Health Check: Science created Prozac but marketing made it sing

I AM a fan of Prozac, but some of the adulatory stuff that I have read marking its tenth anniversary sticks in the craw. Prozac is an excellent drug because it works and - far more important, this - because the publicity around it has persuaded many extra thousands among the legions of the depressed to do something about their misery.

For let us be clear about one thing: Prozac is a marketing success, not a scientific one. This is relevant to the current debate about rationing, Viagra, the price of drugs and whether the National Health Service as we know it is any longer affordable. Science can bring new drugs to the surgery, but only marketing can make them sing.

Let me explain. For decades, depression, which causes enormous suffering and thousands of deaths (by suicide) every year, has been under-treated. So any development that encourages people to seek treatment must be a good thing. The arrival of the selective serotonin re-uptake inhibitors (SSRIs) in the late Eighties, of which Prozac is the best known, was certainly a good thing.

These were antidepressants without (unpleasant) side effects. That was their unique selling point. They were no more effective at lifting depression than the tricyclics which preceded them, but they did it without causing the dry mouth, constipation and drowsiness that were frequent side effects of the older, dirtier, drugs.

This was crucial to improving the acceptability of anti-depressant drugs. Prozac and its relatives were claimed to be the first "clean" anti-depressant - a mood brightener that did not leave you with a leathery tongue, a sluggish gut and cotton wool between your ears.

Except that they were not the first. That accolade belonged to the "new" tricyclics, such as lofepramine (brand name, Gamanil), developed in the Sixties and Seventies, which were refined, cleaned-up versions of the early tricyclics discovered in the Fifties.

Most of the research evidence on which Prozac has built its extraordinary worldwide success - an estimated 35 million prescriptions have been written worldwide and global sales now bring its manufacturer Eli Lilley $1.7bn dollars a year - is thus based on a little white lie, a sin of omission. It compared Prozac with the old tricyclics over which it has the significant advantages I have outlined. I know of no study which has demonstrated similar advantages for Prozac or the other SSRIs over the new tricyclics such as lofepramine, other than in specific conditions such as obsessive compulsive disorder.

So why have the makers of lofepramine not taken to the roof-tops to challenge Prozac's dominance of the market? Simple. It is out of patent so it belongs to nobody. No single company could expect to benefit from its success.

The significance of this is that Prozac costs the NHS twice as much as lofepramine at pounds 20.77 for a month's supply compared with pounds 9.84.

Prescriptions for Prozac have risen from 365,000 in 1991 to more than 2.9 million in 1997, an eightfold increase. The question which Prozac supporters such as Claire Rayner, chairman of the Patients Association, should be asking is not whether the drug brings worthwhile benefits (it certainly does) but whether the benefits it offers over and above those offered by rival drugs, if any, are worth the price differential of pounds 10 per patient per month - or more than pounds 100m a year.

This puts the row over Viagra, a drug which has undisputed advantages over rival treatments, and spending on which was estimated to rise to between pounds 50m and 100m a year even if every man who wanted it got it on the NHS, in perspective.

It is the kind of issue that the new National Institute for Clinical Excellence will be examining when it starts work on April 1.

But I don't envy Professor Sir Michael Rawlins and his team their job.

Who could have predicted, when Prozac received its licence in 1989, that it would become a household name across the world? Yet without the clout of the marketeers behind it, millions might have been denied the release from their misery that the drug has brought.

The story of Prozac demonstrates that there is more to health care than scientific proof of effectiveness and economic proof of value. Health care is about more than science and cost, but Sir Michael and his team will require the judgment of Solomon to ensure that the NHS is neither broken by excessive demand nor weakened by unreasonable denial.

Arts and Entertainment

game of thrones reviewWarning: spoilers

Arts and Entertainment
The original Star Wars trio of Harrison Ford, Carrie Fisher and Mark Hamill

George Osborne confirms Star Wars 8 will film at Pinewood Studios in time for 4 May

film

Arts and Entertainment
Haunted looks: Matthew Macfadyen and Timothy Spall star in ‘The Enfield Haunting’

North London meets The Exorcist in eerie suburban drama

TV

Arts and Entertainment

Filming to begin on two new series due to be aired on Dave from next year

TV

Arts and Entertainment
Kit Harington plays MI5 agent Will Holloway in Spooks: The Greater Good

'You can't count on anyone making it out alive'film
Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    Fishing for votes with Nigel Farage: The Ukip leader shows how he can work an audience as he casts his line to the disaffected of Grimsby

    Fishing is on Nigel Farage's mind

    Ukip leader casts a line to the disaffected
    Who is bombing whom in the Middle East? It's amazing they don't all hit each other

    Who is bombing whom in the Middle East?

    Robert Fisk untangles the countries and factions
    China's influence on fashion: At the top of the game both creatively and commercially

    China's influence on fashion

    At the top of the game both creatively and commercially
    Lord O’Donnell: Former cabinet secretary on the election and life away from the levers of power

    The man known as GOD has a reputation for getting the job done

    Lord O'Donnell's three principles of rule
    Rainbow shades: It's all bright on the night

    Rainbow shades

    It's all bright on the night
    'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

    Bread from heaven

    Dutch survivors thank RAF for World War II drop that saved millions
    Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

    How 'the Axe' helped Labour

    UK will be 'run for the wealthy and powerful' if Tories retain power
    Rare and exclusive video shows the horrific price paid by activists for challenging the rule of jihadist extremists in Syria

    The price to be paid for challenging the rule of extremists

    A revolution now 'consuming its own children'
    Welcome to the world of Megagames

    Welcome to the world of Megagames

    300 players take part in Watch the Skies! board game in London
    'Nymphomaniac' actress reveals what it was really like to star in one of the most explicit films ever

    Charlotte Gainsbourg on 'Nymphomaniac'

    Starring in one of the most explicit films ever
    Robert Fisk in Abu Dhabi: The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers

    Robert Fisk in Abu Dhabi

    The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers
    Vince Cable interview: Charging fees for employment tribunals was 'a very bad move'

    Vince Cable exclusive interview

    Charging fees for employment tribunals was 'a very bad move'
    Iwan Rheon interview: Game of Thrones star returns to his Welsh roots to record debut album

    Iwan Rheon is returning to his Welsh roots

    Rheon is best known for his role as the Bastard of Bolton. It's gruelling playing a sadistic torturer, he tells Craig McLean, but it hasn't stopped him recording an album of Welsh psychedelia
    Russell Brand's interview with Ed Miliband has got everyone talking about The Trews

    Everyone is talking about The Trews

    Russell Brand's 'true news' videos attract millions of viewers. But today's 'Milibrand' interview introduced his resolutely amateurish style to a whole new crowd
    Morne Hardenberg interview: Cameraman for BBC's upcoming show Shark on filming the ocean's most dangerous predator

    It's time for my close-up

    Meet the man who films great whites for a living