. The problem is the NHS feels it has to prescribe the expensive real thing, and not the substitute, so the doctor-patient relationship is not based on a white lie. The placebo pill is cheaper. It might be almost as good in its effects, according to todayâ€™s study. It is guaranteed not to have side effects, but under the rules it cannot be widely used. It poses an interesting ethical dilemma. What should the doctor do? What should the NHS require?