Letters: Oct. 20, 1997

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"We don't need 'cleaner' drugs to help us manipulate the brain better. We need to understand how it is disturbed in the first place." GORDON WILLIAMS, M.D. Florencecourt, Northern Ireland

Much of the art of medicine lies in balancing the risks and benefits of every drug administered [MEDICINE, Sept. 29]. When this balance is disturbed by long-term use of drugs that are intended for short-term therapy or needless administration of drugs for self-limiting conditions, we will continue to have unnecessary tragedies. As drugs become more potent, the potential for these disasters increases. We are a drug-oriented, quick-fix society, so this scenario will be constantly repeated. PETER JENKINS Eagle River, Alaska

I am alarmed at the monster that Johns Hopkins neuroscientist Solomon Snyder and I created when we discovered the simple binding assay for drug receptors 25 years ago. Prozac and other antidepressant serotonin-receptor-active compounds may also cause cardiovascular problems in some susceptible people after long-term use, which has become common practice despite the lack of safety studies.

The public is being misinformed about the precision of these selective serotonin-uptake inhibitors when the medical profession oversimplifies their action in the brain and ignores the body as if it exists merely to carry the head around! In short, these molecules of emotion regulate every aspect of our physiology. A new paradigm has evolved, with implications that life-style changes such as diet and exercise can offer profound, safe and natural mood elevation. CANDACE B. PERT, Research Professor Georgetown University Medical Center Washington

Our moods were elevated by your uncompromising look at current pharmaceutical treatments for mental-health problems. But we found it ironically depressing that the articles made no mention of effective treatment alternatives. Collective research on the treatment of depression and anxiety disorders, including severe forms, strongly suggests that cognitive therapies are just as effective as their chemical alternatives, as well as less costly and safer. Unfortunately, psychotherapies are often overlooked in the mistaken belief that medications are shortcuts to mental health. WILLIAM DANTON DAVID ANTONUCCIO Reno, Nev.

Your excellently researched article on serotonin drugs touched on a much larger picture. One of the curses of living in an advanced industrialized society is a growing propensity to deny responsibility for one's own health and happiness and expect material goods, science and technology to take up the slack. As long as overweight people pop pills instead of taking the stairs and psychiatrists prescribe chemicals, not introspection, mistakes like those made with Redux and fenfluramine are inevitable. Our evolutionary cousins continue to be tortured in the name of science. AMANDA WILSON New York City

The fundamental implication seems to be that people are not responsible for what they do but are victims of their uncontrollable chemistry. What happened to willpower? To freedom of choice? Is all variation from "normal behavior" a deficiency disease to be corrected by a pill or a combination of pills? DAVID T. CARR, M.D. Richmond, Va.

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