Selling Sickness (review)

Based on the 2004 book by the same name, Selling Sickness is a thought-provoking film about the mass marketing of SSRI antidepressants. Although its critical intent is apparent throughout, it provides a complex account. The film includes interviews not only with outspoken critics of the pharmaceutical industry, such as psychiatrist David Healy and policy analyst Barbara Mintzes, but also with people who view the industry more positively, including Murray Stein, a researcher involved in clinical trials of drugs to treat social anxiety, and Vince Parry, head of an advertising agency that specializes in drug campaigns.

The documentary does a particularly good job of portraying the contradictory views that patient/consumers have of the new SSRI antidepressants, especially Paxil, a drug introduced in 1992 by Glaxo-Smith-Kline (GSK). On the positive side are the segments about Amy, a former sufferer from panic disorder who credits Paxil with her recovery (and who is shown winning the title of "Miss Orlando"), and Mary Guardino, founder of the self-help group Freedom from Fear, who explains that FFF accepts funding from pharmaceutical companies in order to help people become more aware of new drug treatments. But such testimony is far outweighed by voices of the discontented—in particular, Harry Skigis and Deborah Olguin. When first introduced, they echo Guardino's upbeat message, explaining how Paxil rescued them from extreme anxiety that made their lives miserable. But soon the dark side of their experience emerges: having been told the drug is not habit-forming, they try to quit, only to suffer severe withdrawal symptoms that force them back on the drug. By the film's end, Harry and Deborah are revealed as parties to the 2001 lawsuit charging GSK with suppressing evidence that Paxil is habit-forming for some users.

Selling Sickness moves from a general discussion of antidepressants and advertising to a more focused account of the controversies surrounding SSRI drugs, in particular the 2001 and 2004 lawsuits concerning Paxil. (The 2004 lawsuit filed by New York Attorney General Elliot Spitzer, charging GSK with fraud for suppressing information about elevated risks of suicide in children and teenagers taking Paxil, was subsequently settled for $2,500,000.) The documentary's most wrenching scenes are taken from 2004 FDA hearings about adverse reactions to Paxil and Zoloft in children and adolescents. The filmmakers follow two families, the McIntoshes and Woodwards, whose daughters were prescribed SSRIs to help them through the emotional turmoil of adolescence, only to commit suicide soon after starting the medication. The parents came to the FDA hearings determined to "spread the word," as one explains, so other families could be alerted to the drugs' risks. After the hearings, the FDA ordered that Paxil carry a label warning that the drug might elevate the risk of suicidal behavior in children and adolescents.

To the extent that the documentary allows any character to emerge as a hero, it is David Healy, the onetime consultant to the pharmaceutical industry who has become one of its most determined critics. Featured prominently, Healy develops the central message: the mass marketing of psychotropic drugs, now taken by an estimated 50–60 million people each year, inevitably raises the risk of serious, unpredictable side effects; to minimize that risk, pharmaceutical companies must be forced to disclose all of the results of clinical trials, not just positive ones. Clinical trials used to be considered the scientific part of drug development, separate from the advertising and marketing end of the business; now they are part of the marketing plan, Healy argues. This fusion of scientific and commercial agendas makes it essential that regulatory agencies have independent auditors review the raw data from all clinical trials, if future tragedies are to be averted.

The one voice missing in the documentary is that of the pharmaceutical companies. The filmmakers note that GSK declined to be interviewed. (They do not state whether Pfizer, makers of Zoloft, were also approached.) Without hearing GSK's side of the story, the...