Stupid Facebook Arguments

I post a lot of silly thoughts on Facebook because I want to amuse people rather than simply talk about my day. I'm not afraid of being wrong nor am I afraid of making a fool of myself. One way you learn is by making mistakes.

Unfortunately, there will always be people who have sufficiently low self-esteem that they cop an attitude if they believe they "catch" you in making an erroneous assertion. I try not to do that, though I'm sure I have come across poorly in such cases as well. Such is the weakness of on-line communication, especially that designed to embrace brevity. In fact, I often wonder how many people bother to click the "see more" link when I write longer posts. My guess is very few.

Yesterday, I remembered something that happened while I was taking a graduate psychopharmacology class at my husband's school and making a presentation on depression. We (my husband and I did the presentation together) were talking about treatment and medication. One of the medicines that is commonly prescribed is an SSRI (selective serotonin reuptake inhibitor). This drug keeps the brain juices that you are deficient in that are possibly causing your depression dancing in the synaptic gaps longer.

A fellow, known for his lateness, self-centeredness, and general disruptiveness in order to bring attention to himself, raised his hand and said that SSRIs were shown to create suicidal ideation in users. I said, and the teacher supported this assertion, that the people who took the drug were depressed and it was impossible to know if the drugs caused it or if they would have had them anyway. As a depressed person, I can say I've had plenty of thoughts of suicide. Generally, they were escape fantasies and I would not have acted upon them. In moments of misery, you can turn to them like a comfy blanket. No matter how bad it gets, there is always this one way out.

This guy wasn't happy that I wasn't on board with his attitude that the drug made things worse instead of better for people with depression. I don't know if they create suicidal thoughts or simply sometimes fail to inhibit the depression which causes one to turn to them. I was simply unwilling to conclude that they cause them.

Yesterday, for some reason, I remembered this exchange from about two years ago and thought about how they'd test for this issue. It occurred to me that the only way to do that would be to do something dangerous and unethical. That would be to give SSRIs to people who were not depressed and see if it made them suicidal. My understanding of drug tests based on whatever journal articles I've read in psychological documents is that the most common way to test them is to get a bunch of people suffering from an illness, give some of them a new drug, some of them an old drug (sometimes), and some of them a placebo. I had never read that drugs (except possibly OTC drugs) were given to people who were healthy to see how it affected them and I've read a fair amount.

I posted my thoughts on Facebook and a Canadian woman who I met through blogging (and who lives in Japan) rather flatly and with what I perceived to be a tone of "you're so stupid, how could you not know this," said that SSRIs were tested on healthy people. I granted that I did not know the data, but that, to me, that seemed akin to giving insulin to people with diabetes. It shocked me that this might be the case. That is not only because I'd never heard of it before, but because there are possible long-term consequences to giving medication that messes with neurotransmitters to people who don't need them. For one thing, any neurotransmitter that plays around between your neurons for a longer time may create more receptors on the neuron. In essence, it makes your neuron "hungrier" for a bigger "meal" of that neurotransmitter now that it's had a chance for a bigger taste. You can take people who are fine and mess them up for good as, once those receptors are formed, they never go away and they may need more serotonin than their body previously produced. Since SSRIs are long-term drugs (they often need to be taken for weeks to get any effect), you wouldn't just take them for a short time in a test situation and stop or the test would be useless as a comparison of the reaction of a healthy population to an unhealthy population.

To me, it makes very little sense to test all drugs, and particularly ones which target very specific problems, on healthy people as they aren't the population that it will be interacting with. What could be discerned from it? It's possible that side effects could be seen, but those same effects would be seen in unhealthy populations as well. Besides messing up the bodies of a healthy person, I could see no reason to test on healthy subjects. It's one thing to test aspirin. It's another to test an SSRI or a drug that affects dopamine (like Parkinson's disease drugs). It seems insanely unethical and of extremely dubious value. It's also a violation of the Hippocratic oath.

This woman misread what I said about it being a shock to me as umbrage at the unethical nature of such tests and got snarky with me. I repeated that I did not know the data, but would appreciate a link in order to educate myself. I was sincere about this. If this is the practice and the studies I've read fail to mention it (not bloody likely), I'd like to know. She ignored the request at first and smugly said, "now you know," as if her saying it made it true to which I replied that I'd still appreciate a link. She finally gave me links, but not to any studies of SSRIs that said they tested on a healthy population. She linked to a general site and three studies which did not describe the testing conditions at all. Either she was too lazy to provide concrete support or she didn't have it. I was not impressed, but I simply said, "thank you" in reply to the links and let the matter drop.

 I still don't discount the possibility that I somehow missed this testing practice. I also don't discount the possibility that the testing conditions are different in Canada or other countries than the U.S. and this woman was speaking as a Canadian with the knowledge she gained there. I also know that disadvantaged populations (prisoners, poor students, poor people) are used at times as guinea pigs and accept or take potentially harmful drugs in exchange for cash. I just never heard of it for SSRIs.

This exchange illustrates one of the things about stupid Facebook exchanges which annoys me and I'm sure others as well. Part of the problem is the tone and degradation in civility. This woman needed to be "right". I didn't need to be "right", but I wasn't going to take her word for it because this is how stupid things become "truths". It's why Snopes exists - people pass around stories long enough for others to believe they're facts. I genuinely wanted to learn something new, if indeed there was something to be learned. What was more frustrating was that she smugly acted as if she was "educating" me, but then when I asked for that education, she either got lazy and provided sloppy links or found out she was wrong and couldn't produce the goods and pretended what she offered was sufficient.

In the end, though I thanked her for the links and let it drop, my husband, who also was skeptical, commented on the lack of substance of the links. He also couldn't believe what she said made any sense. Of course, life doesn't always make sense and companies often don't behave ethically. However, in this case, unless I get pointed at some studies which explain their methodology clearly and say they tested a specific SSRI on a healthy population, I'll remain skeptical that what she said was true.