Views & Reviews From the Frontline

Bad medicine: the rise of duloxetine

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g139 (Published 17 January 2014) Cite this as: BMJ 2014;348:g139
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}yahoo.co.uk

I like to understand how things work. Complexity makes me wary because it often conceals a lack of understanding. We are told that medicine is incredibly complex yet paradoxically we offer the crude simplicity of drug interventions. Some drugs are used in multiple conditions, and this so called indication creep broadens pharmaceutical companies’ potential for profit—certainly good business if not good medicine.

Duloxetine is such a drug and the number four top seller, with projected sales of $4bn (£2.4bn; €2.9) in the United States this year.1 It is licensed for depression, anxiety, fibromyalgia, neuropathic pain, and incontinence. Its …

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