Cross Words: What the doctor ordered?

Head to head: A pill to cure your shyness, another to make you slim: are `lifestyle drugs' a cure-all or a cop-out? Professor David Nutt crosses scalpels with Dr Richard Nicholson

Pro-lifestyle-drugs

"`Lifestyle drugs' is a very pejorative term which implies that these drugs are prescribed and taken for trivial reasons. This is not the case. The so-called `shyness pill', Seroxat, is not targeted at those who are a bit shy, it is used with those whose lives have been completely disrupted by severe anxiety to the extent that they cannot work or get married because of the fear of people looking at them. Again, in the case of `the slimming-pill', Xenical, it is targeted only at the clinically obese, who have a much higher rate of medical illness, not those people who just want to look slim. Helping people, through medication, back to work or to lose weight is cost-effective for the state because it prevents them from becoming a burden in other, costlier ways.

I'm not saying all problems can be solved with medication, but medication is part of the solution. For instance, if you're a single mother living in very unsatisfactory accommodation from which you can't escape, you may get anxious and depressed. Medication can now help you with this, despite the fact that it can't intervene in the social arena. People shouldn't be denied help just because they face unsolvable social and domestic problems.

What we now have are treatments that are being promoted and education for GPs on how to diagnose and treat those conditions that up until now have been ignored or hidden. The drug companies are actually giving sufferers their first real chance of being taken seriously. There are countless patients who have said to me, `Thank God, you've finally given me something that works and I can go and live a normal life again.'"

Professor David Nutt is head of Clinical Medicine at Bristol University

Anti-lifestyle-drugs

"We live in a world where one-tenth of the wealth created each year goes to providing healthcare to the one-seventh of the population who are already the healthiest. Rather than grabbing at every new product which the drug manufacturers offer them, the medical profession in richer Western countries should be asking themselves, what are and what should be the limits of medicine? The definition of what is medically `trivial' is constantly changed by doctors as drugs become available to treat conditions for which they weren't available previously. They would argue that they are doing it for the better, but the amount of benefit is becoming, in some cases, vanishingly small.

The general rule with drugs is that their benefits are always exaggerated to begin with and their risks are underestimated. The anti-fatness drug will, I believe, soon show this to be true. And the SSRI drugs - Selective Serotonin Re-uptake Inhibitors, such as Prozac - have their own drawbacks, one of which is that it's quite difficult to stop using them. But the drug companies have to show a profit for their shareholders' benefit, and these shareholders are much more important to them than patients.

We're renaming conditions which are, in effect, social problems and part of the normal spectrum of life. For example, erectile dysfunction is now treated with Viagra, even though there are sound, biological reasons why older men shouldn't be able to father children. Drugs can provide short-term help but I'm very doubtful whether they provide any long-term solutions."

Dr Richard Nicholson is the editor of `The Bulletin of Medical Ethics'

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