Even First Amendment fundamentalists acknowledge that there is no absolute protection of free speech in the Constitution. Crying fire in a crowded theater is not covered. Neither is false advertising. The three-page Prozac ad now running in magazines around the country -- from Time to Cosmopolitan -- is definitely false advertising.
Under a storm cloud that on the second page is magically transformed into a bright sun, the ad informs us, "When you're clinically depressed... you may have trouble sleeping. Feel unusually sad or irritable. Find it hard to concentrate. Lose your appetite. Lack energy. Or have trouble feeling pleasure. These are some of the symptoms that can point to depression."
These are also some of the symptoms that can point to life. Is there anybody on this planet who has never lacked energy, felt sad or irritable, found it hard to concentrate or had trouble sleeping? Because if there is, I would sure like to meet that perfect specimen.
Prozac already has been prescribed to more than 17 million Americans. And as Eli Lilly, Prozac's manufacturer, admits in the small print of the ad -- on strict lawyers' orders, no doubt -- it has not all come up roses. The adverse side effects listed under "precautions" range from anxiety (I thought Prozac cured anxiety) to suicide (a fail-safe cure for depression, though probably not the one Lilly had in mind).
Despite a page chockablock with small-print warnings and small-print advice to consult a doctor, Lilly has launched a multimillion-dollar ad blitz specifically designed to bypass doctors and target consumers directly.
Treating life as an illness is bad enough. But treating childhood as a disease is tragic. And what makes the timing of this campaign so disturbing is that it coincides with the publication of the only large-scale study on the effects of antidepressants on kids, which is being used by Lilly to get Food and Drug Administration approval for children's Prozac. The University of Texas study found that about half of the 70 8- to 18-year-olds improved. But then, so did one-third of those on a placebo.
On such unshakable evidence, the FDA is widely expected to declare Prozac a drug approved for children. As Wendy Neuberger, a pediatrician who refused to prescribe Prozac, put it: "Prozac is a drug that alters brain chemistry, and we don't know how alteration of brain chemistry in a child might affect their development." Lilly's worldwide sales in 1996 were $ 2.36 billion, up by 14 percent from 1995. In the search for ever-expanding markets, children were bound to be Lilly's next target. But why does the FDA, so eager to protect children from tobacco, have to cooperate? Already, children's prescriptions of adult antidepressants have soared from 342,900 in 1994 to 579,700 in 1996.
There is obviously a small percentage of children -- as there is a small percentage of adults -- who suffer from severe depression that needs to be medically treated. But this glossy ad campaign is not for them. The transformation of a gray cloud into a yellow sun is intended to convince the average American pursuing happiness and not quite finding it that there is an instant solution at hand. More troubling is the fact that the childish drawings are clearly aimed at stressed-out parents too busy to deal with children who are acting up, having trouble at school or simply being moody. The solution is simple: Drug them up to your expectations.
"Children on Prozac," Barbara Ingesoll, a child psychologist, cheerily proclaims, "tell us they are not as angry and not as temperamental, behave better and feel better. It is a tremendous development. We can see a future where mood disorders will be treated not as exotic, uncommon conditions in children but more like dental cavities or poor vision." Ingesoll has seen the future, and it works: "There won't be a stigma for kids on Prozac -- the stigma will be on not taking Prozac."
Perhaps to avoid the stigma and until the ads reach full penetration, we can put it in the water supply -- like fluoride. And since nobody is moodier than a bunch of eighth-graders, why not sell it in vending machines? Exit Joe Camel. Enter Joe Prozac.
At the very moment we are bombarding our children with ads and sermons about saying no to drugs, we are blurring for them any distinction between feeling good from Prozac and feeling good from life. "The unexamined life is not worth living," said Socrates, but we are teaching our children that masking symptoms with drugs is the best way to lead busy, productive lives.
And we don't even see the absurdity of a major advertising campaign for a prescription drug for clinical depression, aggressively marketed like a new candy bar. The kiddy Prozac about to debut is peppermint-flavored. Which makes Eli Lilly just a bigtime drug pusher.
Syndicated column, taken from the Sacramento Bee Op-Ed page, July 25, 1997. Reprinted by permission of the author.